The World Health Organization has released alarming new data revealing a shrinking pipeline of antibacterial treatments at a time when antimicrobial resistance poses an escalating global health threat. The organization's latest analysis shows the number of antibacterials in clinical development decreased from 97 in 2023 to 90 in 2025, with only a fraction offering genuine innovation against drug-resistant bacteria.
Critical Shortage of Innovative Treatments
Of the 90 antibacterials currently in development, only 15 qualify as innovative, according to WHO's Analysis of antibacterial agents in clinical and preclinical development: overview and analysis 2025. More concerning, available data are insufficient to confirm the absence of cross-resistance for 10 of these innovative agents, meaning resistance to one antibacterial could also reduce effectiveness against another treatment.
The pipeline reveals stark inadequacies in addressing WHO's most dangerous bacterial threats. Only 5 of the 90 antibacterials are effective against at least one of the WHO "critical" bacteria – the top risk category in the bacterial priority pathogens list, above 'high' and 'medium' priority classifications.
The current pipeline consists of 50 traditional antibacterial agents and 40 non-traditional approaches such as bacteriophages, antibodies, and microbiome-modulating agents. Among traditional antibiotics, 45 (90%) target priority pathogens, including 18 (40%) focused on drug-resistant Mycobacterium tuberculosis.
Limited Progress in New Chemical Classes
Since July 2017, 17 new antibacterial agents against priority bacterial pathogens have obtained marketing authorization, but only two represent a new chemical class. This limited chemical diversity raises concerns about the long-term sustainability of treatment options as resistance mechanisms evolve.
Significant gaps persist in specific therapeutic areas, including pediatric formulations, oral treatments for outpatient use, and solutions to address escalating resistance such as combination strategies with non-traditional agents.
Fragile Research Ecosystem
The preclinical pipeline remains active with 232 programs across 148 groups worldwide, though the research ecosystem shows concerning fragility. Ninety percent of companies involved are small firms with fewer than 50 employees, highlighting the vulnerability of antibacterial research and development efforts.
The focus remains heavily concentrated on Gram-negative bacteria, where innovation is most urgently needed to combat resistance patterns.
Diagnostic Gaps Compound Treatment Challenges
WHO's companion report, the Landscape analysis of commercially available and pipeline in vitro diagnostics for bacterial priority pathogens, identifies critical diagnostic shortcomings that hamper effective treatment decisions. Key gaps include the absence of multiplex platforms suitable for intermediate referral laboratories to identify bloodstream infections directly from whole blood without culture.
Healthcare systems also face insufficient access to biomarker tests such as C-reactive protein and procalcitonin to distinguish bacterial from viral infections, and limited simple, point-of-care diagnostic tools for primary and secondary care facilities.
These diagnostic limitations disproportionately affect patients in low-resource settings, where most people first present at primary health-care facilities.
Urgent Call for Investment
"Antimicrobial resistance is escalating, but the pipeline of new treatments and diagnostics is insufficient to tackle the spread of drug-resistant bacterial infections," said Dr Yukiko Nakatani, WHO Assistant Director-General for Health Systems. "Without more investment in R&D, together with dedicated efforts to ensure that new and existing products reach the people who most need them, drug-resistant infections will continue to spread."
WHO specifically calls for greater investment in tools designed for resource-limited settings, including those that eliminate the need for culture and simplifying diagnostic platforms for primary and secondary care use. The organization urges developers to publish data on antibacterial activity to foster collaboration, attract investment, and accelerate innovation.
The reports underscore what WHO characterizes as a dual crisis: scarcity and lack of innovation in the antibacterial pipeline, occurring precisely when the global health community faces mounting pressure from drug-resistant bacterial infections.
