Antibiotics: New Breakthroughs Are Positive News, Yet We Are Losing the Bigger Battle

During a tenure as director general of the WHO, a former leader famously remarked that all of the “easy” antimicrobials had long since been discovered. The argument was that in tackling the urgent danger of antibiotic-resistant infections, we would struggle to discover new treatments – or preserve the current arsenal – without finding new ways of working. This view proved correct.

A Sluggish and Challenging Development Path

Since the late 2010s, only 16 antibiotics have gained broad regulatory approval – mostly similar derivatives of medicines currently available and thus unlikely to overcome resistance for long. The creation of novel compounds is a slow and unprofitable business, given that one-off medicines are less lucrative as those treating longer-term conditions. The overall prospect continues to be grim.

A Glimmer of Hope and a Novel Approach

Nevertheless, the recent announcement of a pair of novel FDA-approved antibiotics against gonorrhoea is good news and, crucially, confirms a new way of encouraging research. A particular of the new drugs, Zoliflodacin, is the product of a unique type of partnership between a Swiss non‑profit and a pharmaceutical company. The public health partnership provided funding and managed clinical trials to defray expenses and clear regulatory hurdles. This type of assistance in advance helps steer the sector towards fields of greatest public health necessity.

This model and another lauded “subscription model” – launched to ensure income to companies investing in certain antibiotics – represent the strongest chance of sustaining a dripfeed of novel treatments from the current framework.

The Inevitable Challenge of Drug Resistance

But even hurrying the production of compounds in the pipeline isn't enough. Zoliflodacin is sometimes categorized as a new class of antimicrobial, indicating it targets a part of the pathogen that existing treatments does, in principle forcing the bacterium to start from zero in evolving a countermeasure to it. Researchers and physicians are grateful to have a new drug for gonorrhoea – which has resistant strains to every known antibiotic – but warn that future resistance to this compound is inevitable.

As has become the norm with new antibiotics, exists therefore an argument about whether it should be stockpiled, rationed to extremely drug-resistant infections only – limiting its use to settings where sophisticated diagnostics is accessible. This kind of rational approach should be the global standard, but frequently can't be implemented readily in many regions.

A Diminishing Pipeline of Innovation

More broadly, it is hard to see where the stream of additional new antibiotics we need could realistically come from. The aforementioned statement acknowledged the fact that surveying the natural world for biological compounds – as with penicillin – has had diminishing returns. The application of artificial intelligence has been mooted to speed up the discovery process, although a highly-touted early candidate identified in 2020 has not yet advanced past animal trials. Synthetic drugs, that are largely or entirely lab-created, are constantly in development, but often confront the iron laws of chemistry – just because we envision a compound doesn't mean we can create it without great difficulty.

Moving Quickly to Stay in Place

The prevailing scientific evaluation is that when it comes to antimicrobials, we must run very fast truly just to stay in the current position. Careful, globally managed deployment is the only way to maintain our therapeutic edge. Regrettably, the magnitude of forthcoming breakthroughs is going to seem meager in contrast to the therapeutic revolution of the 20th century.