# New antibiotics need new targets, and better tools to find them

> Why bacterial cell division (FtsZ) and real-time biosensor assays deserve a place in India’s response to antimicrobial resistance.

Source: https://khushisingh.in/policy/briefs/new-antibiotic-targets/
Author: Khushi Singh (khushisingh.in). Licence: CC BY 4.0 for text and original illustrations, unless a credit says otherwise.
Evidence labels used on this site: established, strong evidence, emerging, hypothesis, debated. Where a page has Simple, Curious and Expert versions, all three follow.

---

[Policy brief](https://khushisingh.in/policy/) · v0.9 · 3 October 2026

Draft for expert review: not yet externally reviewed

**For:** MoHFW / NCDC (NAP-AMR 2.0) · ICMR · DBT / BIRAC · ANRF · Office of the Principal Scientific Adviser

## Key messages

1. Antimicrobial resistance (AMR) already causes about 297,000 deaths a year in India and over a million worldwide, and global deaths are forecast to rise to about 1.9 million a year by 2050. (high confidence)
2. The antibiotic pipeline is thin and mostly not innovative: of 90 agents in clinical development, only 15 are innovative and only 5 work against the most critical bacteria. (high confidence)
3. Bacterial cell division, driven by the protein FtsZ, is a validated but under-exploited target, and sensitive real-time assays make screening for new inhibitors easier. (medium confidence)

## What this means for policy

- Fund target-based discovery against under-exploited bacterial processes such as cell division, through ANRF, BIRAC and BioE3 biofoundries.
- Build shared, open screening infrastructure and publish assay protocols so academic labs can contribute.
- Pair new-drug ‘push’ funding with ‘pull’ incentives and strong stewardship (≥70% of use from WHO ‘Access’ antibiotics).

## The issue

Antibiotics underpin modern medicine: surgery, cancer care, childbirth and neonatal care. Resistance is eroding them. Most new antibiotics in development are variations on old classes, which bacteria already know how to resist. **New targets** are needed: essential bacterial processes that existing drugs do not hit.

## The numbers

| Indicator | Value | Source |
| --- | --- | --- |
| Deaths attributable to / associated with bacterial AMR worldwide (2019) | 1.27 million / 4.95 million | GBD, Lancet 2022 |
| Forecast attributable deaths, 2025–2050 | 39 million (1.91 million a year by 2050) | GBD 2021 AMR, Lancet 2024 |
| India, attributable / associated deaths (2019) | ~297,000 / ~1.04 million | IHME |
| India: *E. coli* susceptibility to imipenem, a last-line antibiotic | 81.4% (2017) → 57.6% (2024) | ICMR AMRSN |
| Antibacterials in clinical development | 90 (15 innovative; 5 against “critical” pathogens) | WHO, October 2025 |
| India’s antibiotic consumption, 2000–2015 | roughly doubled | Klein et al. 2018 |

India launched its **National Action Plan on AMR 2.0 (2025–29)** in November 2025, with roles for more than 20 ministries. The 2024 UN political declaration aims to cut AMR deaths by 10% by 2030 and to source at least 70% of human antibiotic use from WHO “Access” antibiotics.

## What science knows

- **Cell division is essential and under-exploited.** Nearly all bacteria divide using FtsZ, which forms a ring at the middle of the cell. It is a distant relative of human tubulin but structurally distinct enough to be targeted selectively. (evidence: established)
- **FtsZ inhibitors work in principle.** The compound PC190723 cured lethal *Staphylococcus aureus* infection in mice (2008), but had poor drug-like properties. A later prodrug, TXA709, has completed Phase 1 trials; no FtsZ inhibitor has yet reached Phase 2. (evidence: strong evidence)
- **Better assays help.** FtsZ burns GTP and releases phosphate only when it assembles. Fluorescent biosensors such as PBP-MDCC detect that phosphate in real time, enabling sensitive kinetic screening in standard plate readers. (evidence: established)
- **Not just new drugs.** Stewardship, infection prevention, diagnostics and One Health surveillance remain essential. New molecules alone will not solve AMR. (evidence: strong evidence)

