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GONORRHoEA IS an old affliction. The book of Leviticus mentions a contagious condition involving the continuous emission of semen and a painful erection. Only 2,500 years later, in the mid-20th century, did the discovery of antibiotics bring relief.
But not, perhaps, for long. Decades of exposure to antibiotics have led N. gonorrhoeae, the bacterium that causes the disease, to develop resistance. With few new antibiotics coming onto the market, the bug is once again gaining the upper hand. Failures of treatment are being reported in many countries. It is now designated a “priority” pathogen by the World Health Organisation.
The news on November 1st that zoliflodacin, a new antibiotic, had been successful in a clinical trial was thus welcome. The drug inhibits an enzyme called type II topoisomerase, which, among other things, is vital to bacterial reproduction. More interesting than how zoliflodacin works, though, is how it came into being. Most drugs are developed by private companies. Zoliflodacin was created with the assistance of the American government and the Global Antibiotic Research and Development Partnership (GARDP), a non-profit outfit funded by a mix of organisations including the Wellcome Trust, a big charity, and the Swiss canton of Geneva.
GARDP worked with Innoviva Speciality Therapeutics, an American pharmaceutical firm. The company handled early development, and is shepherding the drug through registration with the Food and Drug Administration. The National Institute of Allergy and Infectious Diseases guided it through its phase 2 trials, which check whether a new drug works. GARDP supported the drug through subsequent, much bigger phase 3 trials, the final stage before a drug is approved for use. Its support allowed those trials to be tailored to public health goals—such as including in the trials higher-risk patients such as women, adolescents and people with HIV. GARDP is also handling the licensing, which it hopes will make zoliflodacin cheap and widely available.
Duncan Graham-Rowe, a spokesman for GARDP, says such partnerships could boost the supply of new antibiotics. (Another non-profit, CARB–X, is doing similar work.) The dearth of new drugs in recent decades mainly reflects poor incentives. To delay the development of resistance, new antibiotics need to be kept in reserve until they are really needed. But a drug that spends years on the shelf is not commercially attractive.
Governments have tried to fix that problem with ideas such as guaranteed prices and annual payments that are made even if the drugs are not used. State-run drug firms have been mooted too. It will take more than zoliflodacin to show that GARDP has found a winning formula. But the signs are good: it is developing four other antibiotics, including one for complicated urinary tract infections, and more are on the way.■
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