Why conditions like UTI call for new antibiotics

This article was initiated and funded by GSK. GSK was involved in the development and editorial review of the content.

Over half of all women are affected by a UTI in their lifetime, with spikes in incidence observed in young, sexually active females and older, post-menopausal women.¹

“Urinary tract infections (UTI) really impair people's lives,” said Dr Pam Kushner, Clinical Professor of Family Medicine at the University of California, Irvine. “We have a lot of data showing that people don't feel able to go to work. It affects their sex life. They travel around with medications to treat the discomfort. They're afraid of getting a recurrence. It becomes really a big deal that many clinicians need to become more aware of.”

A condition made more challenging due to increasing antimicrobial resistance (AMR),² with multiple broad-spectrum antibiotics that may no longer work for an increasing number of patients.³

Commonly used broad-spectrum antibiotics remain a first-line choice in routine clinical practice, noted Dr Oliseyenum MacDonald Nwose, VP and Global Medical Lead at GSK. However, we’re now seeing treatment failure occurring in approximately 1 in 8 women with UTIs, resulting in prolonged symptoms and delayed recovery.^4,5,6,7

A widespread and serious condition

“About a third of women affected by a UTI will go on to have recurrent UTIs. This can happen for several reasons, for instance, when the organism is not sensitive to commonly used antibiotics, or when the bacteria themselves evolve in ways that makes treatment less effective,” Nwose explained.^8,9,10

Treatment failure or recurrent infections – which can sometimes last for decades – represent a significant health risk for women with UTIs, but also impact their mental well-being. A study conducted in 2022 in US women with UTIs highlighted the anger and worry that comes from treatment failure, and that the prospect of recurrent UTIs can provoke dread and helplessness.¹¹

In addition, women with a UTI can also experience frustrations about the management of their conditions, as not only do they need relief of their symptoms to be able to resume their normal life, but also to have confidence that they’re free of infection.

“Some patients may have an unrealistic expectation,” Dr Kushner noted. “They might expect to have relief of their symptoms within 24 hours. They may not wait for that antibiotic to work or realise that they need to finish that course of antibiotics to prevent a relapse.” This gap in understanding can lead to premature discontinuation of treatment, improper use of antibiotics and, ultimately, poorer health outcomes.¹²

“Part of the problem is that, because it's so common, it's not given the respect that it deserves in terms of time and education,” she added.

The need for new antibiotics and updated prescribing practices

There have been limited novel treatment options for UTIs in the last 30 years.

“Antibiotics that we were using before to treat and cure infections may no longer be effective,” Nwose said. “There is a need to develop new ones because the bugs are getting ahead of us in terms of being able to develop resistance, and we also need different formulations to respond to the patients’ needs.”

Nwose highlights that one of the key strategies to combat resistance is for prescribers to take meaningful action – beginning with a more considered approach to antibiotic use.

As highlighted by Kushner, a key part of the challenge is that UTIs are often underestimated in clinical education and practice.¹³ Addressing this requires not only greater awareness, but also more time spent on developing diagnostic confidence, taking a thorough history, understanding patterns in past culture data, and recognising when further investigation is required. These steps can support more appropriate prescribing and help safeguard antibiotic effectiveness.

Policy solutions

A targeted and responsible approach to antibiotic use is key to not only ensure optimal care for patients, but to support the response to the global issue of growing resistance to antimicrobial medicines. Nwose emphasises the importance of collaboration between multiple stakeholders to raise awareness and join forces in tackling the challenge.

For example, as part of the commitment to tackling this issue, GSK is deepening scientific and policy collaborations, including investment in the Fleming Initiative, which brings together world-class scientific, technology, policy, and behavioural science expertise with clinical experience in a global network focused on solutions to AMR.¹⁴

Changing the traditional model will involve coordinated action from all of these stakeholders, and the consequences of inaction will be far-reaching, affecting individuals, health systems, and communities alike.

“We're working with partners across the world, including patient organisations, healthcare professionals, and policymakers, to safeguard our ability to treat bacterial infections and continue protecting patients from debilitating diseases," Nwose concluded.

