Antibiotics: New Breakthroughs Provide Great News, But Humanity Is Losing the Larger Battle

During her time as director general of the WHO, a past official famously stated that all of the “easy” antibiotics had already been found. The argument was that in addressing the urgent threat of drug-resistant bacterial infections, we would face difficulties to find new treatments – or conserve the current arsenal – without finding new ways of working. This assessment was accurate.

A Sluggish and Unprofitable Development Path

Since 2017, only sixteen antimicrobial agents have received widespread official clearance – mostly similar derivatives of medicines currently available and thus not expected to overcome bacterial resistance for long. The development of novel compounds is a lengthy and unprofitable endeavor, given that curative medicines are not as profitable as ones managing chronic conditions. The scientific outlook continues to be grim.

A Spark of Hope and a Novel Approach

However, the news this month of two new regulator-approved antibiotics for gonorrhoea is good news and, crucially, confirms a new way of incentivising development. A particular of the recently approved medications, a compound called Zoliflodacin, is the product of a unique type of collaboration between a Swiss non‑profit and a pharmaceutical company. The non-profit supplied funding and managed clinical trials to offset costs and clear approval processes. This sort of assistance upfront helps direct the sector towards areas of greatest global need.

This approach and a separate lauded revenue guarantee scheme – initiated to guarantee income to companies that invest in certain antimicrobials – represent the strongest chance of maintaining a dripfeed of new drugs from the existing framework.

The Unavoidable Challenge of Resistance

But even accelerating the production of drugs in the pipeline is not sufficient. The new drug is at times described as a novel type of antibiotic, meaning it attacks a part of the infectious bacteria that existing treatments does, in principle compelling the bacterium to begin anew in developing a defense to it. Scientists and doctors are grateful to have a new option for gonorrhea – which has strains resistant to all existing treatments – but warn that future resistance to this compound is certain.

As has become the norm with new antibiotics, exists consequently an debate about whether it should be stockpiled, restricted to extremely drug-resistant cases only – limiting its use to settings where sophisticated diagnostics is accessible. This kind of rational strategy should be the worldwide norm, but frequently cannot be implemented easily in many parts of the world.

A Diminishing Stream of Discovery

On a wider scale, it is hard to see where the stream of other new antibiotics we require could realistically originate. The aforementioned statement nodded to the fact that searching the natural world for natural sources – as with the first antibiotic – has had declining success. The application of AI has been mooted to speed up the discovery process, although a much-celebrated early candidate found in 2020 hasn't yet progressed past animal trials. Synthetic drugs, that are mainly or fully synthesized, are constantly in development, but often run up against the iron laws of molecular science – just because we envision a molecule doesn't mean we can create it easily.

Running Fast 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 same place. Careful, globally managed deployment is the only way to maintain our therapeutic edge. Regrettably, the magnitude of forthcoming discoveries is going to seem meager compared with the therapeutic revolution of the 20th century.