Antibiotics: New Advances Provide Great Developments, Yet Humanity Are Falling Behind In the Larger Battle

During her tenure as head of the WHO, a past official famously stated that all of the “simple” antibiotics had already been found. The point was that in tackling the urgent danger of antibiotic-resistant bacterial infections, we would struggle to discover new treatments – or conserve the existing ones – without finding novel approaches of operating. This assessment was correct.

A Sluggish and Challenging Development Path

Since the late 2010s, just 16 antimicrobial agents have gained widespread regulatory approval – mostly close relatives of drugs currently available and thus unlikely to overcome resistance for long. The development of new ones is a slow and unprofitable endeavor, given that one-off medicines are not as profitable as ones managing longer-term conditions. The scientific outlook continues to be grim.

A Glimmer of Hope and a Novel Approach

Nevertheless, the news this month of a pair of novel FDA-approved drugs against gonorrhea is good news and, importantly, validates a innovative method of incentivising development. One of the recently approved medications, Zoliflodacin, is the product of a novel kind of collaboration between a Swiss non‑profit and a drug firm. The non-profit supplied funding and managed testing phases to defray costs and clear approval processes. This type of support in advance helps direct the sector towards areas of most pressing global need.

This approach and another lauded revenue guarantee scheme – launched to ensure revenue to firms investing in certain antibiotics – represent the best hope of sustaining a trickle of novel treatments from the current system.

The Inevitable Problem of Resistance

But even accelerating the production of compounds currently in development is not enough. The new drug is sometimes described as a new class of antimicrobial, meaning it targets a component of the pathogen that existing treatments does, in principle forcing the bacterium to begin anew in evolving a countermeasure to it. Scientists and physicians are grateful to have a new option for gonorrhea – which has resistant strains to every known antibiotic – but warn that eventual drug resistance to this compound is certain.

As has grown customary with recent antimicrobials, there is consequently an argument about whether it should be stockpiled, restricted to highly resistant infections only – limiting its application to situations where high‑end lab testing is available. This sort of rational approach should be the global standard, but frequently cannot be implemented readily in many regions.

A Dwindling Stream of Innovation

More broadly, it is hard to see where the flow of additional new antibiotics we require could possibly come from. The aforementioned statement acknowledged the fact that surveying the natural world for biological compounds – as with the first antibiotic – has had diminishing returns. Use of AI has been mooted to accelerate the search, although a highly-touted initial discovery identified in recent years has not yet progressed past animal trials. Fully lab-created compounds, that are mainly or fully synthesized, are continually in development, but often confront the fundamental rules of molecular science – just because we imagine a molecule doesn't mean we can synthesise it easily.

Running Fast to Stay in Place

The dominant expert assessment is that when it comes to antimicrobials, we must run very fast truly just to remain in the current position. Careful, globally managed deployment is the sole method to maintain our therapeutic edge. Regrettably, the scale of forthcoming breakthroughs is likely to seem meager in contrast to the curative bonanza of the previous century.