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During her time as head of the World Health Organization, a past official famously remarked that all of the “easy” antimicrobials had long since been discovered. The point was that in tackling the urgent threat of drug-resistant bacterial infections, we would face difficulties to discover new treatments – or preserve the current arsenal – without finding novel approaches of operating. This assessment proved correct.

A Sluggish and Challenging Pipeline

Since the late 2010s, only sixteen antibiotics have received broad regulatory approval – mostly close relatives of medicines already in use and thus not expected to overcome bacterial resistance for an extended period. The creation of novel compounds is a lengthy and financially unattractive business, given that one-off treatments are not as profitable as those managing chronic conditions. The overall prospect remains bleak.

A Spark of Optimism and a New Model

However, the recent announcement of two new regulator-approved drugs for gonorrhea is good news and, importantly, confirms a innovative method of encouraging research. One of the recently approved medications, a compound called Zoliflodacin, is the result of a novel kind of partnership between a global health organization and a drug firm. The non-profit provided financial support and managed testing phases to offset expenses and navigate regulatory hurdles. This type of assistance upfront helps direct the sector towards areas of greatest public health necessity.

This model and a separate praised revenue guarantee scheme – initiated to guarantee revenue to firms that invest in specific antimicrobials – constitute the best hope of sustaining a trickle of new drugs from the current framework.

The Unavoidable Challenge of Drug Resistance

But even accelerating the production of compounds currently in development isn't sufficient. Zoliflodacin is at times categorized as a novel type of antibiotic, indicating it attacks a component of the infectious bacteria that existing treatments does, in principle compelling the pathogen to start from zero in evolving a countermeasure to it. Researchers and doctors are relieved to have a new option for gonorrhoea – which has resistant strains to every known antibiotic – but warn that eventual drug resistance to it is inevitable.

As has grown customary with new antibiotics, exists consequently an debate about whether it should be stockpiled, rationed to highly resistant cases only – confining its use to situations where sophisticated diagnostics is accessible. This kind of rational approach should be the global standard, but often can't be deployed easily in many parts of the world.

A Dwindling Stream of Discovery

On a wider scale, it is hard to see where the stream of other new antibiotics we require could possibly come from. The former official's statement nodded to the fact that surveying the natural world for natural sources – as with penicillin – has had declining success. Use of artificial intelligence has been mooted to accelerate the search, although a much-celebrated early candidate identified in recent years has not yet progressed past preclinical studies. Synthetic drugs, that are largely or entirely synthesized, are continually in research, but often confront the iron laws of chemistry – the fact that we envision a compound doesn't mean we can synthesise it without great difficulty.

Moving Quickly to Stand Still

The prevailing expert assessment is that when it comes to antibiotics, we must move with great speed truly just to stay in the same place. Prudent, globally managed use is the only way to preserve our advantage. Regrettably, the magnitude of forthcoming breakthroughs is likely to seem meager compared with the therapeutic revolution of the 20th century.