Future antibiotics scenarios: is the tide starting to turn?

The fight against multidrug-resistant (MDR) pathogens continues. This article discusses the gap between the need for new antibiotics and lean research and development (R&D) pipelines. Many large pharmaceutical companies have terminated their antibacterial research programmes as they focus on potentially more lucrative therapeutic areas. At the same time, an increasingly dry funding situation hampers smaller start-up companies. Antibacterial innovation proceeds in waves. Following a wave of broad-spectrum antibiotics in the 1980s and 1990s, many companies focused on the development of small-spectrum antibiotics targeted at Gram-positive bacteria. In recent years, MDR Gram-negative bacteria have emerged and spread rapidly. The resulting intensified need for new therapeutic options against Gram-negative bacteria appears to promise financially rewarding return on investment for pharmaceutical companies within this small market niche. Thus, interest in antibiotics, particularly in drugs effective against MDR Gram-negative bacteria, is back. We appear to be at the start of a new wave of antibacterial drug R&D that will hopefully yield new therapeutic options in the future (10–15 years). Until then, the problem of MDR Gram-negative bacteria must continue to be addressed with a multifaceted set of solutions based on currently available tools.