Are antibiotics still working?

Antimicrobial resistance (AMR) kills an estimated 7,000 people in the UK every year and was directly responsible for 1.27 million deaths globally in 2019 — more than HIV or malaria.^[1,2] Without concerted action, the O'Neill Review projects that figure will reach 10 million per year by 2050.^[3] The mechanism is evolutionary: bacteria exposed to antibiotics that do not kill them develop resistance over generations. In England, the scale is already visible in routine surveillance data. Of all E. coli bloodstream infections — the most common bloodstream infection in the country — 46% are now resistant to third-generation cephalosporins, up from 38% in 2016.^[1] When first-line antibiotics fail, patients must be treated with broader-spectrum drugs that are more expensive, have more side effects, and themselves drive further resistance in a worsening spiral. MRSA rates fell sharply from their mid-2000s peak but have begun rising again.^[1]

The drivers of resistance span three interconnected systems. In human medicine, antibiotics have historically been overprescribed — for viral infections they cannot treat, or as a precaution rather than a diagnosis. Primary care prescribing in England has fallen significantly — from 47 million items in 2014 to around 35 million in 2024, one of the sharpest reductions in the developed world.^[4] But this progress is being outpaced by global overuse, particularly in agriculture, where an estimated 60% of global antibiotic use occurs in livestock. In the environment, pharmaceutical manufacturing waste contaminates rivers with antibiotic residues, creating reservoirs of resistant bacteria. The pipeline has meanwhile run dry: no new antibiotic class has been successfully commercialised since the 1980s, because antibiotics are cheap, used sparingly by design, and rapidly rendered obsolete — making them among the least attractive investments in the pharmaceutical sector.