Antimicrobial Drugs: New Breakthroughs Are Great News, Yet We Are Falling Behind In the Larger Battle

During her tenure as head of the WHO, a former leader famously remarked that all of the “simple” antibiotics had long since been discovered. The point was that in addressing the pressing danger of antibiotic-resistant infections, we would face difficulties to discover new medicines – or preserve the existing ones – without finding novel approaches of working. This assessment proved accurate.

A Slow and Challenging Pipeline

Since the late 2010s, only sixteen antimicrobial agents have gained broad regulatory approval – primarily similar derivatives of medicines currently available and thus not expected to evade resistance for long. The creation of new ones is a slow and unprofitable business, given that curative medicines are less lucrative as ones treating longer-term conditions. The overall prospect continues to be bleak.

A Spark of Hope and a New Model

However, the recent announcement of two new FDA-approved antibiotics against gonorrhoea is a welcome development and, crucially, confirms a innovative method of encouraging research. A particular of the new drugs, a compound called Zoliflodacin, is the result of a novel kind of collaboration between a global health organization and a pharmaceutical company. The public health partnership supplied financial support and organised testing phases to defray expenses and navigate regulatory hurdles. This type of support in advance helps direct the sector towards fields of most pressing public health necessity.

This model and another praised “subscription model” – launched to ensure income to companies investing in certain antibiotics – represent the strongest chance of maintaining a trickle of new drugs from the current framework.

The Inevitable Problem of Drug Resistance

But even accelerating the production of drugs currently in development is not enough. The new drug is at times categorized as a new class of antibiotic, indicating it targets a component of the infectious bacteria that existing treatments does, in principle compelling the bacterium to start from zero in evolving a defense to it. Scientists and doctors are relieved to have a new option for gonorrhoea – which has strains resistant to every known antibiotic – but warn that future resistance to it is inevitable.

As has grown customary with new antibiotics, there is therefore an argument about whether it should be held in reserve, rationed to extremely drug-resistant infections only – limiting its use to situations where high‑end lab testing is accessible. This sort of rational strategy should be the global standard, but often can't be deployed readily in many parts of the world.

A Dwindling Pipeline of Innovation

More broadly, it is hard to see where the flow of additional novel antimicrobials we require could realistically come from. The aforementioned statement nodded to the fact that surveying the living world for biological compounds – as with the first antibiotic – has had diminishing returns. The application of AI has been mooted to accelerate the discovery process, although a much-celebrated initial discovery found in recent years has not yet progressed past preclinical studies. Synthetic drugs, that are largely or entirely synthesized, are continually in development, but often confront the iron laws of chemistry – the fact that we envision a compound doesn't mean we can synthesise it easily.

Running Fast to Stand Still

The prevailing expert assessment is that when it comes to antibiotics, we must move with great speed indeed just to remain in the current position. Careful, internationally coordinated use is the sole method to maintain our therapeutic edge. Regrettably, the magnitude of future discoveries is going to seem miserly in contrast to the therapeutic revolution of the previous century.