Antimicrobial Drugs: New Breakthroughs Are Great Developments, Yet Humanity Are Falling Behind In the Larger Battle

During a tenure as head of the World Health Organization, a past official famously remarked that all of the “simple” antimicrobials had already been found. The argument was that in addressing the urgent danger of antibiotic-resistant bacterial infections, we would face difficulties to discover new treatments – or conserve the existing ones – without developing novel approaches of working. This assessment proved accurate.

A Slow and Challenging Pipeline

Since 2017, only 16 antibiotics have gained broad official clearance – mostly close relatives of medicines currently available and thus unlikely to evade bacterial resistance for long. The creation of new ones is a lengthy and financially unattractive endeavor, given that one-off medicines are not as profitable as those managing longer-term conditions. The scientific outlook remains grim.

A Glimmer of Optimism and a New Model

Nevertheless, the recent announcement of two new FDA-approved antibiotics against gonorrhea is a welcome development and, importantly, validates a new way of incentivising research. A particular of the new drugs, Zoliflodacin, is the product of a novel kind of partnership between a global health organization and a drug firm. The public health partnership provided funding and managed clinical trials to offset expenses and navigate regulatory hurdles. This sort of support in advance helps direct the industry towards fields of most pressing global need.

This model and another lauded “subscription model” – launched to ensure revenue to companies that invest in certain antimicrobials – constitute the strongest chance of sustaining a trickle of novel treatments from the existing system.

The Unavoidable Challenge of Drug Resistance

But even accelerating the production of compounds in the pipeline is not enough. The new drug is at times categorized as a new class of antibiotic, meaning it targets a part of the infectious bacteria that no other drug does, theoretically forcing the pathogen to start from zero in evolving a countermeasure to it. Scientists and physicians are grateful to have a new drug for gonorrhea – which has resistant strains to all existing treatments – but caution that eventual drug resistance to it is certain.

As has become the norm with new antibiotics, there is consequently an debate about whether it should be held in reserve, restricted to highly resistant infections only – limiting its use to settings where high‑end lab testing is accessible. This kind of prudent strategy should be the global standard, but frequently cannot be implemented easily in many regions.

A Diminishing Pipeline of Innovation

On a wider scale, it is difficult to see where the flow of additional novel antimicrobials we need could possibly originate. The former official's statement nodded to the fact that surveying the natural world for biological compounds – as with the first antibiotic – has had declining success. Use of artificial intelligence has been proposed to accelerate the discovery process, although a highly-touted initial discovery identified in 2020 hasn't yet progressed past animal trials. Fully lab-created compounds, which are mainly or fully synthesized, are constantly in research, but often confront the fundamental rules of chemistry – the fact that we envision a molecule does not guarantee we can synthesise it easily.

Moving Quickly to Stay in Place

The dominant expert assessment is that when it comes to antibiotics, we must move with great speed indeed just to stay in the current position. Careful, internationally coordinated deployment is the sole method to maintain our therapeutic edge. Regrettably, the scale of future breakthroughs is going to seem meager in contrast to the therapeutic revolution of the previous century.