Antibiotics have saved millions of lives since they were first developed over a century ago. Scroll through our gallery to see some of the key moments and structures as the number of new antibiotics increased rapidly, then slowed to a trickle.
1910 – the first antibiotic Paul Ehrlich discovered that Salvarsan, an organoarsenic compound, could treat syphilis.
1932 – prontosil German chemical company Bayer introduced sulfonamide drug Prontosil, the first broad spectrum antibiotic.
1928 – penicillin Alexander Fleming observes the effects of penicillin, but it took over a decade before Howard Florey and Ernst Chain’s Oxford group isolated the compound. By 1943, billions of doses were being produced.
1943 – streptomycin Streptomycin – the first antibiotic effective against gram-negative bacteria and the first to treat tuberculosis – was isolated from Streptomyces bacteria. Streptomyces belong to the larger class of actinomycetes, bacteria typically found in soil, that are prolific producers of antibiotic coumpounds. Today over 60% of antibiotics are derived from these bacteria.
1940s–1960s – the golden era With the success of early antibiotic discoveries, research ramped up enormously. Over 20 new classes were discovered in the following decades and pharmaceutical firms invested heavily in large screening projects. Synthetic derivatives of natural products were developed to optimise their properties by making them more potent, or broadening their spectrum of activity.
1940s–1960s – the golden era Chlortetracycline, a tetracycline, was isolated from actinomycetes bacteria in 1948
1940s–1960s – the golden era Erythromycin, a macrolide, was isolated from actinomycetes bacteria in 1952
1940s–1960s – the golden era Vancomycin, a glycopeptide, was isolated from actinomycetes bacteria in 1955
1940s–1960s – the golden era Nalidixic acid, the first synthetic quinolone, was discovered in 1962
1974 – fighting resistance Bacteria quickly developed defences against antibiotics, with the β-lactamase enzyme that breaks down penicillin identified in 1940. The first β-lactamase inhibitor, clavulanic acid, was developed in 1974 at the Beecham pharmaceutical company in the UK to counter that resistance mechanism.
1980s onward – the pipeline dries up The last new classes of antibiotic discovered were the oxazolidinones and lipopeptides (such as daptomycin) discovered in 1987...
1980s onward – the pipeline dries up ...this left a long gap before diarylquinolones (such as bedaquiline) were discovered in the early 2000s.
1910 – the first antibiotic Paul Ehrlich discovered that Salvarsan, an organoarsenic compound, could treat syphilis.
1932 – broad spectrum German chemical company Bayer introduced sulfonamide drug Prontosil, the first broad spectrum antibiotic.
1928 – penicillin Alexander Fleming observes the effects of penicillin, but it took over a decade before Howard Florey and Ernst Chain’s Oxford group isolated the compound. By 1943, billions of doses were being produced.
1943 – streptomycin Streptomycin – the first antibiotic effective against gram-negative bacteria and the first to treat tuberculosis – was isolated from Streptomyces bacteria. Streptomyces belong to the larger class of actinomycetes, bacteria typically found in soil, that are prolific producers of antibiotic coumpounds. Today over 60% of antibiotics are derived from these bacteria.
1940s–1960s – the golden era With the success of early antibiotic discoveries, research ramped up enormously. Over 20 new classes were discovered in the following decades and pharmaceutical firms invested heavily in large screening projects. Synthetic derivatives of natural products were developed to optimise their properties by making them more potent, or broadening their spectrum of activity.
1940s–1960s – the golden era Chlortetracycline, a tetracycline, was isolated from actinomycetes bacteria in 1948
1940s–1960s – the golden era Erythromycin, a macrolide, was isolated from actinomycetes bacteria in 1952
1940s–1960s – the golden era Vancomycin, a glycopeptide, was isolated from actinomycetes bacteria in 1955
1940s–1960s – the golden era Nalidixic acid, the first synthetic quinolone, was discovered in 1962
1974 – fighting resistance Bacteria quickly developed defences against antibiotics, with the β-lactamase enzyme that breaks down penicillin identified in 1940. The first β-lactamase inhibitor, clavulanic acid, was developed in 1974 at the Beecham pharmaceutical company in the UK to counter that resistance mechanism.
1980s onward – the pipeline dries up The last new classes of antibiotic discovered were the oxazolidinones and lipopeptides (such as daptomycin) discovered in 1987...
1980s onward – the pipeline dries up ...this left a long gap before diarylquinolones (such as bedaquiline) were discovered in the early 2000s.
It’s striking how different the timescales have been between discovery, approval and bacteria developing resistance to new antibiotics. In some cases, that’s because drugs that were initially regarded as poor prospects because of low potency or problems with toxicity have become more valuable as bacteria developed resistance to other drugs. The first lipiarmycin and pleuromutilin drugs, for example, were developed decades after the classes were first discovered.
2. The rise of resistance
Antibiotic usage
Antibiotics are crucial drugs, prescribed around the world every day. But their usage is neither uniform nor static. The data below shows how usage changed between 2000 and 2018, and also reveals in which countries the supply of drugs is more limited.
Resistance is a growing problem
And the countries with lower availability of antibiotics – usually poorer ones – are generally the ones with more bugs that are resistant to the drugs. This map shows where the problem is worse based on analysis of genes associated with AMR present in bacteria found in wastewater.
What resistance means
Predictably, it’s the poorer countries without access to antibiotics and with more drug-resistant bacteria that suffer the most deaths attributable to AMR. Resistance is a complex issue that isn’t linked solely to antibiotic use; a broad range of factors relating to public health policies and infrastruture all play a part.
3. Where will new antibiotics come from?
Recently approved drugs
Only a few new antibiotic drugs have been released in recent years – and no new classes since the 1980s. In this visualisation showing when different agencies approved recent antibiotics, hovering over the date bars shows to which class the drug belongs, its tradename and its marketing authorisation holder (MAH).
Antibiotics in clinical development
There are more drugs being developed, but most are still in early phases of clinical trials. And it’s notable that not many of them are being developed by the big pharma companies. Read more on current efforts to create new antibiotics.
The money problem
The lack of interest from big pharma is most likely caused by the historically poor return on investment antibiotics offer compared to the cost of developing them. But how does that compare to the potential cost to society if new drugs are not developed? Read more on how governments and NGOs are trying to incentivise antibiotic drug development.
Source: Data from Wellcome, Global AMR R&D Hub, AMR Industry Alliance and the World Bank
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