Antibiotic-resistant infections and related deaths have risen sharply in England despite slight reductions in overall antibiotic use, the UK Health Security Agency (UKHSA) has warned.

The agency’s latest English surveillance programme for antimicrobial utilisation and resistance (ESPAUR) report for 2024 to 2025 shows a rise in resistant bacteraemia cases and a widening inequality gap between the most and least deprived communities.

The UKHSA reported 20,484 cases of resistant bacteraemia in 2024, up 9.3% from 18,740 cases in 2023. This equates to an average of nearly 400 new cases each week.

Deaths linked to resistant infections also increased, rising from 2041 in 2023 to 2379 in 2024. That is an increase of 338 deaths, or 16.6%.

Routine Care at Risk

Experts continue to describe antimicrobial resistance (AMR) as an urgent global threat. They warn that without action, routine procedures could become unsafe to perform, and common infections could become untreatable.

ESPAUR reports have been published annually since 2014.

Escherichia coli remained the leading cause of resistant bacteraemia over the past 6 years, accounting for 65% of cases.

National Plan Off to a Difficult Start

The findings come 1 year into the government’s 5-year national action plan on AMR. Published in May 2024, the plan describes effective antimicrobials as a “cornerstone” of modern medicine and aims to contain, control, and mitigate AMR by 2040.

The UKHSA said that antibiotic-resistant bacteria are less likely to respond to treatment and can cause serious complications such as bacteraemia, sepsis, and hospitalisation. People with resistant infections are more likely to die within 30 days than those with antibiotic-susceptible infections.

Private Prescribing Fuels Overall Rise

Antibiotic use in NHS primary care fell slightly from 14.21 to 13.96 daily defined doses per 1000 inhabitants per day (DID) between 2019 and 2024. However, private dispensing in community pharmacies more than doubled over the same period, from 1.95 to 3.93 DID.

This led to a 10.7% overall rise in primary care antibiotic use across NHS and private non-NHS prescriptions combined. In 2024, 22% of antibiotics were dispensed privately. 

The latest ESPAUR report includes Pharmacy First prescribing data for the first time. The service accounted for 4% of primary care antibiotic prescriptions.

Tase Oputu, chair of the Royal Pharmaceutical Society England board and a hospital pharmacist for nearly 30 years, told Medscape News UK: “Pharmacy First is underpinned by evidence-based clinical pathways that ensure antibiotics are only supplied when clinically indicated, supporting pharmacists’ long-standing role in antimicrobial stewardship.

“As more of the pharmacy workforce become independent prescribers, we expect pharmacists to play a growing role in managing common conditions, improving timely access to care and reducing system pressures.”

Inequalities Deepen

Dr Catrin Moore, reader and associate professor in global health and infectious diseases at City St George’s, University of London, and co-chair of the Knocking Out AMR Scientific Advisory Group for the Microbiology Society, said she was “concerned” that private dispensing had more than doubled in 1 year. 

''Antimicrobial resistance is an urgent healthcare crisis,” she told Medscape News UK. She added that the widening gap in resistant bacteraemia between the most and least deprived communities was “deeply troubling.” The inequality gap grew from 29% in 2019 to 47% in 2024.

“This crisis is here and now — and happening here in the UK, not only low- and middle-income countries,” she said. “We must take action now and challenge our decision makers to consider the growing health inequalities in the UK.”

Dr Jonathan Cox, senior lecturer in microbiology at Aston University and a member of the advisory group, agreed that rising private prescriptions were a “significant concern.” He told Medscape News UK: “Colleagues working in private practices must consider the long-term implications of inappropriate prescribing. 

“It is everyone's responsibility to reduce inappropriate antibiotic consumption and maintain the principles of antimicrobial stewardship.

“In the meantime, the UK government needs urgently to invest into research and development of novel and alternative antimicrobials and streamlining the regulatory process to bring these to market.”

Dr Sheena Meredith is an established medical writer, editor, and consultant in healthcare communications, with extensive experience writing for medical professionals and the general public. She is qualified in medicine and in law and medical ethics.