The
rising prevalence of multidrug-resistant bacteria is an urgent
health crisis that can only be countered through renewed investment
in the discovery and development of antibiotics. There is no panacea
for the antibacterial resistance crisis; instead, a multifaceted approach
is called for. In this Perspective we make the case that, in the face
of evolving clinical needs and enabling technologies, numerous validated
antibacterial targets and associated lead molecules deserve a second
look. At the same time, many worthy targets lack good leads despite
harboring druggable active sites. Creative and inspired techniques
buoy discovery efforts; while soil screening efforts frequently lead
to antibiotic rediscovery, researchers have found success searching
for new antibiotic leads by studying underexplored ecological niches
or by leveraging the abundance of available data from genome mining
efforts. The judicious use of “polypharmacology” (i.e.,
the ability of a drug to alter the activities of multiple targets)
can also provide new opportunities, as can the continued search for
inhibitors of resistance enzymes with the capacity to breathe new
life into old antibiotics. We conclude by highlighting available pharmacoeconomic
models for antibacterial discovery and development while making the
case for new ones.