Antimicrobial Resistance Versus the Discovery and Development of New Antimicrobials

Abstract

In many areas of infectious diseases, there is a disparity between the intensity of medical need and the perceived commercial potential for the appropriate products. Wellknown examples include malaria and tuberculosis. For a variety of reasons, the same disparity is becoming reality for new antibacterial compounds which could address existing and emerging pathogens that are resistant to current antibiotics. In this chapter, we will review the history of antibiotic discovery and development to put everything else in an appropriate context. We will then explore the scientifi c challenges that have resulted in the paucity of novel antibacterials in today’s pipeline. Then we will examine the various factors that have coalesced to make antibacterials seem less commercially attractive for large companies. We will compare the situation in biotechnology and small pharmaceutical companies with that in large pharmaceutical companies. Finally, we will speculate on the future of antibacterial discovery and development given the emerging trends in science, in the marketplace, within the regulatory environment, and in the context of the pharmaceutical business.