Almost 100 years after Fleming noticed a certain species of mould could suppress the growth of bacteria, the use of antibiotics is now approaching a tipping point

While it’s true antibiotics typically add over 20 years to life expectancy and have revolutionised modern medicine to become one of the most precious resources we’ve ever known, there exists an often unspoken but very real public health emergency that’s getting worse. Bacteria is no longer responding to antibiotics in ways it was before and infections are becoming harder to treat.

Four years ago, bacterial antimicrobial resistance (AMR) – as it’s known – was connected to almost 5 million deaths annually, it’s already a leading cause of death today and experts calculate by 2050, AMR (encompassing not just bacteria, but also how viruses, fungi and parasites are no longer responding to medicines) could cause up to 10 million deaths a year worldwide – that’s the same as cancer. To bring the reality of this emergency into focus, a friend and colleague of mine noticed she had a urinary tract infection (UTI), just as many of us do from time to time. She was given antibiotics by her GP and took them as directed, considering it taken care of. A few weeks later, she became unwell very quickly, feeling nauseous, feverish and then being sick. After seeing her GP again for a urine test, she was referred immediately to hospital where she collapsed. Waking up in a hospital bed, she was told the UTI had been caused by E.coli, had travelled to her kidney and caused sepsis. 24 hours later she was told the antibiotics were not working and she was moved to intensive care. Eventually, one intravenously-administered antibiotic began to work and she was discharged a week later with a final course of antibiotics.

Thankfully, she fully recovered. Sadly, AMR is likely to make death from ‘everyday’ infections more common. And make routine medical procedures too dangerous to do.

Misuse and overuse of antibiotics is driving this increase in resistance.

The scale of the problem is worsened by the World Health Organization’s warning that a weak pipeline for new antibiotics is undermining efforts to tackle AMR sufficiently and health authorities around the world are ramping up efforts to look for ways to address the issue, preventing it from becoming as dangerous as it could. That includes the European Commission’s proposal put forward in April this year to incentivise a wider search for new antibiotics and solutions as part of its proposed revision of the EU’s pharmaceutical legislation.

The good news is innovators around the world are working hard to extinguish the danger too.

  • Santero, a spin-out of the Université Libre de Bruxelles, is tackling superbugs by targeting a specific enzyme essential to the survival and development of bacterial cells. This protein, which is found across all families of bacteria, has so far had no natural or artificial antibiotic, but the company has overcome this problem by developing revolutionary inhibitors – molecules that are able to suppress the enzyme’s activity. Because all types of bacteria contain the target enzyme, Santero’s approach could be applied to virtually any pathogen over the long term. But the startup’s immediate focus is on high-priority pathogens like E.coli and Staphylococcus aureus.
  • Another group of researchers at Cold Spring Harbor Laboratory has developed an antibiotic that can change shape to respond quickly to new drug-resistant pathogens. The new antibiotic uses a molecule called bullvalene, in which the atoms can swap positions. This means the molecule can shapeshift, with over a million possible configurations. The research team chose the antibiotic vancomycin to test its approach. Used to treat a wide range of illnesses, vancomycin has become less effective over time at killing bacteria such as vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), and vancomycin-intermediate/resistant Staphylococcus aureus (VRSA), as these pathogens have developed resistance to it. The researchers used a technique called ‘click chemistry’ to combine two molecules of vancomycin with a bullvalene centre. They then tested the shape-shifting drug on a VRE-infected moth, finding it was more effective than standard vancomycin at clearing the infection. The novel antibiotic also did not induce any further resistance in the bacteria.
  • Going beyond purely pharmaceutical treatments, researchers at the University of Toronto have developed a therapy that kills superbugs using polydopamine nanoparticles, an antimicrobial peptide, and laser light. Polydopamine is a naturally occurring hormone and neurotransmitter, which makes it the perfect biocompatible material for the nanoparticles. These particles kill pathogens in two ways. First, their surfaces can be covered with the peptide, a short chain of amino acids that binds with bacterial membranes, destabilising the harmful cells. Second, the nanoparticles are highly sensitive to light, which means they become hot when exposed to low-powered lasers. The particles heat-up the bacteria cells, in turn, killing them.
  • A team at Brown University has developed a material that responds to bacteria by releasing encapsulated medication. The material could lead to the development of wound dressings that deliver medication only when it is needed, giving bacteria less opportunity to develop resistance.
  • To improve our understanding of drug-resistant bacteria, Solu is helping scientists detect dangerous new pathogens more effectively by building a pathogen DNA library that collects data on superbugs in real-time and monitors their evolution. DNA sequencing is widely believed to be the next step in combatting drug-resistance, but today there is a lack of bioinformaticians to analyse data from sequencing devices. With Solu, however, labs need only upload the output data from their device to obtain results.
  • Resistomap is helping to detect drug-resistant pathogens in the environment. The company analyses environmental samples for antibiotic resistance through its data-driven laboratory service. This helps hospitals, researchers, water and sewage companies, and the food production industry understand where antibiotics are inadvertently entering the environment from their operations.

Back in the UK, Imperial College Healthcare NHS Trust and Imperial College London announced in July it will open a new centre in 2028 to mark 100 years since Fleming discovered antibiotics to drive a global movement to tackle antimicrobial resistance. So there’s hope more answers are coming.

The pace of AMR and its threat to global health is worrying. But the more aware of the issue we are, the more urgency we can place on finding solutions and working together, across therapeutics, policy and technological innovation, to keep the risk from tipping over to an even greater mainstream reality.

Lou Dalton is a Senior Director in Health