Intended for healthcare professionals

Rapid response to:


UK launches subscription style model for antibiotics to encourage new development

BMJ 2020; 369 doi: (Published 18 June 2020) Cite this as: BMJ 2020;369:m2468

Rapid Response:

New antibiotics to prevent antimicrobial resistance (AMR) is fatally flawed

Dear Editor

How sad to read in seven Days in Medicine (27 June) that the government’s plan to address AMR is simply to encourage the production of more antibiotics.

Their original five-year national plan on tackling AMR (Jan 2019) was an excellent wide ranging document, acknowledging our lack of understanding regarding ideal dose, duration and route of administration of antibiotics. They were even so innovative as to suggest we should focus on novel therapeutic agents, investigate novel chemistry, and the mining of natural products.

Urinary tract infections (UTIs) were given special mention because of the potential for these frequent, poorly treated infections to add to the spiraling crisis of AMR.

It is well established that most UTI arise from organisms in our own colon ascending up the urethra to invade the bladder, but only relatively recently recognized that these organisms rapidly become intracellular so avoiding immune attack and urinary antibiotics. Almost exclusively antibiotics are administered orally or intravenously, where they are diluted significantly on entering the bladder. This route of administration also fails to address the special uro-pathogenic induction process within the bladder and has the potential for deleterious effects on our gut microbiome.

It is perverse and truly regrettable that government has ignored their own good advice and simply focused on the banality of promoting more antibiotics. This is certainly not innovative; ignoring novel non-antibiotic interventions where there is increasing evidence and strangling any true innovation at birth.

Albert Einstein famously described doing the same thing over and over and expecting a different outcome as the definition of insanity. More antibiotics may in the short term be helpful, but will inevitably result in more antimicrobial resistance, which is exactly what we are trying to prevent. We need truly innovative approaches if we are to deal effectively with AMR.

Competing interests: No competing interests

14 July 2020
Laurence H Stewart
Consultant Urological Surgeon
Spire Murrayfield Hospital Edinburgh