Antibiotics: Recent Breakthroughs Are Great News, Yet Humanity Is Falling Behind In the Larger Battle

During her time as head of the WHO, a former leader famously remarked that all of the “simple” antibiotics had long since been discovered. The argument was that in addressing the pressing danger of drug-resistant infections, we would struggle to find new treatments – or conserve the current arsenal – without finding novel approaches of working. This view proved accurate.

A Sluggish and Unprofitable Development Path

Since the late 2010s, just 16 antimicrobial agents have gained broad regulatory approval – primarily similar derivatives of drugs currently available and thus unlikely to overcome resistance for long. The creation of new ones is a lengthy and financially unattractive business, given that curative medicines are less lucrative as those managing chronic ailments. The scientific outlook continues to be bleak.

A Spark of Hope and a Novel Approach

However, the news this month of a pair of novel regulator-approved antibiotics against gonorrhea is good news and, importantly, validates a new way of encouraging research. One of the recently approved medications, a compound called Zoliflodacin, is the result of a novel kind of collaboration between a global health organization and a pharmaceutical company. The public health partnership provided financial support and managed testing phases to offset expenses and navigate regulatory hurdles. This sort of support in advance helps steer the sector towards areas of greatest global need.

This approach and a separate lauded revenue guarantee scheme – launched to guarantee revenue to companies that invest in certain antibiotics – constitute the best hope of sustaining a trickle of novel treatments from the existing framework.

The Inevitable Challenge of Resistance

But even hurrying the production of drugs in the pipeline isn't sufficient. The new drug is at times described as a new class of antibiotic, indicating it attacks a component of the pathogen that existing treatments does, in principle forcing the bacterium to start from zero in developing a countermeasure to it. Scientists and physicians are grateful to have a new option for gonorrhoea – which has strains resistant to every known antibiotic – but warn that future resistance to it is certain.

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 high‑end lab testing is accessible. This kind of prudent strategy should be the global standard, but frequently can't be implemented easily in many parts of the world.

A Diminishing Stream of Discovery

On a wider scale, it is difficult to see where the flow of other new antibiotics we need could realistically come from. The aforementioned statement acknowledged the fact that surveying the living world for natural sources – as with penicillin – has had declining success. Use of artificial intelligence has been proposed to accelerate the search, although a much-celebrated initial discovery identified in 2020 hasn't yet advanced past preclinical studies. Fully lab-created compounds, which are largely or entirely lab-created, are continually in development, but often run up against the iron laws of chemistry – just because we imagine a compound doesn't mean we can synthesise it easily.

Running Fast to Stand Still

The prevailing scientific evaluation is that when it comes to antimicrobials, we must move with great speed indeed just to stay in the same place. Prudent, internationally coordinated deployment is the sole method to preserve our therapeutic edge. Sadly, the magnitude of future discoveries is likely to seem meager compared with the therapeutic revolution of the 20th century.