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R44AI165008 is a first-in-class parenteral small molecule antibiotic developed by Prokaryotics. It functions as an inhibitor of Penicillin-binding protein (PBP) transglycosylase, an essential enzyme involved in the synthesis of the bacterial peptidoglycan cell wall. Unlike traditional beta-lactam antibiotics that target the transpeptidase activity of PBPs, R44AI165008 targets the transglycosylase domain, providing a novel mechanism of action against multidrug-resistant (MDR) Gram-negative pathogens. The drug is specifically being developed for the treatment of infections caused by multidrug-resistant *Acinetobacter baumannii* and is intended for use in combination with polymyxin antibiotics to enhance bactericidal activity. The program has been supported by the National Institute of Allergy and Infectious Diseases (NIAID) and reached Phase 1 clinical development.
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