Antimicrobial Drugs: New Advances Are Great Developments, Yet Humanity Is Losing the Bigger Race

During a tenure as director general of the WHO, a former leader famously remarked that all of the “easy” antibiotics had long since been discovered. The argument was that in tackling the pressing danger of drug-resistant bacterial infections, we would struggle to discover new medicines – or preserve the existing ones – without developing new ways of working. This assessment proved accurate.

A Sluggish and Challenging Development Path

Since 2017, only 16 antibiotics have gained widespread regulatory approval – mostly close relatives of drugs already in use and thus unlikely to overcome bacterial resistance for an extended period. The development of new ones is a slow and financially unattractive business, given that curative medicines are not as profitable as ones treating chronic ailments. The scientific outlook remains bleak.

A Spark of Optimism and a Novel Approach

Nevertheless, the recent announcement of a pair of novel FDA-approved drugs against gonorrhoea is good news and, importantly, confirms a new way of encouraging research. A particular of the recently approved medications, a compound called Zoliflodacin, is the result of a novel kind of partnership between a global health organization and a drug firm. The public health partnership provided funding and organised clinical trials to offset expenses and navigate regulatory hurdles. This type of support upfront helps direct the sector towards fields of greatest global need.

This approach and another lauded “subscription model” – launched to guarantee revenue to companies investing in certain antimicrobials – represent the best hope of maintaining a trickle of novel treatments from the current framework.

The Unavoidable Challenge of Resistance

But even hurrying the production of compounds in the pipeline isn't enough. Zoliflodacin is sometimes described as a novel type of antibiotic, indicating it targets a component of the infectious bacteria that no other drug does, in principle forcing the pathogen to begin anew in evolving a defense to it. Researchers and physicians are grateful to have a new drug for gonorrhoea – which has strains resistant to every known antibiotic – but warn that future resistance to it is certain.

As has become the norm with recent antimicrobials, exists consequently an debate about whether it should be stockpiled, rationed to extremely drug-resistant cases only – limiting its use to settings where high‑end lab testing is available. This kind of rational approach should be the worldwide norm, but often cannot be implemented easily in many parts of the world.

A Diminishing Stream of Discovery

More broadly, it is hard to see where the flow of additional novel antimicrobials we require could realistically originate. The former official's statement nodded to the fact that searching the natural world for natural sources – as with penicillin – has had declining success. Use of artificial intelligence has been mooted to accelerate the discovery process, although a much-celebrated initial discovery identified in recent years hasn't yet advanced past preclinical studies. Synthetic drugs, that are largely or entirely synthesized, are constantly in development, but often run up against the fundamental rules of molecular science – just because we envision a compound doesn't mean we can create it easily.

Moving Quickly to Stand Still

The prevailing expert assessment is that when it comes to antibiotics, we must move with great speed truly just to stay in the current position. Prudent, globally managed deployment is the sole method to preserve our advantage. Sadly, the magnitude of future breakthroughs is likely to seem meager in contrast to the therapeutic revolution of the previous century.