Current pipeline for antibiotics insufficient in tackling drug resistance

The current pipeline for antibiotics is insufficient in addressing drug resistance in the world’s most dangerous bacteria, a new report by the World Health Organisation has revealed.

WHO’s Antibacterial Pipeline Report found that the 43 antibiotics currently in clinical development do little to address the problem of drug resistance in the world’s most dangerous bacteria.

Since 2017, WHO has highlighted which drug-resistant bacteria should be targeted as priority areas for research & development R&D. The WHO Bacterial Priority Pathogens List (WHO PPL) classes pathogens into critical, high and medium priorities for R&D.

The new report states that the current antibiotic pipeline is near to being static and that only a few antibiotics have been approved in recent years. More so, 82% of recently approved antibiotics offer limited clinical benefit over existing treatments as they are derivatives of existing antibiotic classes with well-established drug-resistance.

“The persistent failure to develop, manufacture, and distribute effective new antibiotics is further fuelling the impact of antimicrobial resistance (AMR) and threatens our ability to successfully treat bacterial infections,” says Dr Hanan Balkhy, WHO assistant director general on AMR.

The impact of antimicrobial resistance (AMR) is largely felt in resource-constrained settings and vulnerable groups including new-borns and young children. For instance, bacterial pneumonia and bloodstream infections are a major cause of death in children under the age of five. More so, approximately 30% of newborns with sepsis die due to bacterial infections that have become resistant to multiple first-line antibiotics.

The report does examine 27 non-traditional antibacterial agents that range from antibodies to bacteriophages and therapies that support the patient’s immune response and weaken the effect of the bacteria. However, tough economic conditions for drug development can mean that only a fraction of these will ever reach the market. Interest from investors and large pharmaceutical companies into antibiotic therapies has dwindled due to the small return on investment seen in successful antibiotic products.

WHO does mention that there are lessons to be learned from Covid-19 regarding antibiotic resistance. Currently, new antibiotic products are being driven by small-and medium-sized companies, which can often struggle to finance their products to the final stages of clinical development.

“Opportunities emerging from the Covid-19 pandemic must be seized to bring to the forefront the needs for sustainable investments in R&D of new and effective antibiotics,” said Haileyesus Getahun, director of AMR Global Coordination at WHO.  “Antibiotics present the Achilles heel for universal health coverage and our global health security. We need a global sustained effort including mechanisms for pooled funding and new and additional investments to meet the magnitude of the AMR threat.”

The threat of AMR has meant that a number of initiatives have emerged to help both fight and monitor the situation. This includes the Global Antibiotic R&D Partnership (GARDP) which is developing treatment to tackle AMR; non-profit funding partners such as CARB-X which is helping accelerate antibacterial research; and the AMR Action Fund which has been set up to strengthen antibiotic development through global pooled funding.