The global fight against antibiotic-resistant superbugs has received a rare piece of good news. This month, the US Food and Drug Administration (FDA) approved two new antibiotics specifically for the treatment of gonorrhoea, a sexually transmitted infection with strains that have grown resistant to every other known class of drug.
A New Model for a Stagnant Pipeline
The development is significant not just for public health, but for validating a novel approach to incentivising essential medical research. One of the new drugs, Zoliflodacin, is the result of a pioneering partnership between the non-profit Global Antibiotic Research and Development Partnership (GARDP) and the pharmaceutical firm Innoviva.
This model, where a non-profit provides upfront funding and manages costly clinical trials, is designed to steer the industry towards areas of urgent global need that are otherwise commercially unattractive. It mirrors the innovative thinking behind the UK government's 'subscription model', launched in 2022, which guarantees revenue to companies developing certain high-priority antibiotics.
The Inevitable March of Resistance
While the arrival of Zoliflodacin is a relief to scientists and doctors, it comes with a sobering caveat. The drug is sometimes described as a new class of antibiotic, meaning it attacks bacteria in a novel way, theoretically forcing pathogens to start from scratch in evolving resistance. However, experts universally caution that future resistance to Zoliflodacin is inevitable.
This reality sparks a difficult debate: should such a precious new tool be held in reserve, rationed only for the most resistant infections? While this rational approach is ideal, it is often impractical to implement globally, particularly in regions with limited access to advanced laboratory testing.
A Bleak Outlook for Discovery
The broader landscape for antibiotic discovery remains deeply challenging. As former World Health Organization director-general Dr Margaret Chan observed, the 'easy' antibiotics have all been found. The golden age of discovering curative drugs from natural sources, like penicillin, is long over.
Since 2017, only 16 new antibiotics have gained widespread approval, and most are closely related to existing drugs, offering only a temporary reprieve from resistance. The search has turned to synthetic, lab-created drugs and the use of artificial intelligence, but progress is slow. Promising AI-identified candidates, like halicin in 2020, have yet to progress past animal trials, and synthetic chemistry is constrained by what is physically possible to create.
The prevailing scientific view is stark: in the battle against bacterial evolution, we must run exceptionally fast just to stand still. Careful, internationally coordinated use of existing antibiotics is now as crucial as developing new ones. While breakthroughs like this month's FDA approvals are vital, the scale of future discoveries is unlikely to match the medical bonanza of the last century, underscoring the urgent need to preserve the medicines we have left.
