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During her time as head of the World Health Organization, a past official famously stated that all of the “simple” antimicrobials had long since been discovered. The point was that in tackling the urgent threat of antibiotic-resistant bacterial infections, we would face difficulties to discover new medicines – or conserve the current arsenal – without developing new ways of working. This assessment was correct.

A Slow and Challenging Development Path

Since 2017, only sixteen antibiotics have gained broad regulatory approval – mostly similar derivatives of medicines already in use and thus not expected to overcome resistance for an extended period. The development of new ones is a slow and unprofitable endeavor, given that curative medicines are less lucrative as those managing longer-term conditions. The overall prospect continues to be grim.

A Glimmer of Optimism and a Novel Approach

Nevertheless, the recent announcement of two new FDA-approved antibiotics for gonorrhea 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 novel kind of collaboration between a global health organization and a pharmaceutical company. The non-profit provided funding and organised testing phases to offset costs and navigate approval processes. This sort of support upfront helps direct the industry towards areas of greatest global need.

This model and another praised revenue guarantee scheme – launched to guarantee income to companies that invest in specific antibiotics – represent the best hope of sustaining a trickle of new drugs from the current system.

The Unavoidable Problem of Drug Resistance

But even accelerating the production of drugs in the pipeline isn't sufficient. Zoliflodacin is sometimes categorized as a new class of antimicrobial, meaning it targets a part of the infectious bacteria that existing treatments does, theoretically compelling the pathogen to begin anew in developing a defense to it. Researchers and doctors are grateful to have a new option for gonorrhea – which has resistant strains to every known antibiotic – but warn that eventual drug resistance to it is inevitable.

As has become the norm with new antibiotics, exists consequently an debate about whether it should be stockpiled, rationed to extremely drug-resistant infections only – limiting its application to situations where sophisticated diagnostics is available. This kind of rational strategy should be the worldwide norm, but often cannot be deployed easily in many parts of the world.

A Dwindling Stream of Innovation

On a wider scale, it is difficult to see where the stream of other new antibiotics we require could realistically come from. The former official's statement acknowledged the fact that surveying the living world for biological compounds – as with the first antibiotic – has had diminishing returns. The application of AI has been proposed to speed up the discovery process, although a much-celebrated initial discovery identified in recent years hasn't yet progressed past animal trials. Synthetic drugs, which are largely or entirely lab-created, are constantly in development, but often run up against the iron laws of chemistry – the fact that we imagine a molecule doesn't mean we can synthesise it easily.

Running Fast to Stay in Place

The dominant scientific evaluation is that when it comes to antibiotics, we must move with great speed truly just to remain in the same place. Prudent, globally managed deployment is the sole method to preserve our therapeutic edge. Regrettably, the scale of forthcoming discoveries is likely to seem meager in contrast to the curative bonanza of the 20th century.