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During her tenure as director general of the World Health Organization, a former leader famously remarked that all of the “simple” antibiotics had already been found. The argument was that in addressing the pressing threat of antibiotic-resistant infections, we would struggle to discover new medicines – or preserve the current arsenal – without finding novel approaches of operating. This view was accurate.

A Slow and Challenging Development Path

Since the late 2010s, just 16 antimicrobial agents have received widespread regulatory approval – primarily similar derivatives of medicines currently available and thus not expected to overcome resistance for long. The development of novel compounds is a lengthy and unprofitable business, given that curative medicines are less lucrative as those treating chronic ailments. The scientific outlook continues to be grim.

A Glimmer of Hope and a Novel Approach

Nevertheless, the recent announcement of two new regulator-approved drugs against gonorrhoea is a welcome development and, crucially, confirms a innovative method of incentivising development. A particular of the new drugs, Zoliflodacin, is the product of a unique type of partnership between a global health organization and a pharmaceutical company. The non-profit provided financial support and managed testing phases to offset expenses and navigate regulatory hurdles. This sort of assistance upfront helps direct the sector towards fields of greatest public health necessity.

This model and a separate lauded “subscription model” – launched to guarantee income to companies investing in specific antibiotics – constitute the strongest chance of maintaining a trickle of novel treatments from the current system.

The Inevitable Problem of Drug Resistance

But even hurrying the production of compounds in the pipeline isn't sufficient. Zoliflodacin is sometimes categorized as a novel type of antibiotic, indicating it targets a component of the pathogen that no other drug does, in principle forcing the pathogen to begin anew in evolving a countermeasure to it. Researchers and physicians are grateful to have a new option for gonorrhoea – which has resistant strains to all existing treatments – but warn that eventual drug resistance to it is certain.

As has grown customary with new antibiotics, exists therefore an debate about whether it should be stockpiled, rationed to highly resistant cases only – limiting its application to settings where high‑end lab testing is accessible. This kind of prudent approach should be the global standard, but often can't be deployed easily in many regions.

A Diminishing Stream of Discovery

On a wider scale, it is difficult to see where the stream of other new antibiotics we need could possibly come from. The aforementioned statement acknowledged the fact that surveying the living world for natural sources – as with the first antibiotic – has had declining success. The application of artificial intelligence has been proposed to accelerate the search, although a highly-touted early candidate found in recent years hasn't yet progressed past preclinical studies. Fully lab-created compounds, which are mainly or fully lab-created, are constantly in development, but often run up against the fundamental rules of chemistry – just because we envision a molecule doesn't mean we can create it without great difficulty.

Running Fast to Stand Still

The dominant scientific evaluation is that when it comes to antimicrobials, we must run very fast truly just to remain in the same place. Prudent, internationally coordinated deployment is the only way to preserve our therapeutic edge. Sadly, the magnitude of forthcoming discoveries is likely to seem miserly in contrast to the curative bonanza of the previous century.