PIPELINE REVIEW OF TRADITIONAL SMALL MOLECULE ANTIBACTERIAL MEDICINES
Author(s)
rhiannon Green, MRes1, Nicola Nowak, MSci2, Nick James Pooley, PhD3, Tom Arrowsmith, PhD2.
1Systematic Reviewer, Maverex Limited, Newcastle upon Tyne, United Kingdom, 2Maverex Limited, Newcastle Upon Tyne, United Kingdom, 3Maverex Limited, Manchester, United Kingdom.
1Systematic Reviewer, Maverex Limited, Newcastle upon Tyne, United Kingdom, 2Maverex Limited, Newcastle Upon Tyne, United Kingdom, 3Maverex Limited, Manchester, United Kingdom.
OBJECTIVES: The 2025 World Health Organization (WHO) antibacterial report warned that current research and development (R&D) efforts are insufficient to meet the need for new treatments against the most drug-resistant bacteria. To guide antibacterial R&D, the WHO prioritised 24 resistant pathogens and has highlighted the need for more innovative therapies, paediatric options, and sustainable funding models. This review aimed to use a commercial database to analyse the current traditional antibacterial pipeline.
METHODS: The commercial database GlobalData Plc1 was searched up to 12.06.2026 to identify small molecule antibiotics targeting bacterial infections, from investigational filing to pre-registration. Already marketed or assumed inactive medicines were excluded. Handsearching was performed to supplement data extraction. Medicines were counted for a single indication and formulation/combination; those in different stages of development in different countries were counted once.
RESULTS: Traditional antibacterials in active development were identified (n=76). The most common indication was Mycobacterium tuberculosis (n=22), followed by Acinetobacter (n=6), MRSA (n=5) and Clostridioides difficile (n=4); others included Neisseria gonorrhoeae, Salmonella, and resistant Pseudomonas aeruginosa infections. As 36% of the pipeline antibacterials were in Phase I, some had unspecified bacterial infections (n=7); nearly half targeted cell wall biosynthesis, followed by protein synthesis (17%) and DNA replication (7%). Regarding innovation, 11% were new combinations and 36% were identified as first-in-class antibiotics. However, few were under investigation in paediatric populations (n=5) or close to market entry (pre-registration [n=3]).
CONCLUSIONS: The current antibacterial pipeline contains drugs targeting WHO priority pathogens, largely M. tuberculosis, and several drug-resistant pathogens, with one-third being considered first-in-class. However, the pipeline is relatively small, there are notable WHO priority absences e.g., Shigella, and the majority of the pipeline will not be available to tackle the antimicrobial resistance crisis for many years. 1.GlobalData Plc. (2026). [AdvancedDrugSearchData]. GlobalData Intelligence Center. Retrieved [12.06.2026], from [https://pharma.globaldata.com]
METHODS: The commercial database GlobalData Plc1 was searched up to 12.06.2026 to identify small molecule antibiotics targeting bacterial infections, from investigational filing to pre-registration. Already marketed or assumed inactive medicines were excluded. Handsearching was performed to supplement data extraction. Medicines were counted for a single indication and formulation/combination; those in different stages of development in different countries were counted once.
RESULTS: Traditional antibacterials in active development were identified (n=76). The most common indication was Mycobacterium tuberculosis (n=22), followed by Acinetobacter (n=6), MRSA (n=5) and Clostridioides difficile (n=4); others included Neisseria gonorrhoeae, Salmonella, and resistant Pseudomonas aeruginosa infections. As 36% of the pipeline antibacterials were in Phase I, some had unspecified bacterial infections (n=7); nearly half targeted cell wall biosynthesis, followed by protein synthesis (17%) and DNA replication (7%). Regarding innovation, 11% were new combinations and 36% were identified as first-in-class antibiotics. However, few were under investigation in paediatric populations (n=5) or close to market entry (pre-registration [n=3]).
CONCLUSIONS: The current antibacterial pipeline contains drugs targeting WHO priority pathogens, largely M. tuberculosis, and several drug-resistant pathogens, with one-third being considered first-in-class. However, the pipeline is relatively small, there are notable WHO priority absences e.g., Shigella, and the majority of the pipeline will not be available to tackle the antimicrobial resistance crisis for many years. 1.GlobalData Plc. (2026). [AdvancedDrugSearchData]. GlobalData Intelligence Center. Retrieved [12.06.2026], from [https://pharma.globaldata.com]
Conference/Value in Health Info
2026-11, ISPOR Europe 2026, Vienna, Austria
Value in Health, Volume 29, Issue 12S
Code
HPR226
Topic
Epidemiology & Public Health, Health Policy & Regulatory
Topic Subcategory
Reimbursement & Access Policy
Disease
Infectious Disease (non-vaccine), No Additional Disease & Conditions/Specialized Treatment Areas