Sources of novel antibiotics—aside the common roads

Microbial pathogens are becoming increasingly resistant to available treatments, and new antibiotics are badly needed, but the pipeline of compounds under development is scarce. Furthermore, the majority of antibiotics under development are improved derivatives of marketed compounds, which are at best only partially effective against prevailing resistance mechanisms. In contrast, antibiotics endowed with new mechanisms of action are expected to be highly effective against multi-drug resistant pathogens. In this review, examples are provided of new antibiotics classes in late discovery or clinical development, arising from three different avenues: (1) compounds discovered and never brought to market by large pharmaceutical companies; (2) old compounds reanalyzed and rejuvinated with today’s tools; and (3) newly discovered molecules. For each compound, we will briefly describe original discovery, mechanism of action, any known resistance, antimicrobial profile, and current status of development.