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During a time as director general of the WHO, a former leader famously stated that all of the “easy” antimicrobials had long since been discovered. The point was that in addressing the pressing danger of antibiotic-resistant bacterial infections, we would struggle to find new treatments – or conserve the current arsenal – without developing new ways of working. This assessment proved accurate.

A Sluggish and Unprofitable Development Path

Since the late 2010s, only 16 antimicrobial agents have received broad regulatory approval – mostly close relatives of medicines already in use and thus unlikely to overcome resistance for long. The creation of new ones is a lengthy and financially unattractive business, given that one-off medicines are less lucrative as those managing chronic ailments. The scientific outlook continues to be grim.

A Glimmer of Hope and a New Model

However, the news this month of two new regulator-approved drugs against gonorrhea is a welcome development and, importantly, validates a innovative method of incentivising development. A particular of the recently approved medications, a compound called Zoliflodacin, is the product of a unique type of partnership between a Swiss non‑profit and a drug firm. The non-profit provided funding and managed testing phases to offset costs and navigate regulatory hurdles. This sort of assistance in advance helps direct the sector towards areas of most pressing global need.

This approach and another lauded “subscription model” – launched to ensure income to firms investing in specific antibiotics – represent the best hope of sustaining a trickle of novel treatments from the current framework.

The Inevitable Challenge of Drug Resistance

But even accelerating the production of compounds in the pipeline isn't enough. Zoliflodacin is sometimes categorized as a new class of antibiotic, indicating it targets a component of the infectious bacteria that existing treatments does, in principle forcing the bacterium to begin anew in evolving a defense to it. Researchers and doctors 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 certain.

As has grown customary with new antibiotics, exists therefore an debate about whether it should be held in reserve, rationed to extremely drug-resistant cases only – confining its application to settings where sophisticated diagnostics is accessible. This kind of rational strategy should be the global standard, but frequently can't be implemented easily in many regions.

A Diminishing Pipeline of Discovery

More broadly, it is hard to see where the stream of other novel antimicrobials we need could possibly come from. The former official's statement nodded to the fact that searching the natural world for biological compounds – as with penicillin – has had diminishing returns. Use of artificial intelligence has been proposed to speed up the search, although a highly-touted early candidate found in recent years has not yet progressed past animal trials. Fully lab-created compounds, which are mainly or fully synthesized, are constantly in development, but often confront the fundamental rules of molecular science – the fact that we imagine a compound doesn't mean we can synthesise it without great difficulty.

Moving Quickly to Stand Still

The dominant scientific evaluation is that when it comes to antibiotics, we must move with great speed truly just to stay in the same place. Prudent, internationally coordinated use is the sole method to maintain our therapeutic edge. Regrettably, the magnitude of forthcoming discoveries is likely to seem miserly in contrast to the therapeutic revolution of the previous century.