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During a time as head of the World Health Organization, a past official famously remarked that all of the “easy” antimicrobials had long since been discovered. The argument was that in addressing the urgent danger of drug-resistant bacterial infections, we would face difficulties to discover new medicines – or preserve the existing ones – without finding new ways of operating. This view was accurate.

A Slow and Challenging Pipeline

Since 2017, just 16 antibiotics have gained broad official clearance – primarily similar derivatives of medicines currently available and thus not expected to overcome bacterial resistance for an extended period. The development of novel compounds is a slow and financially unattractive endeavor, given that curative treatments are less lucrative as ones managing chronic conditions. The overall prospect remains bleak.

A Glimmer of Optimism and a New Model

Nevertheless, the recent announcement of two new regulator-approved drugs against gonorrhea is good news and, importantly, validates a new way of encouraging research. A particular of the recently approved medications, a compound called Zoliflodacin, is the result of a unique type of partnership between a global health organization and a drug firm. The public health partnership provided financial support and managed testing phases to offset costs and navigate approval processes. This sort of support in advance helps steer the industry towards areas of most pressing public health necessity.

This approach and another praised revenue guarantee scheme – launched to ensure income to firms investing in certain antimicrobials – represent the best hope of maintaining a trickle of new drugs from the existing system.

The Unavoidable Problem of Resistance

But even accelerating the development of drugs currently in development isn't enough. Zoliflodacin is sometimes described as a new class of antibiotic, indicating it attacks a component of the infectious bacteria that no other drug does, theoretically compelling the bacterium to start from zero in developing a defense to it. Scientists and doctors are grateful to have a new drug for gonorrhoea – which has resistant strains to every known antibiotic – but caution that eventual drug resistance to it is inevitable.

As has grown customary with new antibiotics, there is therefore an argument about whether it should be stockpiled, rationed to highly resistant infections only – limiting its use to situations where sophisticated diagnostics is available. This sort of prudent approach should be the worldwide norm, but often cannot be deployed easily in many regions.

A Dwindling Stream of Discovery

More broadly, it is hard to see where the flow of other novel antimicrobials we require could possibly originate. The aforementioned statement acknowledged the fact that searching the natural world for biological compounds – as with penicillin – has had declining success. Use of AI has been proposed to speed up the discovery process, although a much-celebrated initial discovery identified in recent years hasn't yet advanced past animal trials. Fully lab-created compounds, that are mainly or fully lab-created, are continually in research, but often confront the fundamental rules of molecular science – just because we imagine a compound doesn't mean we can synthesise it without great difficulty.

Moving Quickly 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 same place. Careful, globally managed use is the only way to maintain our therapeutic edge. Sadly, the magnitude of future breakthroughs is likely to seem miserly compared with the curative bonanza of the 20th century.