Let’s step back a bit on this question. We care about antibiotics and antibiotic resistance because they impact our ability to avoid suffering and death due to bacterial infections. Antibiotics are just a means to an end. Antibiotic resistance blocks one path to that end, but it is just one path; there are others.
I’ll say more about these paths in a moment, but first let me (sort of) answer the question as it was asked.
We have the technology to develop many more new antibiotics than we do. Historically, the most productive method of antibiotic discovery has been to “mine” the soil for antibiotic producing bacteria and fungi. Improvements in this mining technology led to the discovery of teixobactin, and should yield other new discoveries.
From A new antibiotic kills pathogens without detectable resistance
But there are other ways to discover new antibiotics. Some of the most interesting work in the field uses bacterial genomics, AI-based drug design and cell engineering methods to identify and test new antibiotic candidates. I wrote about this here: New antibiotic R&D – the return of socialized drug development
Our technology is plenty good to develop new antibiotics. What we don’t have are markets sufficient to attract private capital to harness this technology. Antibiotics are best used sparingly, limiting the amount of units that can be sold. Manufacturers can’t make up for small volume by jacking up prices because there are so many cheap antibiotics that work nearly all the time. This is why public investment is the best way to finance antibiotic R&D.
Antibiotics are not the only technology we have to defend our health from bacterial infections. And broad-spectrum antibiotics may be damaging our microbiota and causing more health problems than we realized.
In addition to traditional antibiotics, we can develop other technologies, such as antivirulence therapies. Rather than killing bacteria outright, antivirulence therapiesdisarm bacteria and limit the damage they cause.
But the best approach is not to cure infections but to prevent them. Vaccines, clean food and water and better hygiene are much better ways than antibiotic therapy to combat bacterial infections. Antibiotics worked so well for so long that they became a crutch for sloppy medicine, and enabled neglect of public health systems.
The emergence of antibiotic resistance is shaking us from this complacency. In fact, I think there is a good case to be made that antibiotic resistance is improving the quality of healthcare. The emergence of resistance may be teaching us that there is more to medicine and health than pills and shots. For this, we should thank our bacterial teachers.