DDuring his tenure as Director-General of the World Health Organization, Dr Margaret Chan Used to say that everyone “Easy“Antibiotics were already found. Her point was that in responding to the immediate threat of antibiotic-resistant infections, we would struggle to find new drugs – or to preserve the ones we have – if we didn’t find new ways to work. She was right.
Since 2017, there are only 16 antibiotics Received broad regulatory approval – Close relatives of most drugs are already in use and therefore unlikely to escape long-term resistance. Developing new drugs is a slow and unprofitable business, with curative drugs being less lucrative than drugs treating long-term conditions. And the scientific outlook remains bleak.
Still, the announcement this month of two new US Food and Drug Administration-approved antibiotics against gonorrhea is good news and, importantly, validates a new way to encourage research. One of the new drugs, zoliflodasin, is the product of a new kind of partnership between the Swiss non-profit Global Antibiotic Research and Development Partnership (GARDP) and the pharmaceutical company Innoviva. GARDP provided funding and conducted clinical trials to reduce costs and overcome regulatory barriers. Such advance assistance helps direct industry toward areas of greatest global need.
This approach was appreciated by the UK government “Subscription Model” – launched in 2022 to guarantee revenues to companies investing in certain antibiotics – represents the best hope of maintaining a dripfeed of new drugs from the existing system.
But rushing into the production of drugs currently under development is also not enough. Zoliflodacin is sometimes described as a new class of antibiotics, meaning that it targets a part of the infectious bacteria that no other drug does, theoretically forcing the pathogen to start from scratch to develop a resistance to it. Scientists and doctors are relieved to have found a new drug for gonorrhea—which has strains resistant against every known antibiotic—but caution that future resistance to zoliflodacin is inevitable.
As has become the norm with new antibiotics, so there is an argument Regarding whether it should be reserved, rationed only to highly resistant infections – its use should be limited to places where high-level laboratory testing is available. This type of rational approach should be the norm around the world, but often cannot be easily implemented in the Global South.
More broadly, it is hard to see where the other new antibiotics we need could possibly come from. Dr. Chan’s comments point to the fact that surveying the living world for natural sources – such as with penicillin – has yielded diminishing returns. The use of artificial intelligence has been considered to speed up the discovery process, although a highly anticipated early candidate called helicin, identified in 2020, has not yet progressed beyond animal trials. Synthetic drugs, made primarily or entirely in the laboratory, are constantly in development, but often run up against the iron rules of chemistry – just because we imagine a molecule does not mean we can easily synthesize it.
The prevailing scientific assessment is that when it comes to antibiotics, we must run very fast indeed to stay in the same place. Careful internationally coordinated use is the only way to maintain our advantage. Sadly, the scale of future successes is likely to pale in comparison to the therapeutic gifts of the 20th century.
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