Conclusion and outlook
RESISTANT INFECTION
The shape of the antibacterial pipeline has changed since our first analysis in 2011 [In contrast to the early-stage pipeline, the late-stage pipeline is still experiencing issues. There were only two new small molecule antibacterial drugs first approved between 2020 and 2022 (Table In addition to the difficulty in identifying novel lead compounds suitable for antibacterial drug development, the ability to secure funding for phase-III trials and NDA/MAAs, as well as the capacity to generate adequate revenue to get positive net returns on investment for marketed antibacterial drugs [At least 19/26 (73%) phase-I compounds target G-ve bacteria (12 traditional compounds, one anti-virulence and six BL/BLI combinations), with four of these also possessing anti-G+ve activity. The high percentage of G-ve candidates being developed mirrors the clinical need and the recent focus of most funding schemes; however, the addition of G+ve activity to the 2022/23 CARB-X funding calls reflects the high mortality observed for global G+ve resistant infections in 2019 [In conclusion, despite the encouraging trends in phase-I and -II antibacterial drug candidates and plans to address issues with the late-stage pipeline, it is not the time to relax the urgency to continue to stimulate further antibacterial drug discovery and development.