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Bugs & Drugs

I found that I was losing the plot about what was where! Here’s my quick guide to (i) priority pathogens (just below), (ii) pipeline reviews, and (iii) antibiotic manufacturing standards. 

Note in particular that a comparative Summary of the priority pathogens lists is provided. For my summary of incentives to support this pipeline, see this webpage. Corrections and amends gratefully received.

Priority Pathogen / Threat Lists

  • By my count, eight priority pathogen lists have been proposed / published to date; all are mainly bacterial unless otherwise noted:
    1. WHO 2024 PPL: Newsletter is here, report is here.
    2. WHO 2022 Fungal PPL: Newsletter is here, report is here.
    3. India 2021: Newsletter is here, report is here.
    4. Japan 2021: Summary in English; Extended details in Japanese
    5. CDC 2019: Newsletter is here, report itself is here.
    6. WHO 2017: Newsletter is here, report itself is here.
    7. CDC 2013: Report itself is here.
    8. ESKAPE list 2008-9: This is the grandfather/mother of them all! The original papers are here:
      • (link) Rice LB. Federal funding for the study of antimicrobial resistance in nosocomial pathogens: no ESKAPE. J Infect Dis. 2008;197(8):1079-81.
      • (link) Boucher HW et al. Bad Bugs, No Drugs: No ESKAPE! An Update from the Infectious Diseases Society of America. Clinical Infectious Diseases. 2009;48(1):1-12

To help you keep them organized, a comparative summary of the priority pathogen lists (including the 2022 WHO fungal PPL) as a PowerPoint deck is here (or here as a .pdf).

  • Please also see this newsletter for a further discussion of the priority pathogen lists as well as the idea of first- vs. best-in-class.

Pipeline Reviews (therapeutic products for bacterial infections, unless otherwise noted)

  • Reviews by WHO
    • WHO 2024 antifungal preclinical and clinical pipeline review (data cut-off of 1 Sep 2024, published 1 April 2025): My newsletter is here and the WHO report (plus a great dashboard!) is here.
    • WHO 2024 antifungal diagnostic pipeline review (data cut-off of 1 July 2024, published 1 April 2025): My newsletter is here and the WHO report is here.
    • WHO 2023/24 preclinical and clinical pipeline review (data cut-off of 31 Dec 2023, published in 2024): My newsletter is here and WHO’s report is here. There is also a summary of the report (nice graphics!) with an editorial in Lancet Microbe.
    • WHO 2022 review of preclinical and clinical vaccines (data cut-off not stated, appears to be from 2010 forward). Here are links to the report, a press release, and a newsletter about the report.
    • WHO 2021/22 clinical pipeline review (data cut-off 30 June 2021, published in 2022): My newsletter is here and the review itself is here. 
    • WHO 2020 (data cut-off 1 Sep 2020): My newsletter is here (and includes a video chat with Peter Beyer, one of the key drivers of the report). The review itself is here.
    • WHO 2019: My newsletter is here, commentary by WHO staff is here, the pre-clinical pipeline review is here and is supported by a data-mining interface here; the clinical pipeline review is here.
    • WHO 2017: Newsletter is here, report is here, and manuscript about the review is here.
  • Reviews by the Pew Trusts (all updated as of March 2021; see also this newsletter)
    • Go here for traditional therapeutics.
    • Go here for a visualization of pipeline changes during 2014-2020.
    • Non-traditional products are separately summarized here.
  • Independent pipeline reviews
    • Preclinical pipeline review: Theuretzbacher, U., Jumde, R.P., Hennessy, A. et al. Global health perspectives on antibacterial drug discovery and the preclinical pipeline. Nat Rev Microbiol (2025). (https://doi.org/10.1038/s41579-025-01167-w) is an annotated tour by mechanism of current pre-clinical strategies with a focus on projects that have been peer-reviewed by one of the competitive funding processes (e.g., CARB-X). The survey covers both classical direct-acting small molecules as well as the various possible non-traditional strategies (antibodies, phage, etc.).
    • Clinical pipeline: Paterson DL: Expert Opin Investig Drugs 2024 (Mar 6:1-17, doi: 10.1080/13543784.2024.2326028) is an excellent survey of the 28 small molecules and 20 non-traditional products currently in Phases 1-3 as candidate therapies for Gram-negative bacteria.
    • Clinical pipeline: Butler et al. J Antibiot 2023 (https://doi.org/10.1038/s41429-023-00629-8) is an update through December 2022 of the Butler et al. 2020 J Antibiot paper cited below.
    • Clinical pipeline: Neha Prasad, author of the excellent “Leaky Pipeline” paper (AAC 2022,  doi:10.1128/aac.00054-22, see also this 14 June 2022 newsletter) has posted on LinkedIn a comprehensive 6-part summary of clinical and corporate antibacterial development news for 2022-2023.
    • Clinical pipeline: Theuretzbacher et al. Nat Rev Microbiol 2020 (https://doi.org/10.1038/s41579-020-0340-0) is an extended commentary on the current pipeline by the group who did the WHO 2019 review.
    • Clinical pipeline: Butler and Paterson, J Antibiot 2020 https://doi.org/10.1038/s41429-020-0291-8: Not open access, but you can view it online here.
    • Commercial view of recently approved drugs: Alan Carr 2020: Newsletter is here. Alan’s regularly updated summary analyzes products approved in the US since 2009
    • Non-traditional products: Theuretzbacher and Piddock, Cell Host Microb 2019 (https://doi.org/10.1016/j.chom.2019.06.004) and Rex et al. Nat Commun 2019,  https://doi.org/10.1038/s41467-019-11303-9: Focused reviews and discussions of non-traditional products. Go here for a newsletter about these two papers.
    • Preclinical pipeline: Theuretzbacher et al. Nat Rev Microbiol 2019 (https://www.nature.com/articles/s41579-019-0288-0) surveys 400+ active preclinical programs. 
  • Access- and Stewardship-focused reviews
    • CDDEP’s “The State of the World’s Antibiotics Report in 2021” (link) presents extensive data on global antimicrobial use and resistance, a brief pipeline review, and by-country dashboards
    • ATMF’s “2021 Access to Medicine Index” (link) summarizes progress made and work to be done on access.

Drug Manufacturing Standards

Updated FDA Q&A on Antibacterials for Unmet Medical Need

Dear All, An updated version of FDA’s very helpful Q&A entitled “Antibacterial Therapies for Patients With an Unmet Medical Need for the Treatment of Serious Bacterial Diseases – Questions and Answers” has just been released. Here are the links you need to get started: The new June 2025 guidance itself The webpage about the guidance

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