Antimicrobial Drugs: New Advances Are Positive Developments, Yet Humanity Is Losing the Larger Race

During a time as director general of the WHO, a past official famously remarked that all of the “simple” antimicrobials had long since been discovered. The argument was that in tackling the pressing danger of antibiotic-resistant infections, we would struggle to find new treatments – or conserve the existing ones – without finding new ways of operating. This view proved correct.

A Sluggish and Unprofitable Pipeline

Since the late 2010s, just sixteen antibiotics have received widespread official clearance – primarily similar derivatives of medicines already in use and thus not expected to overcome bacterial resistance for long. The creation of new ones is a slow and financially unattractive business, given that curative medicines are less lucrative as ones treating longer-term conditions. The scientific outlook remains bleak.

A Glimmer of Hope and a New Model

Nevertheless, the news this month of two new regulator-approved drugs for gonorrhea is a welcome development and, crucially, validates a innovative method of encouraging research. A particular of the new drugs, a compound called Zoliflodacin, is the result of a unique type of collaboration between a global health organization and a pharmaceutical company. The public health partnership provided funding and managed clinical trials to offset expenses and clear approval processes. This sort of assistance upfront helps steer the industry towards areas of most pressing public health necessity.

This model and another praised “subscription model” – launched to ensure revenue to firms investing in specific antibiotics – represent the best hope of sustaining a dripfeed of new drugs from the existing system.

The Inevitable Challenge of Resistance

But even accelerating the development of drugs currently in development is not sufficient. The new drug is at times categorized as a new class of antibiotic, indicating it attacks a component of the pathogen that no other drug does, in principle compelling the pathogen to start from zero in evolving 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 recent antimicrobials, exists consequently an debate about whether it should be stockpiled, rationed to highly resistant cases only – confining its use to settings where high‑end lab testing is available. This sort of prudent approach should be the global standard, but often cannot be implemented easily in many regions.

A Diminishing Stream of Discovery

More broadly, it is hard to see where the stream of additional novel antimicrobials we need could possibly come from. The former official's comment nodded to the fact that searching the living world for natural sources – as with the first antibiotic – has had declining success. The application of artificial intelligence has been proposed to speed up the discovery process, although a much-celebrated early candidate identified in recent years has not yet advanced past preclinical studies. Fully lab-created compounds, that are largely or entirely synthesized, are continually in development, but often run up against the fundamental rules of molecular science – the fact that we imagine a compound does not guarantee we can synthesise it easily.

Moving Quickly to Stand Still

The prevailing expert assessment is that when it comes to antimicrobials, we must move with great speed truly just to remain in the current position. Prudent, globally managed use is the sole method to preserve our advantage. Regrettably, the scale of future discoveries is likely to seem meager in contrast to the curative bonanza of the 20th century.