The antibiotic pipeline has shrunk 35 percent in five years, falling behind growing antimicrobial resistance worldwide, according to a new report.
Industry efforts to combat antimicrobial resistance are failing to keep pace with growing drug-resistant infections, a new report has found.
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The pipeline of drugs aimed at tackling antimicrobial resistance (AMR) has shrunk by 35 percent over the past five years, according to a report by Access to Medicine Foundation, a Dutch independent non-profit working for medicine access in low and middle-income countries.
In 2026, just 60 projects are in development from large research-based pharmaceutical companies, down from 92 in 2021.
“The need for new antibiotics has never been greater,” Jayasree K. Iyer, CEO at Access to Medicine Foundation, wrote in the report.
“Without significant change, AMR will cause a devastating rise in deaths from preventable infections over the next two decades, with vulnerable populations living in poorer countries hit the hardest,” she noted.
The current lack of infectious disease research and development (R&D) is one of the biggest challenges in the battle against AMR.
The report anaylsed the R&D of 15 companies – seven large research-based and eight small and medium enterprises – including GSK, Pfizer, Shionogi, MSD, and Otsuka.
The British multinational GSK remains the leader, with 30 drugs spanning preventive vaccines and antibacterial therapeutics, including three innovative medicines.
Japan’s Shionogi has now overtaken Pfizer, which held second place in 2021.
“Performance across companies remains mixed, and no company is yet close to reaching its full potential, showing that there is still a long way to go in the fight against AMR,” the report reads.
AMR, a growing threat
Antimicrobial resistance occurs when bacteria, viruses, fungi, and parasites no longer respond to antimicrobial medicines. While it is a natural process that happens over time through genetic changes in pathogens, it is rapidly accelerating due to human activity, mainly the misuse and overuse of antimicrobials.
As of late 2025, one in six lab-confirmed bacterial infections is now resistant to standard treatments, according to the World Health Organization.
AMR is responsible for more than 35,000 deaths every year in the European Union alone, and between 2025 and 2050, 39 million deaths are projected to be directly attributable to bacterial AMR worldwide.
Children are especially vulnerable
Children, especially those living in low and middle-income countries, are disproportionately vulnerable to infections. Yet, the report identified only five paediatric drugs in the pipeline.
Only 13 percent of antimicrobial pipeline projects are developed for children under five, leaving delays in paediatric approvals, even for existing antibiotics, the report noted. Of all new antibiotics introduced since 2000, only 10 percent carry a paediatric label.
Child-friendly formulations can take years to be approved, the report said, and at the same time, the availability of existing antibiotics in low- and middle-income countries is often inadequate.
What’s next?
The report also identified seven innovative projects in late-stage development with significant potential against drug-resistant infections.
Three are being developed by large research-based companies – GSK, Otsuka, and Shionogi – and four by SMEs, BioVersys, F2G, Innoviva, and Venatorx.
However, the analysis warned that despite these promising projects, development of innovative antimicrobials that can overcome resistance when older drugs fail remains sparse.
“Industry efforts cannot advance at the pace and scale required without global and country-level reform – especially in procurement, financing, and regulation,” the report noted.
The authors added that until antibiotic discovery is funded at a scale that matches the threat posed by AMR, efforts will be reactive instead of proactive, costing money and lives.
