Fig. 8: Summary of the challenges involved in antibiotic development.

The figure summarises the key challenges in antibiotic development, divided into scientific, economic, and regulatory categories. Scientifically, the development of effective antibiotics faces significant hurdles such as the difficulty of penetrating the outer membrane of Gram-negative bacteria, antibiotic inactivation by bacterial enzymes, alterations in bacterial targets, and the role of multidrug efflux pumps that expel drugs from bacterial cells. Economically, antibiotics suffer from short treatment durations and restricted use due to stewardship concerns, which limit market size and profitability. The existence of multiple analogues further dilutes potential revenue, and the absence of a sustainable economic model, coupled with low antibiotic pricing, creates financial disincentives for pharmaceutical companies to invest in this space. Regulatory challenges exacerbate these issues, with clinical trials often hampered by poor design, low patient recruitment, and complex inclusion criteria. Moreover, varying global regulatory standards and difficulties in obtaining regulatory and health technology assessment (HTA) approvals further complicate the antibiotic innovation process. These overlapping barriers highlight the urgent need for a collaborative and integrated approach to revitalise antibiotic development.