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During a tenure as director general of the World Health Organization, a former leader famously stated that all of the “easy” antimicrobials had long since been discovered. The argument was that in addressing the pressing threat of antibiotic-resistant infections, we would struggle to discover new medicines – or conserve the current arsenal – without developing novel approaches of working. This assessment proved correct.

A Sluggish and Challenging Development Path

Since the late 2010s, just 16 antibiotics have gained widespread regulatory approval – primarily similar derivatives of medicines already in use and thus not expected to evade resistance for an extended period. The development of new ones is a slow and unprofitable business, given that curative treatments are not as profitable as those treating longer-term conditions. The overall prospect continues to be grim.

A Spark of Hope and a New Model

Nevertheless, the recent announcement of a pair of novel regulator-approved drugs for gonorrhoea is a welcome development and, importantly, confirms a new way of encouraging development. A particular of the new drugs, a compound called Zoliflodacin, is the product of a novel kind of collaboration between a Swiss non‑profit and a drug firm. The public health partnership provided financial support and managed clinical trials to defray expenses and clear regulatory hurdles. This type of assistance in advance helps steer the industry towards fields of greatest global need.

This approach and another lauded revenue guarantee scheme – initiated to ensure revenue to firms investing in specific antibiotics – represent the best hope of maintaining a trickle of novel treatments from the current framework.

The Inevitable Challenge of Drug Resistance

But even accelerating the development of drugs in the pipeline isn't enough. The new drug is sometimes categorized as a novel type of antimicrobial, meaning it attacks a component of the pathogen that no other drug does, theoretically 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 inevitable.

As has grown customary with recent antimicrobials, exists consequently an debate about whether it should be stockpiled, restricted to highly resistant infections only – confining its application to settings where sophisticated diagnostics is accessible. This sort of rational strategy should be the global standard, but often can't be implemented readily in many parts of the world.

A Dwindling Pipeline of Discovery

On a wider scale, it is difficult to see where the flow of additional new antibiotics we require could realistically originate. The aforementioned statement nodded to the fact that searching the natural world for natural sources – as with penicillin – has had declining success. Use of AI has been mooted to speed up the discovery process, although a highly-touted initial discovery found in 2020 hasn't yet advanced past animal trials. Fully lab-created compounds, which are mainly or fully lab-created, are continually in research, but often confront the iron laws of chemistry – the fact that we envision a compound does not guarantee we can create it easily.

Moving Quickly to Stand Still

The dominant expert assessment is that when it comes to antibiotics, we must move with great speed indeed just to remain in the same place. Prudent, internationally coordinated use is the sole method to preserve our advantage. Regrettably, the magnitude of future discoveries is going to seem meager in contrast to the therapeutic revolution of the previous century.