New Antibiotics: Needs, Challenges, and Status

The accelerating rise of antimicrobial resistance (AMR) poses a profound threat to global health, demanding urgent development of new antibiotics. Existing drugs are losing effectiveness against critical pathogens, including carbapenem-resistant Enterobacterales, multidrug-resistant Acinetobacter baumannii, and rifampicin-resistant Mycobacterium tuberculosis. The World Health Organisation’s 2024 Bacterial Priority Pathogens List highlights urgent gaps, particularly for Gram-negative bacteria, which remain resistant to last-resort treatments. Despite incremental progress, the current antibiotic pipeline remains fragile, characterised by limited innovation and an over-reliance on modifications of existing molecules. Between 2017 and 2024, only a few novel agents were approved, with even fewer representing entirely new classes. Barriers include high research and development costs, scientific complexity, limited market incentives, and stringent regulatory requirements. Innovative solutions—such as AI-enabled discovery, novel β-lactamase inhibitors, pathogen-specific agents, and non-traditional approaches—show promise but require sustained investment to fully realise their potential. Strengthened public–private partnerships, global collaboration, economic pull incentives, and improved diagnostics are essential to revitalise antibiotic development. Without urgent reforms, the world risks entering a post-antibiotic era where common infections and medical procedures become life-threatening.