Magic bullets, magic shields, and antimicrobials in between

Abstract

There are only two classes of small-molecule drugs for infectious disease: pathogen-directed antimicrobials and host-directed immunomodulators. The former includes antibiotics and antivirals while the latter comprises corticosteroids such as dexamethasone. Here I inaugurate a third class, immunomodulatory antimicrobials (IAs), which considers small-molecule drugs harbouring both pathogen-directed and host-directed pharmacology. I review seven types of IAs, and argue that their high repositionability and network pharmacological ability to counter multiple pathogen types render them more applicable to pandemic-preparedness research than antivirals.