Antibiotics: Recent Breakthroughs Are Great Developments, But Humanity Are Falling Behind In the Bigger Race

During her tenure as head of the World Health Organization, a former leader famously remarked that all of the “simple” antimicrobials had already been found. The point was that in addressing the pressing danger of drug-resistant infections, we would face difficulties to find new medicines – or conserve the existing ones – without finding novel approaches of working. This assessment was accurate.

A Sluggish and Challenging Pipeline

Since the late 2010s, only sixteen antibiotics have received broad official clearance – mostly close relatives of drugs already in use and thus unlikely to evade resistance for an extended period. The creation of novel compounds is a lengthy and unprofitable business, given that one-off medicines are not as profitable as those managing chronic conditions. The overall prospect remains grim.

A Spark of Optimism and a New Model

Nevertheless, the recent announcement of a pair of novel FDA-approved drugs against gonorrhea is good news and, importantly, validates a new way of encouraging development. One of the recently approved medications, a compound called Zoliflodacin, is the product of a novel kind of collaboration between a Swiss non‑profit and a drug firm. The public health partnership provided financial support and managed testing phases to offset expenses and clear regulatory hurdles. This type of support in advance helps steer the industry towards areas of most pressing public health necessity.

This model and another lauded “subscription model” – initiated to ensure revenue to firms investing in specific antimicrobials – represent the best hope of sustaining a trickle of new drugs from the existing system.

The Unavoidable Challenge of Resistance

But even accelerating the development of drugs in the pipeline is not sufficient. Zoliflodacin is sometimes described as a new class of antimicrobial, meaning it attacks a component of the pathogen that existing treatments does, in principle forcing the pathogen to begin anew in developing a defense to it. Researchers and physicians are grateful to have a new option for gonorrhoea – which has strains resistant to all existing treatments – but caution that eventual drug resistance to this compound is inevitable.

As has become the norm with recent antimicrobials, exists therefore an argument about whether it should be held in reserve, rationed to extremely drug-resistant cases only – confining its use to situations where sophisticated diagnostics is accessible. This kind of rational strategy should be the worldwide norm, but often can't be implemented easily in many regions.

A Dwindling Pipeline of Discovery

More broadly, it is hard to see where the flow of other new antibiotics we require could possibly come from. The aforementioned comment nodded to the fact that searching the natural world for biological compounds – as with penicillin – has had diminishing returns. The application of AI has been proposed to speed up the discovery process, although a highly-touted initial discovery identified in 2020 hasn't yet progressed past preclinical studies. Synthetic drugs, which are largely or entirely lab-created, are constantly in research, but often run up against the fundamental rules of molecular science – just because we imagine a compound does not guarantee we can synthesise it without great difficulty.

Moving Quickly to Stay in Place

The dominant scientific evaluation is that when it comes to antibiotics, we must move with great speed truly just to stay in the current position. Prudent, globally managed use is the sole method to preserve our therapeutic edge. Sadly, the magnitude of future breakthroughs is likely to seem meager compared with the therapeutic revolution of the previous century.