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During her tenure as director general of the WHO, a former leader famously stated that all of the “simple” antimicrobials had already been found. The argument was that in addressing the urgent danger of drug-resistant infections, we would face difficulties to find new treatments – or preserve the current arsenal – without finding new ways of operating. This view proved correct.

A Slow and Unprofitable Development Path

Since 2017, just 16 antimicrobial agents have gained widespread official clearance – primarily close relatives of drugs already in use and thus not expected to evade bacterial resistance for an extended period. The development of new ones is a lengthy and unprofitable endeavor, given that one-off treatments are not as profitable as ones treating chronic ailments. The scientific outlook remains grim.

A Spark of Optimism and a Novel Approach

Nevertheless, the recent announcement of a pair of novel regulator-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 product of a novel kind of collaboration between a Swiss non‑profit and a pharmaceutical company. The non-profit supplied financial support and managed clinical trials to offset expenses and navigate regulatory hurdles. This type of support in advance helps steer the sector towards areas of most pressing global need.

This approach and a separate lauded revenue guarantee scheme – initiated to guarantee income to companies that invest in specific antibiotics – represent the strongest chance of maintaining a trickle of new drugs from the current framework.

The Unavoidable Problem of Drug Resistance

But even accelerating the production of compounds in the pipeline isn't sufficient. The new drug is at times described as a novel type of antibiotic, meaning it attacks a part of the infectious bacteria that existing treatments does, theoretically compelling the pathogen to start from zero in developing a countermeasure to it. Scientists and physicians are grateful to have a new drug for gonorrhea – which has resistant strains to every known antibiotic – but warn that future resistance to this compound is inevitable.

As has become the norm with new antibiotics, there is therefore an argument about whether it should be stockpiled, restricted to highly resistant cases only – limiting its application to situations where high‑end lab testing is available. This sort of prudent approach should be the global standard, but often cannot be implemented easily in many regions.

A Dwindling Pipeline of Innovation

On a wider scale, it is hard to see where the flow of other new antibiotics we require could possibly originate. The former official's comment nodded to the fact that searching the living world for biological compounds – as with penicillin – has had declining success. The application of AI has been proposed to speed up the discovery process, although a highly-touted early candidate identified in recent years hasn't yet progressed past preclinical studies. Synthetic drugs, which are largely or entirely lab-created, are constantly in development, but often run up against the fundamental rules of molecular science – just because we imagine a molecule does not guarantee we can synthesise it easily.

Moving Quickly to Stay in Place

The dominant expert assessment is that when it comes to antibiotics, we must run very fast truly just to stay in the current position. Prudent, internationally coordinated deployment is the sole method to maintain our advantage. Regrettably, the scale of future discoveries is going to seem meager compared with the therapeutic revolution of the previous century.