Beyond the industry: the multiple determinants of bacterial resistance and the limits of antibiotic development.
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Abstract
Bacterial resistance to antimicrobials represents one of the greatest challenges to global public health, being associated with increased morbidity, mortality, and costs related to the treatment of infections. The present study aimed to analyze the challenges faced by the pharmaceutical industry in developing new antibiotics against multidrug-resistant bacteria, addressing microbiological, economic, and regulatory aspects involved in this process. This is a narrative literature review, conducted based on scientific articles published between 2016 and 2026 in the PubMed, SciELO, and Google Scholar databases. The results demonstrate that the indiscriminate use of antimicrobials, combined with the high adaptive capacity of bacteria, favors the emergence and spread of resistance mechanisms. It was also observed that the pipeline of new antibiotics remains limited, mainly due to the high cost of research and development, low financial return, and strict regulatory requirements. Furthermore, a large portion of the new drugs under development consists of modifications of existing classes, offering temporary solutions in the face of bacterial resistance. The study also highlights the importance of innovative strategies, such as the use of nanotechnology, as well as the need for economic incentives and public policies that encourage pharmaceutical innovation. Therefore, it is inferred that combating bacterial resistance requires a multidisciplinary and integrated approach among governments, the pharmaceutical industry, research institutions, and health professionals, aiming to ensure the sustainable development of new antimicrobials and the rational use of already available medications.
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