Intended for healthcare professionals

Letters Antimicrobial resistance

A paradigm shift in approach to antimicrobials is needed

BMJ 2013; 346 doi: (Published 10 April 2013) Cite this as: BMJ 2013;346:f2138
  1. Richard L Puleston, associate professor of public health1, honorary consultant2
  1. 1University of Nottingham, Nottingham, UK
  2. 2Health Protection Agency East Midlands, City Hospital, Nottingham NG5 1PB, UK
  1. richard.puleston{at}

The focus on antimicrobial resistance highlights the challenges of providing healthcare when antibiotic effectiveness has changed.1 Improved antibiotic stewardship is important, but new agents are also needed, especially to treat inherently resistant organisms (Acinetobacter baumannii) and those acquiring new resistance mechanisms (Escherichia coli and Klebsiella spp), yet the pipeline of new antimicrobials is running dry.

Economics explains why few antimicrobials are in …

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