Antibiotics: New Advances Are Positive Developments, But Humanity Are Losing the Larger Battle

During her time as director general of the WHO, a past official famously remarked that all of the “easy” antibiotics had already been found. The argument was that in tackling the pressing threat of drug-resistant bacterial infections, we would face difficulties to find new medicines – or preserve the current arsenal – without developing novel approaches of working. This view was correct.

A Slow and Unprofitable Development Path

Since 2017, only sixteen antimicrobial agents have gained widespread regulatory approval – mostly similar derivatives of drugs already in use and thus not expected to evade bacterial resistance for long. The development of new ones is a lengthy and unprofitable business, given that one-off medicines are not as profitable as those managing chronic ailments. The scientific outlook continues to be bleak.

A Spark of Optimism and a New Model

However, the recent announcement of a pair of novel FDA-approved drugs for gonorrhea is a welcome development and, importantly, confirms a new way of encouraging development. One of the new drugs, Zoliflodacin, is the result of a unique type of partnership between a Swiss non‑profit and a pharmaceutical company. The non-profit supplied funding and managed clinical trials to offset costs and navigate regulatory hurdles. This type of assistance upfront helps direct the sector towards fields of greatest global need.

This model and a separate praised “subscription model” – initiated to ensure revenue to companies that invest in certain antibiotics – represent the strongest chance of maintaining a dripfeed of new drugs from the existing framework.

The Unavoidable Challenge of Drug Resistance

But even accelerating the production of compounds in the pipeline isn't sufficient. Zoliflodacin is at times categorized as a new class of antimicrobial, indicating it attacks a part of the infectious bacteria that no other drug does, theoretically forcing the pathogen to begin anew in evolving a countermeasure to it. Scientists and doctors are grateful to have a new drug for gonorrhoea – which has strains resistant to all existing treatments – but warn that future resistance to this compound is inevitable.

As has grown customary with recent antimicrobials, exists therefore an debate about whether it should be held in reserve, restricted to highly resistant infections only – limiting its use to settings where sophisticated diagnostics is accessible. This kind of rational strategy should be the global standard, but often cannot be deployed easily in many regions.

A Diminishing Pipeline of Innovation

On a wider scale, it is difficult to see where the stream of other novel antimicrobials we require could realistically originate. The aforementioned comment nodded to the fact that surveying the living world for biological compounds – as with the first antibiotic – has had diminishing returns. The application of artificial intelligence has been mooted to accelerate the discovery process, although a highly-touted initial discovery found in recent years hasn't yet progressed past animal trials. Fully lab-created compounds, which are largely or entirely synthesized, are constantly in development, but often run up against the fundamental rules of chemistry – the fact that we envision a compound doesn't mean we can synthesise it without great difficulty.

Moving Quickly to Stand Still

The prevailing scientific evaluation is that when it comes to antimicrobials, we must move with great speed indeed just to remain in the same place. Careful, globally managed deployment is the sole method to maintain our advantage. Regrettably, the scale of forthcoming discoveries is likely to seem miserly compared with the curative bonanza of the 20th century.