khushi singh.in

Policy brief · v0.9 · 3 October 2026

Draft for expert review: not yet externally reviewed

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.

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. 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. 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. Established
  • Not just new drugs. Stewardship, infection prevention, diagnostics and One Health surveillance remain essential. New molecules alone will not solve AMR. 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
  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
  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
  4. Indian Council of Medical Research. Antimicrobial Resistance Research and Surveillance Network (AMRSN) annual reports. link
  5. World Health Organization (2025) Antibacterial agents in clinical and preclinical development (released 2 October 2025). link
  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
  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
  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
  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
  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