Antibiotics: New Breakthroughs Are Great News, But We Are Losing the Bigger Race

During her tenure as director general of the WHO, a former leader famously stated that all of the “simple” antimicrobials had already been found. The point was that in addressing the pressing danger of drug-resistant bacterial infections, we would face difficulties to discover new medicines – or preserve the existing ones – without developing new ways of working. This view proved accurate.

A Slow and Challenging Development Path

Since 2017, only 16 antibiotics have received widespread official clearance – mostly close relatives of drugs currently available and thus unlikely to evade resistance for an extended period. The creation of new ones is a lengthy and financially unattractive endeavor, given that curative treatments are less lucrative as ones treating chronic ailments. The scientific outlook remains bleak.

A Spark of Optimism and a Novel Approach

Nevertheless, the news this month of a pair of novel regulator-approved drugs against gonorrhoea is a welcome development and, crucially, confirms a innovative method of incentivising research. One of the new drugs, a compound called Zoliflodacin, is the result of a unique type of partnership between a Swiss non‑profit and a drug firm. The public health partnership supplied financial support and organised testing phases to defray costs and navigate regulatory hurdles. This sort of assistance in advance helps steer the sector towards fields of most pressing public health necessity.

This approach and another lauded revenue guarantee scheme – initiated to guarantee income to firms that invest in specific antimicrobials – represent the strongest chance of maintaining a dripfeed of new drugs from the existing system.

The Inevitable Challenge of Resistance

But even hurrying the development of compounds currently in development is not enough. Zoliflodacin is at times categorized as a novel type of antibiotic, indicating it attacks a part of the infectious bacteria that no other drug does, theoretically compelling the bacterium to begin anew in developing a countermeasure to it. Researchers and doctors are grateful to have a new drug for gonorrhea – which has strains resistant to every known antibiotic – but caution that eventual drug resistance to it is inevitable.

As has grown customary with new antibiotics, exists therefore an argument about whether it should be stockpiled, rationed to highly resistant infections only – confining its application to situations where sophisticated diagnostics is accessible. This sort of rational strategy should be the global standard, but frequently cannot be deployed readily in many parts of the world.

A Dwindling Stream of Innovation

More broadly, it is difficult to see where the stream of additional novel antimicrobials we require 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 diminishing returns. Use of AI has been proposed to speed up the search, although a highly-touted initial discovery identified in recent years has not yet advanced past animal trials. Synthetic drugs, which are largely or entirely lab-created, are continually in research, but often run up against the iron laws of chemistry – the fact that we envision a compound does not guarantee we can create it without great difficulty.

Running Fast to Stay in Place

The prevailing expert assessment is that when it comes to antimicrobials, we must run very fast truly just to stay in the current position. Careful, internationally coordinated deployment is the sole method to preserve our therapeutic edge. Sadly, the scale of forthcoming discoveries is going to seem meager in contrast to the therapeutic revolution of the 20th century.