References

Czajkowski, K, et al. Urinary tract infection in women. Prz Menopauzalny. 2021;20(1):40-7.
Aronin SI, et al. Increased rates of extended-spectrum beta-lactamase isolates in patients hospitalized with culture-positive urinary Enterobacterales in the United States: 2011 - 2020. Diagn Microbiol Infect Dis. 2022;103(4):115717.
Kaye KS, et al. Antimicrobial resistance trends in urine Escherichia coli isolates from adult and adolescent females in the United States from 2011 to 2019: rising ESBL strains and impact on patient management. Clin Infect Dis. 2021;73:1992–1999. doi: 10.1093/cid/ciab560
Fromer D, et al. Incidence of Treatment Failure When Treated with Empiric Oral Antibiotics Among US Female Outpatients with Uncomplicated Urinary Tract Infection. Open Forum Infectious Diseases. Volume 10, Issue Supplement_2, December 2023, ofad500.2439, https://doi.org/10.1093/ofid/ofad500.2439.
Franklin M, et al. Healthcare Resource Use and Costs Associated With Oral Antibiotic Treatment Failure in Uncomplicated Urinary Tract Infection in the US. Value in Health. 2023;26(Suppl_6):S159, https://doi.org/10.1016/j.jval.2023.03.2526.
Franklin M, et al. Cost Burden of Patients With Oral Antibiotic Treatment Failure for Uncomplicated Urinary Tract Infection in the United States. Open Forum Infect Dis. 2023;10(Suppl_2):ofad500.2449, https://doi.org/10.1093/ofid/ofad500.2449.
Fromer D, et al. Risk Factors for Treatment Failure Among US Female Outpatients With Uncomplicated Urinary Tract Infection Treated with Empirically Prescribed Oral Antibiotics. J Manag Care Spec Pharm. 2023;29(Suppl_10a):N4, https://doi.org/10.18553/jmcp.2023.29.10-a.s1
Ku JH, et al. Antibiotic Resistance of Urinary Tract Infection Recurrences in a Large Integrated US Healthcare System. J Infect Dis 2024;230(6):e1344–e1354.
Valentine-King A, et al. Predicting Antibiotic Susceptibility Among Patients With Recurrent Urinary Tract Infection Using a Prior Culture. The Journal of Urology 2024;211:144-152.
Sirwan A, et al. Antimicrobial resistance: Impacts, challenges, and future prospects. Journal of Medicine, surgery and Public Health 2024;2:100081.
Grigoryan L, Mulgirigama A, Powell M, Schmiemann G. The emotional impact of urinary tract infections in women: a qualitative analysis. BMC Womens Health. 2022 May 18;22(1):182. doi: 10.1186/s12905-022-01757-3
Kramer M, et al. Living With And Managing Uncomplicated Urinary Tract Infection: Mixed Methods Analysis of Patients Insights From Social Media. Med Internet Res 2025;27:e58882. https://doi.org/10.2196/58882
Cooper E, et al. Diagnosis and Management of UTI in Primary Care Settings—A Qualitative Study to Inform a Diagnostic Quick Reference Tool for Women Under 65 Years. Antibiotics (Basel) 2020;9(9):581.
GSK. GSK to become a founding partner of Fleming Initiative to fight antimicrobial resistance (AMR). 2024. Available at: https://www.gsk.com/en-gb/media/press-releases/gsk-to-become-a-founding-partner-of-fleming-initiative-to-fight-antimicrobial-resistance-amr/. Last accessed September 2025

About the interviewees

Dr Pamela Kushner

Pamela Kushner is Clinical Professor of Family Medicine at the University of California, Irvine, USA. She is also a board-certified family physician, who for over 20 years has run a private practice in Long Beach, USA and specialising in preventive medical care. In addition, Dr Kushner volunteers as a clinical professor at an indigent clinic in Santa Ana, USA. She received both her bachelor’s degree and master’s degree in biology from University of California, Los Angeles before going on to obtain her medical degree from the University of California, Irvine.

Dr Kushner’s research interests focus on dipeptidyl peptidase-4 inhibitors, minimising the risk of hypoglycaemia in patients with Type 2 diabetes mellitus, hypertension and new paradigms for the treatment of Type 2 diabetes. Dr Kushner also devotes a proportion of her time to educating physicians and other clinicians on the newest medical therapies.

Dr Kushner has been listed in Best Doctors in America every year since 2015 and has also received the Senior Resident Clinical Professor of the Year Award from the University of California, Irvine Medical Center (2015). She is a Fellow of the American Academy of Family Physicians (AAFP) and has served as Chair of the AAFP Drugs and Devices Committee. Dr Kushner is a reviewer for the Medical Board of California and has widely published in medical and lay journals including Stroke and Women’s Health.

Dr Oliseyenum MacDonald (Don) Nwose

Oliseyenum MacDonald (Don) Nwose, VP, Global Medical Lead (GML) brings over 20 years of experience across laboratory research, clinical development, pharmaceutical and biotechnology R&D, and medical affairs. Throughout his career, he has led multiple successful clinical development programmes and product launches across a range of therapeutic areas.

Most recently, Nwose served as Vice President of Medical Affairs for the Plasma-Derived Therapeutics unit at Takeda, where he led his team to three successful launches in 2023. Prior to this, he was Executive Global Medical Director for the Endocrinology business at NPS/Shire Pharmaceuticals, where he oversaw a major US product launch, supported global market expansion, and managed the knowledge transfer of key therapies and devices following acquisition.

Earlier in his career, Nwose held roles of increasing responsibility in translational medicine, early and late-stage clinical development (Phases I–IV), and drug safety across both Europe and the US. He worked with organisations including Novartis, Chugai, Neurocrine, BioMarin, Daiichi-Sankyo, NPS/Shire, and Vifor. He began his career at AstraZeneca as a Clinical Research Fellow, eventually serving as Medical Advisor within the Clinical Pharmacology Unit, where he conducted numerous first-in-human and early-phase studies.

Nwose is a Fellow of the Royal College of Pathologists and the Faculty of Pharmaceutical Medicine at the Royal College of Physicians, UK. He is also a Board-Certified Medical Affairs Specialist.