Greer Massey , 2025-10-27 13:39:00
The antibiotic resistance battle has been going on for years, and unfortunately, bacteria, especially multidrug-resistant organisms, continue to make a formidable enemy. In addition, the scope of the problem is growing. The Centers for Disease Control and Prevention, for example, reports 2.8 million resistant infections each year in the United States.
This growing threat also carries substantial direct and indirect costs. Direct costs increase because of delayed pathogen identification, longer hospital stays, and higher acuity care with more complex patients to manage. Indirect costs include loss of productivity and overall economic shortcomings.
Even so, it’s not time to surrender. There is some progress in staying one step ahead of resistant bacteria, with Roche announcing May 26, 2025 that its antibiotic zosurabalpin is entering Phase 3 clinical trials. If development continues, zosurabalpin could become the first in a new class of antibiotics to treat Gram-negative infections approved by the FDA since 1968. Contrary to widespread beliefs, there are economic incentives to develop other novel antibiotics – either with new mechanisms of action or new classes of agents entirely. These incentives are through initiatives for companies in the U.K. and because of public-private partnerships between the U.S. government and entrepreneurial companies.
Technology to the rescue?
More rapid and precise diagnostic capabilities allow healthcare providers to identify the precise pathogen(s) or “superbugs” causing these infections, eliminating the need for long courses of broad-spectrum antibiotics. Empiric therapy is well-intentioned but can strengthen the ranks of resistant organisms. Instead, rapid diagnostics using polymerase chain reaction (PCR) analysis can return results in 24 hours versus up to 5 days with cultured assays–allowing more targeted and effective therapy.
PCR has long been a reliable, rapid, and precise method for detection of pathogens. From conventional PCR to real-time PCR, the technology continues to be an essential tool in detecting pathogens, identifying resistant strains and guiding antibiotic stewardship. In fact, for stewardship to be successful, you need to know precisely which pathogen you’re up against.
Confirming the pathogen you suspect is causing the resistance can be accomplished with a single PCR assay but testing for one bacterium at a time can be inefficient. In contrast, multiplex PCR panels can save laboratory time and money by evaluating the same sample for multiple bacteria.
The latest weapon in the fight against antibiotic resistance could be artificial intelligence. Some experts predict AI will reveal new targets for therapy and speed up the research and development process through increased efficiencies. In short, rapid DNA sequencing and AI models could help researchers predict resistance.
In a case of looking back to move forward, scientists at the University of Pennsylvania have even turned to ancient DNA for answers. Using machine learning, researchers are examining the DNA of Neanderthals, woolly mammoths, giant sloths and other animals that once roamed the earth for peptides that confer antibiotic properties. They’ve termed the process “molecular de-extinction,” and they hope to generate new therapies by using bioactive molecules that are no longer encoded by organisms alive today.
Making antibiotics financially attractive
Developing antibiotics in 2025 is not fiscally feasible for many companies. Even if they understand the dangers of growing antibiotic resistance, the return on investment just isn’t there. For example, Wellcome estimates it can take 10-15 years and over $1 billion to develop a new antibiotic.
The U.K. is taking an innovative approach, paying companies to develop much-needed new antibiotics. It’s been termed a “Netflix-style” payment model where the government’s National Health Service pays a fixed annual fee for access to two new antibiotics – Pfizer’s Zavicefta (ceftazidime/avibactam) and Shionogi’s Fetcroja (cefiderocol). The payments are not tied to market volume, so the focus is more on creating solutions. Closer to home, the PASTEUR Act was re-introduced in Congress in 2023 to create a similar incentive but has not yet passed to become law.
Funding early research
The U.S. government also has been partnering with private companies to support development of new antibiotics. The aim is to fund early research and act as a bridge to get promising products to a stage where pharmaceutical companies will take over development. Recognizing the seriousness of the threat from resistant bacteria, the government includes these efforts within the Chemical, Biological, Radiological and Nuclear threat division of the Center for Biomedical Advance Research and Development Authority (BARDA), which is part of the U.S. Department of Health and Human Services.
BARDA has supported six antibiotics with new formulations or new indication that ultimately received FDA approval, including Blujepa (Gepotidacin), EMBLAVEO (aztreonam-avibactam), ZEVTERA (ceftobiprole medocaril sodium for injection), Xerava (eravacycline for injection), ZEMDRI (plazomicin) injection, and Vabomere (carbavance). BARDA also partnered with the National Institute of Allergy and Infectious Diseases (NIAID) and Wellcome to create the Combating Antibiotic-Resistant Bacteria Biopharmaceutical Accelerator (CARB-X) initiative. CARB-X also identifies and funds innovative, early stage antibacterials and offers companies expert guidance on reaching the clinical market. BARDA provided an initial $200 million to the CARB-X collaboration, and in the past year it grew to become the world’s largest public-private partnership dedicated to early development of antimicrobial resistance products.
A global threat
In the meantime, before these efforts yield novel antibiotics, there are still gaps to address. Animals treated with antibiotics can introduce resistant bacteria into the food supply. Another source is environmental runoff from land where these animals are raised. Linking efforts to address threats from human, animal, and environmental sources is called the One Health approach and can help promote antibiotic stewardship.
Also, given the global nature of antibiotic resistance, initiatives are needed to encourage low- and middle-income countries to adopt antibiotic stewardship and other strategies to reduce risk. This is also true in global conflict zones, where the growing threat of antibiotic resistance may not be top of mind for public health leaders and healthcare providers.
The Center for Global Development points out that investments toward improving treatment for bacterial infections. Also increasing access to antibiotics including new antibiotics worldwide will offer significant health and economic advantages. Without these efforts, the Center predicted healthcare costs among higher income countries will increase by $176 billion each year, for example. In addition, global economic output related to increasing resistance could be $1.7 trillion lower per year compared to a world without antimicrobial resistance.
Harvard University researchers also looked at the global burden of antimicrobial resistance from 1990 to 2021 and predicted changes up until 2050. They analyzed death records, hospital discharge information and microbiology data to examine historical trends and future scenarios across 204 countries. They found that higher risk populations, such as older people, are likely to experience the largest increase in drug-resistant bacteria infections. Policy makers should emphasize interventions that meet the unique needs of different regions of the world, improve antibiotic stewardship and PCR surveillance programs, and increase collaboration worldwide so data and resources can be shared globally.
A path forward
Antibiotic resistance is a growing global threat with serious health and economic consequences. Yet there is progress – from rapid PCR diagnostics and AI-driven research to new drug development and innovative funding models. Continued collaboration, smarter stewardship, and equitable access will be essential to stay ahead in this high-stakes fight.
Photo: Flickr user Sheep purple
Greer Massey, PhD, is Chief Scientific Officer at Molecular Designs and guides the development of multiplex PCR assays for research use, as well as complementary reagents and instrumentation. Previously, Dr. Massey led Research & Development at Assurance Scientific, where she directed efforts for their SARS-CoV-2 emergency use authorization for symptomatic and asymptomatic testing. She also helped establish the consulting services. Before that, Dr. Massey managed the Bioanalytical Department at Southern Research and developed multiplex assays and their lyophilization as Senior Products Manager at BioGX, Inc. Dr. Massey received both her MS in Biology and PhD in Microbiology from the University of Alabama at Birmingham.
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