Alternatives to antibiotics – a pipeline portfolio review

Lloyd Czaplewski, Richard Bax, Martha Clokie, Mike Dawson, Heather Fairhead, Vincent A Fischetti, Simon Foster, Brendan F Gilmore, Robert E W Hancock, David Harper, Ian R Henderson, Kai Hilpert, Brian V Jones, Aras Kadioglu, David Knowles, Sigríður Ólafsdóttir, David Payne, Steve Projan, Sunil Shaunak, Jared SilvermanChristopher M Thomas, Trevor J Trust, Peter Warn, John H Rex

Research output: Contribution to journalArticlepeer-review

392 Citations (Scopus)
518 Downloads (Pure)


Antibiotics have saved countless lives and enabled the development of modern medicine over the past 70 years. However, it is clear that the success of antibiotics might only have been temporary and we now expect a long-term and perhaps never-ending challenge to find new therapies to combat antibiotic-resistant bacteria. A broader approach to address bacterial infection is needed. In this Review, we discuss alternatives to antibiotics, which we defined as non-compound approaches (products other than classic antibacterial agents) that target bacteria or any approaches that target the host. The most advanced approaches are antibodies, probiotics, and vaccines in phase 2 and phase 3 trials. This first wave of alternatives to antibiotics will probably best serve as adjunctive or preventive therapies, which suggests that conventional antibiotics are still needed. Funding of more than £1·5 billion is needed over 10 years to test and develop these alternatives to antibiotics. Investment needs to be partnered with translational expertise and targeted to support the validation of these approaches in phase 2 trials, which would be a catalyst for active engagement and investment by the pharmaceutical and biotechnology industry. Only a sustained, concerted, and coordinated international effort will provide the solutions needed for the future.

Original languageEnglish
Pages (from-to)239–251
Number of pages13
JournalThe Lancet Infectious Diseases
Issue number2
Early online date13 Jan 2016
Publication statusPublished - Feb 2016


Dive into the research topics of 'Alternatives to antibiotics – a pipeline portfolio review'. Together they form a unique fingerprint.

Cite this