“Humans are locked in an arms race with microbes, but scientists are pursuing diverse approaches to keep one step ahead or slow down the competition.” This is the first sentence of the news feature ‘Five ways science is tackling the antibiotic resistance crisis’ published in Nature this week.

The article starts with three examples of the depth of this crisis and then summarises five solutions. The good news is that those examples make no sense (to me); the bad news is that the solutions are far from innovative.

It starts with the description of someone suffering from multi-organ failure due to sepsis in which three different antibiotics were used before the patient finally recovered, even though “the microbe behind the mystery infection” was not identified. Difficult to link this to treatment failure because of antibiotic resistance.

Then, it is (correctly) stated that currently “most new antibiotics are simply variants of a known class”, but also that these “can be used for just a few years before resistance emerges – not only limiting the drugs’ efficacy, but also making their development a financial loser for pharmaceutical companies.” This is not true. Indeed, resistance to any new compound will be reported soon after its discovery (journal editors love it), but that does not mean that an antibiotic can no longer be used. We’re still using penicillin, despite many reports of resistance. The real problem for companies is that any new antibiotic will be treated as a “last-resort-resting-on-the-shelf-only-to-be-used-when-everything-else-fails”. Changing this economic catch-22 has been on the agenda for decades (see here), so far with no solution.

And then comes the inevitable quantification of the problem: “By 2050, such infections could kill as many as ten million people every year, according to an expert panel commissioned by the UK government in 2014.” The scientific merits of that estimate have been pulverised.

I am convinced that AMR is a growing problem worldwide, and a serious threat to patients in some areas. But not all problems or bad outcomes are caused by AMR, and we – as scientists – should aim to better quantify the scope of this problem in the different parts of the world.

Then, the five innovative solutions: Natural products (innovative???, that was already used to discover penicillin); the promise of AI (could be, but still a promise only); combination therapies (that’s not new); immune assistance (GM-CSF to prevent recurrent infections in critically ill patients? that’s not new); efficient diagnostics (identifying a causative pathogen plus susceptibility profile in blood in 10 minutes: the holy grail with a graveyard of promising breakthroughs that all failed in clinical evaluation during the last 20 years).

A missed opportunity is not mentioning other, at least equally innovative approaches. These include bacteriophage therapy (discovered in 1915, but still lacking appropriate clinical evaluation for widespread use), antibodies preventing infections or restoring susceptibility in resistant bacteria, vaccines, and – probably the most effective – good infection control to prevent infections and transmission of resistant bacteria.

With these in mind, the better news is that there are at least ten ways science is tackling the antibiotic resistance crisis.