Intended for healthcare professionals


3Rs for innovating novel antibiotics: sharing resources, risks, and rewards

BMJ 2012; 344 doi: (Published 03 April 2012) Cite this as: BMJ 2012;344:e1782
  1. Anthony D So, director1,
  2. Quentin Ruiz-Esparza, associate in research1,
  3. Neha Gupta, associate in research 1,
  4. Otto Cars, professor of infectious diseases2
  1. 1Program on Global Health and Technology Access, Sanford School of Public Policy, Duke University, Durham, NC 27708, USA
  2. 2Department of Medical Sciences, Uppsala University, Uppsala, Sweden
  1. Correspondence to: A D So{at}

The stream of new antibiotics is struggling to keep up with emerging bacterial resistance. Anthony So and colleagues examine what can be done to increase innovation

The dearth of novel antibiotics poses challenges to the treatment of bacterial infection and points to shortcomings in the system of pharmaceutical innovation. Increasing bacterial resistance to existing antibiotics causes substantial morbidity and mortality and threatens society’s ability to realise benefits from modern medical advances. Access to effective antibiotics is essential to treating the unavoidable infections that come with cancer chemotherapy, organ transplantation, or the care of premature babies.

Yet studies have repeatedly confirmed the faltering research pipeline for novel antibiotics and cited the exit of major pharmaceutical firms from this therapeutic area. In the publicly disclosed pipelines of the top 15 drug companies, only five drug candidates, or 1.6% of the pipeline, were antibiotics.1 A more comprehensive search of two commercial databases also turned up few novel antibacterial drug candidates.2 Of the 15 candidates identified that could be administered systemically, only four were active against Gram negative bacteria, two of which acted on new targets; none of the four had a novel mechanism of action.2

With few promising drug candidates in sight, the near term prospects of new antibiotics are dismal.3 The bottlenecks in bringing a novel antibiotic to market span from discovery to delivery (fig 1). Upstream in the research and development pipeline, concerns have surfaced over identification of leads and medicinal chemistry. Especially critical is the step between preclinical and clinical development (the “valley of death”). Drug companies have been hesitant to take compounds into large and costly clinical programmes because of the uncertain return on investment and academic researchers and smaller companies find it difficult to get venture capital for clinical research. Downstream, concerns over …

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