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During a time as head of the WHO, a past official famously stated that all of the “easy” antibiotics had already been found. The argument was that in addressing the pressing danger of drug-resistant bacterial infections, we would struggle to find new medicines – or preserve the current arsenal – without finding new ways of working. This view was correct.

A Sluggish and Challenging Development Path

Since the late 2010s, only 16 antibiotics have gained widespread official clearance – mostly similar derivatives of drugs already in use and thus not expected to evade resistance for long. The development of novel compounds is a slow and financially unattractive endeavor, given that curative treatments are not as profitable as ones managing longer-term conditions. The scientific outlook remains bleak.

A Spark of Hope and a New Model

Nevertheless, the news this month of two new FDA-approved antibiotics for gonorrhea is good news and, crucially, confirms a innovative method of incentivising development. A particular of the recently approved medications, Zoliflodacin, is the product of a novel kind of collaboration between a global health organization and a drug firm. The non-profit provided funding and organised testing phases to defray expenses and clear regulatory hurdles. This type of assistance upfront helps steer the sector towards areas of most pressing public health necessity.

This approach and a separate lauded revenue guarantee scheme – initiated to guarantee revenue to companies that invest in certain antimicrobials – constitute the best hope of sustaining a trickle of novel treatments from the current framework.

The Unavoidable Challenge of Resistance

But even hurrying the production of drugs currently in development is not enough. Zoliflodacin is sometimes described as a new class of antimicrobial, indicating it targets a part of the pathogen that existing treatments does, theoretically forcing the pathogen to start from zero in developing a countermeasure to it. Scientists and doctors are relieved to have a new drug for gonorrhoea – which has strains resistant to all existing treatments – but caution that future resistance to it is inevitable.

As has become the norm with new antibiotics, exists consequently an argument about whether it should be stockpiled, rationed to highly resistant cases only – limiting its application to situations where high‑end lab testing is accessible. This sort of rational approach should be the worldwide norm, but often can't be deployed readily in many parts of the world.

A Diminishing Pipeline of Discovery

On a wider scale, it is difficult to see where the stream of other new antibiotics we need could possibly originate. The aforementioned comment nodded to the fact that surveying the natural world for biological compounds – as with the first antibiotic – has had declining success. The application of artificial intelligence has been proposed to accelerate the search, although a much-celebrated early candidate identified in recent years hasn't yet progressed past animal trials. Fully lab-created compounds, that are mainly or fully synthesized, are constantly in development, but often confront the iron laws of molecular science – the fact that we envision a compound does not guarantee we can synthesise it without great difficulty.

Running Fast 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 same place. Careful, internationally coordinated use is the sole method to maintain our therapeutic edge. Regrettably, the scale of forthcoming discoveries is going to seem meager compared with the curative bonanza of the 20th century.