Antimicrobial Drugs: Recent Breakthroughs Provide Positive News, But Humanity Is Falling Behind In the Bigger Battle

During a time as director general of the World Health Organization, a past official famously remarked that all of the “simple” antimicrobials had long since been discovered. The point was that in tackling the pressing danger of drug-resistant bacterial infections, we would face difficulties to discover new medicines – or conserve the current arsenal – without developing novel approaches of working. This view proved accurate.

A Sluggish and Unprofitable Development Path

Since 2017, only 16 antibiotics have gained widespread official clearance – primarily similar derivatives of medicines already in use and thus unlikely to overcome bacterial resistance for an extended period. The development of novel compounds is a lengthy and unprofitable business, given that one-off treatments are less lucrative as ones treating chronic ailments. The scientific outlook continues to be bleak.

A Spark of Hope and a Novel Approach

Nevertheless, the news this month of two new regulator-approved drugs for gonorrhea is good news and, importantly, validates a innovative method of encouraging research. A particular of the recently approved medications, Zoliflodacin, is the result of a novel kind of collaboration between a global health organization and a pharmaceutical company. The public health partnership provided financial support and organised clinical trials to offset expenses and navigate regulatory hurdles. This sort of support in advance helps direct the industry towards areas of greatest public health necessity.

This approach and another lauded revenue guarantee scheme – initiated to guarantee revenue to firms investing in certain antimicrobials – constitute the strongest chance of maintaining a trickle of novel treatments from the existing system.

The Inevitable Challenge of Resistance

But even accelerating the development of compounds currently in development isn't sufficient. The new drug is sometimes categorized as a new class of antibiotic, meaning it attacks a component of the pathogen that existing treatments does, in principle compelling the pathogen to begin anew in evolving a defense to it. Researchers and physicians are grateful to have a new drug for gonorrhea – which has strains resistant to all existing treatments – but warn that eventual drug resistance to this compound is inevitable.

As has grown customary with new antibiotics, there is therefore an argument about whether it should be held in reserve, rationed to extremely drug-resistant cases only – confining its use to situations where sophisticated diagnostics is accessible. This sort of rational strategy should be the worldwide norm, but often cannot be implemented easily 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 aforementioned statement nodded to the fact that searching the living world for natural sources – as with the first antibiotic – has had diminishing returns. Use of AI has been proposed to speed up the search, although a much-celebrated early candidate found in recent years has not yet advanced past preclinical studies. Fully lab-created compounds, that are mainly or fully synthesized, are constantly in development, but often confront the iron laws of molecular science – just because we imagine a compound doesn't mean we can create it easily.

Running Fast to Stay in Place

The prevailing expert assessment 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 future breakthroughs is likely to seem miserly compared with the therapeutic revolution of the 20th century.