🔗 Share this article

During her time as head of the World Health Organization, a former leader famously stated that all of the “easy” antimicrobials had long since been discovered. The point was that in tackling the pressing danger of drug-resistant infections, we would struggle to find new medicines – or conserve the current arsenal – without finding novel approaches of operating. This assessment proved correct.

A Sluggish and Unprofitable Development Path

Since the late 2010s, just sixteen antimicrobial agents have gained broad official clearance – mostly similar derivatives of medicines already in use and thus unlikely to overcome bacterial resistance for an extended period. The development of new ones is a slow and unprofitable endeavor, given that curative medicines are not as profitable as ones treating longer-term ailments. The overall prospect continues to be bleak.

A Spark of Optimism and a Novel Approach

However, the recent announcement of a pair of novel FDA-approved antibiotics against gonorrhoea is a welcome development and, crucially, validates a new way of encouraging development. A particular of the new drugs, Zoliflodacin, is the product of a unique type of collaboration between a Swiss non‑profit and a pharmaceutical company. The non-profit provided financial support and organised clinical trials to defray costs and navigate approval processes. This sort of support upfront helps steer the industry towards areas of greatest global need.

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

The Unavoidable Challenge of Drug Resistance

But even accelerating the production of compounds in the pipeline isn't enough. Zoliflodacin is sometimes categorized as a novel type of antibiotic, meaning it attacks a component of the pathogen that existing treatments does, theoretically forcing the pathogen to start from zero in evolving a defense to it. Researchers and doctors are relieved to have a new drug for gonorrhea – which has strains resistant to all existing treatments – but warn that future resistance to it is inevitable.

As has grown customary with new antibiotics, exists therefore an argument about whether it should be stockpiled, restricted to highly resistant cases only – limiting its use to settings where sophisticated diagnostics is available. This sort of prudent strategy should be the global standard, but often can't be deployed readily in many parts of the world.

A Diminishing Stream of Innovation

More broadly, it is difficult to see where the stream of other novel antimicrobials we need could realistically come from. The aforementioned statement nodded to the fact that surveying the natural world for natural sources – as with the first antibiotic – has had diminishing returns. Use of artificial intelligence has been mooted to speed up the search, although a highly-touted initial discovery identified in recent years has not yet advanced past preclinical studies. Fully lab-created compounds, that are largely or entirely synthesized, are continually in development, but often confront the iron laws of chemistry – just because we imagine a molecule doesn't mean we can synthesise it without great difficulty.

Moving Quickly to Stand Still

The dominant scientific evaluation 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 only way to preserve our advantage. Regrettably, the scale of forthcoming breakthroughs is going to seem meager in contrast to the therapeutic revolution of the previous century.