Dr. Juri B Kalita
Medical progress typically follows a predictable pattern: as diseases become more challenging, science develops better treatments. Cancer therapies grow more sophisticated. Cardiac care advances. Diabetes management improves. Yet with antibiotics, we face a paradox: as resistance increases our need for new drugs, pharmaceutical innovation has largely stalled.
Most antibiotics used today were discovered between 1940 and 1970. That golden age of antibiotic development produced the major drug classes we still depend upon. Since then, progress has slowed to a trickle. We’ve essentially been fighting 21st-century bacterial resistance with 20th-century weapons.
The explanation lies in economic realities. Developing a new antibiotic requires approximately ten to fifteen years and costs between one and two billion dollars. Yet unlike medications for chronic conditions—blood pressure pills taken daily for decades, diabetes drugs used continuously—antibiotics are prescribed briefly. A typical course lasts seven to fourteen days. The revenue potential simply doesn’t match the investment required.
Moreover, when new antibiotics do reach the market, medical prudence dictates they be reserved as last-resort options, used sparingly to delay resistance development. From a pharmaceutical company’s perspective, investing billions to develop a drug that will be deliberately restricted in use makes little business sense. Several companies that successfully developed new antibiotics have faced bankruptcy despite having approved products.
This market failure has driven most major pharmaceutical firms out of antibiotic research. Where once more than fifteen companies pursued antibiotic development, fewer than ten remain active today. The pipeline of new drugs has become dangerously thin precisely when we need it most.
The situation isn’t hopeless, however. Some governments have begun implementing alternative incentive structures. “Subscription models” guarantee pharmaceutical companies fixed annual payments for access to new antibiotics, regardless of volume used. This separates revenue from sales volume, addressing the core economic problem. Other approaches include extended patent protections, research grants, and streamlined regulatory pathways.
Scientific innovation continues as well, exploring approaches beyond traditional antibiotics. Bacteriophages—viruses that specifically target bacteria—show promise. CRISPR gene-editing technology offers new possibilities. Immunotherapy approaches that enhance the body’s natural defences are under investigation. Artificial intelligence assists in identifying potential new drug compounds from vast chemical libraries.
In India, including institutions in the Northeast, researchers contribute to this effort. Understanding local resistance patterns, identifying novel antimicrobial compounds from natural sources, and developing affordable diagnostic tools all represent important work. The challenge is ensuring this research receives adequate support and finds pathways to practical application.
The innovation deficit also highlights why preserving existing antibiotics’ effectiveness is crucial. Each drug that loses efficacy through resistance narrows our options further. When the pipeline of new drugs is so constrained, we cannot afford to squander the medicines we have.
This brings responsibility back to individuals. Every time antibiotics are used appropriately, their effectiveness is preserved a bit longer. Every unnecessary prescription, every incomplete course, every inappropriate use accelerates the day when those drugs no longer work.
Public investment in antibiotic research deserves support. This means advocating for government funding of basic research, supporting policies that incentivise pharmaceutical development, and recognising that preserving antibiotic effectiveness represents a public good transcending market economics.
The bacteria are evolving. Whether science can keep pace depends partly on research investment and pharmaceutical innovation—but also on how wisely we use the antimicrobial tools we currently possess.
(The writers is a Consultant Microbiologist & Infection Control Officer, Bethany Hospital, Shillong)
