🔗 Share this article

During a time as head of the WHO, a past official famously stated that all of the “easy” antibiotics had already been found. The point was that in tackling the pressing danger of antibiotic-resistant infections, we would struggle to find new medicines – or preserve the existing ones – without finding new ways of operating. This view proved accurate.

A Slow and Challenging Pipeline

Since the late 2010s, just sixteen antibiotics have received widespread regulatory approval – primarily similar derivatives of medicines already in use and thus not expected to evade resistance for long. The development of new ones is a lengthy and unprofitable endeavor, given that curative treatments are not as profitable as those managing longer-term ailments. The overall prospect remains grim.

A Spark of Optimism and a New Model

Nevertheless, the news this month of a pair of novel regulator-approved antibiotics for gonorrhoea is a welcome development and, crucially, validates a innovative method of encouraging research. A particular of the new drugs, Zoliflodacin, is the result of a unique type of collaboration between a global health organization and a drug firm. The non-profit provided funding and organised testing phases to offset costs and clear approval processes. This type of assistance in advance helps steer the sector towards fields of most pressing public health necessity.

This approach and a separate lauded “subscription model” – launched to guarantee income to companies that invest in specific antimicrobials – constitute the best hope of maintaining a trickle of novel treatments from the existing system.

The Inevitable Challenge of Resistance

But even accelerating the development of drugs currently in development is not sufficient. Zoliflodacin is at times described as a novel type of antimicrobial, indicating it attacks a component of the infectious bacteria that no other drug does, in principle compelling the bacterium to begin anew in evolving a countermeasure to it. Researchers and physicians are relieved to have a new drug for gonorrhoea – 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, there is consequently an argument about whether it should be held in reserve, restricted to extremely drug-resistant cases only – limiting its use to situations where sophisticated diagnostics is available. This kind of rational strategy should be the global standard, but often can't be deployed easily in many regions.

A Diminishing Pipeline of Discovery

On a wider scale, it is difficult to see where the stream of other novel antimicrobials we require could realistically originate. The aforementioned statement acknowledged the fact that surveying the living world for biological compounds – as with penicillin – has had diminishing returns. Use of artificial intelligence has been mooted to speed up the discovery process, although a highly-touted early candidate found in 2020 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 fundamental rules of molecular science – the fact that we envision a molecule does not guarantee we can create it easily.

Running Fast to Stay in Place

The prevailing expert assessment is that when it comes to antibiotics, we must move with great speed truly just to remain in the current position. Prudent, internationally coordinated use is the sole method to preserve our therapeutic edge. Sadly, the magnitude of future discoveries is likely to seem miserly in contrast to the curative bonanza of the previous century.