🔗 Share this article

During a tenure as director general of the World Health Organization, a former leader famously stated that all of the “easy” antibiotics had already been found. The argument was that in addressing the pressing danger of drug-resistant infections, we would face difficulties to discover new medicines – or preserve the current arsenal – without finding new ways of operating. This assessment was accurate.

A Sluggish and Challenging Development Path

Since the late 2010s, just 16 antibiotics have received widespread regulatory approval – mostly close relatives of drugs currently available and thus unlikely to evade resistance for an extended period. The creation of new ones is a slow and financially unattractive business, given that curative medicines are less lucrative as ones managing longer-term ailments. The overall prospect remains bleak.

A Glimmer of Optimism and a New Model

However, the recent announcement of a pair of novel regulator-approved antibiotics against gonorrhoea is a welcome development and, crucially, validates a innovative method of encouraging research. A particular of the new drugs, a compound called Zoliflodacin, is the product of a unique type of collaboration between a global health organization and a drug firm. The non-profit supplied financial support and organised testing phases to defray expenses and clear approval processes. This type of assistance in advance helps direct the industry towards fields of most pressing global need.

This model and another praised “subscription model” – initiated to ensure revenue to companies that invest in certain antibiotics – represent the strongest chance of sustaining a trickle of novel treatments from the current system.

The Inevitable Challenge of Drug Resistance

But even hurrying the development of compounds currently in development is not sufficient. Zoliflodacin is at times described as a new class of antibiotic, meaning it attacks a component of the infectious bacteria that no other drug does, in principle forcing the bacterium to start from zero in evolving a defense to it. Scientists and physicians are relieved to have a new drug for gonorrhea – which has resistant strains to every known antibiotic – but caution that future resistance to it is inevitable.

As has become the norm with new antibiotics, there is consequently an argument about whether it should be held in reserve, rationed to highly resistant infections only – confining its application to settings where high‑end lab testing is available. This kind of prudent strategy should be the global standard, but often cannot be implemented readily in many parts of the world.

A Dwindling Stream of Discovery

More broadly, it is hard to see where the stream of other new antibiotics we need could realistically come from. The former official's statement acknowledged the fact that surveying the natural world for natural sources – as with the first antibiotic – has had declining success. Use of AI has been proposed to accelerate the search, although a much-celebrated early candidate found in recent years has not yet advanced past preclinical studies. Synthetic drugs, that are mainly or fully lab-created, are continually in development, but often confront the fundamental rules of chemistry – the fact that we imagine a compound doesn't mean we can create it without great difficulty.

Moving Quickly to Stand Still

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, globally managed use is the only way to preserve our therapeutic edge. Regrettably, the magnitude of forthcoming breakthroughs is going to seem meager in contrast to the therapeutic revolution of the previous century.