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During a time as head of the WHO, a former leader famously stated that all of the “simple” antibiotics had already been found. The point was that in addressing the pressing threat of antibiotic-resistant bacterial infections, we would struggle to find new treatments – or conserve the existing ones – without developing novel approaches of working. This assessment was accurate.

A Sluggish and Challenging Pipeline

Since the late 2010s, only 16 antibiotics have gained broad official clearance – mostly similar derivatives of medicines already in use and thus unlikely to evade resistance for an extended period. The development of novel compounds is a lengthy and unprofitable endeavor, given that one-off treatments are not as profitable as those managing longer-term ailments. The scientific outlook continues to be bleak.

A Spark of Hope and a Novel Approach

However, the recent announcement of two new FDA-approved antibiotics for gonorrhea is good news and, importantly, validates a innovative method of encouraging research. A particular of the new drugs, Zoliflodacin, is the result of a unique type of partnership between a Swiss non‑profit and a pharmaceutical company. The non-profit provided funding and managed clinical trials to offset expenses and navigate approval processes. This sort of assistance in advance helps steer the industry towards areas of greatest public health necessity.

This approach and another lauded “subscription model” – initiated to guarantee income to firms that invest in specific antimicrobials – constitute the strongest chance of maintaining a trickle of new drugs from the existing framework.

The Unavoidable Challenge of Drug Resistance

But even accelerating the development of compounds currently in development isn't enough. The new drug is sometimes described as a novel type of antimicrobial, indicating it attacks a component of the pathogen that no other drug does, in principle forcing the bacterium to begin anew in developing a countermeasure to it. Scientists and physicians are grateful to have a new option for gonorrhea – which has resistant strains to all existing treatments – but caution that eventual drug resistance to it is certain.

As has grown customary with new antibiotics, exists consequently an argument about whether it should be held in reserve, rationed to highly resistant infections only – confining its use to settings where high‑end lab testing is accessible. This sort of prudent approach should be the worldwide norm, but frequently can't be deployed readily in many parts of the world.

A Diminishing Pipeline of Innovation

On a wider scale, it is hard to see where the stream of other new antibiotics 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. Use of artificial intelligence has been mooted to speed up the search, although a highly-touted early candidate found in 2020 has not yet advanced past animal trials. Synthetic drugs, that are largely or entirely lab-created, are constantly in research, but often confront the iron laws of chemistry – just because we imagine a molecule does not guarantee we can create it without great difficulty.

Moving Quickly to Stay in Place

The dominant expert assessment is that when it comes to antibiotics, we must move with great speed indeed just to stay in the current position. Careful, globally managed deployment is the sole method to maintain our therapeutic edge. Sadly, the magnitude of future discoveries is going to seem meager compared with the curative bonanza of the 20th century.