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The escalating challenge of antimicrobial resistance (AMR) has led to a surge of global research and policy discourse on refilling an empty antibiotic pipeline. The empty pipeline metaphor is, however, wrought with paradoxes. Drawing on critical social sciences and humanities research on pharmaceutical innovation, this comment article presents five of the key paradoxes that structure contemporary innovation discourse: Was the so-called “Golden Age” of antibiotics really golden? Was rational drug design truly rational in terms of antibiotic development? Was the antibiotic pipeline really built on a foundation of scientific breakthroughs by an elite group of (male) inventors? How can antibiotics, powerful symbols of industrial power, be considered as market failures? How could the crisis of antibiotics become the golden hour of their policing? Rather than dissect each paradox, the article aims to complicate standard problem diagnoses and encourage creative new conceptualizations of inclusive antimicrobial innovation.