## Options

| Option | Benefit | Cost / feasibility | Risk | Evidence |
| --- | --- | --- | --- | --- |
| Target-based discovery grants (ANRF, BIRAC, BioE3 biofoundries) for under-exploited targets such as FtsZ | Builds Indian discovery capacity | Moderate | Long timelines; high attrition | Medium |
| Shared screening facilities plus open assay protocols | Lets academic labs contribute cheaply | Moderate set-up; low running cost | Coordination | Medium |
| “Pull” incentives (e.g. subscription-style payments, as piloted in the UK) | Rewards new antibiotics without promoting overuse | Needs budget commitment | Design complexity | Medium |
| Stewardship towards ≥70% “Access” antibiotics (UNGA 2024) | Slows resistance now | Training, audit, diagnostics | Access must be preserved | Strong |
| One Health surveillance under NAP-AMR 2.0 | Tracks resistance across people, animals, environment | Ongoing | Data silos | Strong |

## Research needed

Which bacterial processes beyond FtsZ are best placed for selective drugs? How can Indian academic screening be linked to medicinal chemistry and clinical development? What pull-incentive design fits India’s market?

## Method

A non-systematic synthesis of global burden studies, WHO pipeline reports, Indian surveillance data and peer-reviewed literature on FtsZ (searched October 2026). The author’s research training includes biosensor-based kinetics of FtsZ; no unpublished data are used. External expert review is pending.

## References

1. Antimicrobial Resistance Collaborators (2022) Global burden of bacterial antimicrobial resistance in 2019: a systematic analysis. Lancet 399:629–655. [doi:10.1016/S0140-6736(21)02724-0](https://doi.org/10.1016/S0140-6736(21)02724-0)
2. GBD 2021 Antimicrobial Resistance Collaborators (2024) Global burden of bacterial antimicrobial resistance 1990–2021: a systematic analysis with forecasts to 2050. Lancet 404:1199–1226. [doi:10.1016/S0140-6736(24)01867-1](https://doi.org/10.1016/S0140-6736(24)01867-1)
3. Institute for Health Metrics and Evaluation (2023) The burden of antimicrobial resistance (AMR) in India. Source: IHME. Used with permission. All rights reserved. [link](https://www.healthdata.org/)
4. Indian Council of Medical Research. Antimicrobial Resistance Research and Surveillance Network (AMRSN) annual reports. [link](https://www.icmr.gov.in/)
5. World Health Organization (2025) Antibacterial agents in clinical and preclinical development (released 2 October 2025). [link](https://www.who.int/news/item/02-10-2025-who-releases-new-reports-on-new-tests-and-treatments-in-development-for-bacterial-infections)
6. United Nations General Assembly (2024) Political Declaration of the High-level Meeting on Antimicrobial Resistance (26 September 2024).
7. Klein EY, et al. (2018) Global increase and geographic convergence in antibiotic consumption between 2000 and 2015. PNAS 115:E3463–E3470. [doi:10.1073/pnas.1717295115](https://doi.org/10.1073/pnas.1717295115)
8. Erickson HP, Anderson DE, Osawa M (2010) FtsZ in bacterial cytokinesis: cytoskeleton and force generator all in one. Microbiology and Molecular Biology Reviews 74:504–528. [doi:10.1128/mmbr.00021-10](https://doi.org/10.1128/mmbr.00021-10)
9. Haydon DJ, et al. (2008) An inhibitor of FtsZ with potent and selective anti-staphylococcal activity. Science 321:1673–1675. [doi:10.1126/science.1159961](https://doi.org/10.1126/science.1159961)
10. Wang MW, et al. (2025) Review of FtsZ inhibitors and their clinical progress. Acta Pharmaceutica Sinica B 15:3978–3996. [doi:10.1016/j.apsb.2025.06.008](https://doi.org/10.1016/j.apsb.2025.06.008)
11. Brune M, Hunter JL, Corrie JET, Webb MR (1994) Direct, real-time measurement of rapid inorganic phosphate release using a novel fluorescent probe. Biochemistry 33:8262–8271. [doi:10.1021/bi00193a013](https://doi.org/10.1021/bi00193a013)

**How to cite:** Singh K. (2026). New antibiotics need new targets, and better tools to find them. khushisingh.in policy brief, version 0.9. https://khushisingh.in/policy/briefs/new-antibiotic-targets/

**Disclaimer:** Personal views of the author, a student researcher. Not the position of the Max Planck Institute of Immunobiology and Epigenetics, IISER Pune or any funder. Evidence syntheses from published sources; no unpublished data. Not medical advice.

**Confidence levels** follow a simplified IPCC-style scale combining the amount of evidence and the agreement between studies. See [how we work](https://khushisingh.in/policy/how-we-work/).