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This report gives a comprehensive overview of global antibiotic resistance, the antibiotics pipeline and new strategies to target resistance mechanisms. It identifies 109 antibiotics in the development pipeline, approximately 70% of which are in early development (Preclinical and Phase 1). In contrast, there are just 9 candidates at Phase 3, while there are 31 at Phase 2. These developments are being progressed by 66 companies, of which nine (14%) are major international corporations and 57 (86%) are Small/Medium Sized Enterprises (SMEs).
While antibiotics are effective for the majority of infections, increasing resistance in some pathogens threatens to undermine the few remaining drugs that are still effective against them. This is evident in the case of Klebsiella pneumoniae. Since 2005, there has been a significant decrease of susceptibility to carbapenems in invasive Klebsiella pneumoniae, causing concerns due to the lack of therapeutic options for treating these infections.Antibiotic resistance is a long-evolved trait in prokaryotes. The extensive capabilities of the resistome, together with the ability of bacteria to establish new mutant variants in response to man-made antibiotics, suggest that antibiotic resistance will remain an ever-present threat. It is therefore not so much a question of whether a pathogen will become resistant to an antibiotic, but when. However, the development of new drugs and targeting mechanisms provide an opportunity to "reset the clock" on resistance levels in particular pathogens.In the last decade, the capacity to target pathogens has also been undermined by a lack of innovation, which has seen a 60% fall in the numbers of new approvals and few novel molecules. However, as this report has shown, this trend is changing. Today, there are more than 100 candidate antibiotics in development, of which half are in the clinical pipeline. While there are several promising candidates at Phase 3 which offer hope of new approvals in the coming years, Phase 2 developments are now substantial, suggesting the emergence of a new era in the types of antibiotics and the strategies that will be available to target pathogens in the future.