Changing the script

An ounce of prevention is worth a pound of antibiotics

The antibiotic resistance crisis is one of the most pressing challenges facing global healthcare. Without effective action, routine procedures, cancer treatments and even minor infections could once again become life-threatening.

The UK, Europe and the broader international community are grappling with this reality and solutions that bridge the gap between pharmaceutical innovation and public health are urgently needed.

A critical obstacle to solving this crisis is the broken economic model for antibiotics. Despite the high medical need, the market incentives to develop new antibiotics are fundamentally flawed.

Investors have retreated, major pharmaceutical firms have deprioritised antimicrobial research and new antibiotics struggle to reach patients due to financial unsustainability. However, alongside efforts to revitalise antibiotic development an underappreciated solution is emerging: preventive antimicrobials.

The reasons for this are well known. Developing new antibiotics is just as complex and expensive as any other drug but their commercial prospects are far bleaker compared with other novel drugs.

New antibiotics must compete with cheap generics and their use is often restricted to delay resistance development leading to low sales volumes.

This combination makes it nearly impossible for developers to recover their development costs and a reasonable profit. The collapse of Achaogen, a biotech that developed an FDA-approved antibiotic yet still went bankrupt in 2019, exemplifies this economic dysfunction.

Without a profit motive private capital cannot flow from investors – which these days means pension funds endowments and other such institutions – to entrepreneurs leaving the government and foundations as the funders of last resort.

Public-sector initiatives like CARB-X and the UK’s subscription-style reimbursement model for novel antibiotics are crucial steps forward but they alone cannot fix the system.

Their resources are simply too scant. A more sustainable approach requires rethinking how anti-infective drugs are developed and deployed – this is where preventive antimicrobials hold unique promise.

Preventive medicines that have transformed healthcare in other areas – vaccines for childhood infections, statins for heart disease, HIV pre-exposure prophylaxis – all demonstrate how prevention can improve patient outcomes while remaining commercially viable. Thriving even. The same logic can apply to bacterial infection.

Unlike traditional antibiotics, which treat infections after they occur, preventive antimicrobials aim to stop infections before they start. This shift in approach fundamentally changes the economics of anti-infective drug development:
Expanded market potential – Preventive drugs are used by a broader population reaching individuals at risk rather than only those already infected. This larger market creates better revenue potential making investment more attractive.

Healthcare system savings – Preventing infection reduces hospitalisations, ICU stays and the need for costly treatments. NHS payers and global health systems recognise this economic advantage making preventive antimicrobials an appealing solution.

Superior patient benefit – This one is obvious: everything else being equal all patients would prefer a treatment that prevents their illness to one that resolves it.

A good example of preventive antimicrobials in action is Clostridioides difficile infection (CDI) prevention.

CDI is one of the most common and costly hospital-acquired infections with estimates suggesting it drives over 2% of US hospital spending.

Current CDI preventives including faecal microbiota transplants and monoclonal antibodies are expensive and difficult to scale.

As a result, they are typically reserved for patients with recurrent infections leaving a vast number of at-risk individuals unprotected. The cheapest and most widely available, bezlotoxumab, was recently pulled from the market likely due to modest efficacy, significant side effects and high manufacturing costs.

New oral biologic preventives such as Lumen Bio’s investigational drug LMN-201 offer a breakthrough solution. These drugs are inexpensive to manufacture, scalable and easy to administer – making them viable for broader use including primary prevention in high-risk patients.

Preventive antimicrobials face unique regulatory hurdles. Because these drugs are given to individuals who are not yet infected, they must meet higher safety standards requiring larger and more rigorous clinical trials. However, the benefits outweigh these challenges.

Modern protein engineering methods can be used to make more potent, better targeted biologic drugs, which are safer than conventional small-molecule antibiotics.

Next-generation biomanufacturing technology can now be used to make these products cheaply and scalable enough to be administered orally in tablets—even in lower-income countries.

Dose timing is also straightforward in most cases. Many infections have well-documented high-risk periods making it possible to efficiently identify and enrol at-risk patients.

For CDI the connection between antibiotic use and infection risk is well established allowing clinicians to target at-risk populations based on existing medical records.

Similar approaches could be applied to other infections such as pneumonia prevention in ventilated patients or urinary tract infection prevention in catheterised individuals.

The antibiotic resistance crisis demands fresh thinking. Preventive antimicrobials offer a commercially sustainable solution that benefits patients healthcare systems and the pharmaceutical industry alike.

By reducing infections before they start these drugs can lower healthcare costs improve outcomes and revitalise investment in anti-infective development.

Traditional antibiotics remain essential but they are imperfect. They often have severe side effects and were recently linked to higher incidence of bowel cancer.

They remain essential for modern medicine but must be complemented by new strategies to protect against infections in the first place.

If the UK Europe and the broader global health community embrace preventive antimicrobials, we may finally have a sustainable path forward in the fight against antibiotic resistance.

By prioritising prevention, we can ensure that modern medicine continues to move forward—rather than sliding back into the pre-antibiotic era.

For a conversation ona Brian Finrow is Chairman and CEO at Lumen Bioscience