Lifeline: an antimicrobial resistance musical — transcription
[Lifeline rehearsal audio]
Siobhan: Hello, and welcome back to The PJ Pod. Today, I’m reporting from a rehearsal space in London, where a couple of pharmacists are singing about an issue close to their hearts.
[Lifeline rehearsal music]
Shay [on recording]: My name’s Shay. I’m a specialist infection pharmacist and dually qualified as an advanced clinical practitioner. We’re having the best time ever. This is our first-ever proper run-through of the full first act, so everything’s kind of coming together.
Marsha [on recording]: I’m Marsha, and I’m an emergency department pharmacist. I’m really enjoying being part of this amazing musical, and it’s an amazing message. So yeah, it’s really amazing to be part of it.
Siobhan: The musical is Lifeline, and it tells the story of Alexander Fleming and his discovery of penicillin almost a whole century ago — and his recognition not long after that, that antimicrobial resistance would become a problem.
[Music clip: “The Drugs Are in the Water”]
Siobhan: In this episode, we’ll find out the motivations of these thespian pharmacists and speak to the writer behind the musical. Also, we’ll chat with highly qualified critic Diane Ashiru-Oredope, lead antimicrobial resistance pharmacist at the UK Health Security Agency, about innovative ways like this to increase awareness of antimicrobial resistance.
Diane [on recording]: Definitely, I think there is something about considering innovative approaches to raising awareness about AMR [antimicrobial resistance]. But one of the key things we also have to think about, though, is ensuring that they’re evidence-based and that they’re potentially cost-effective.
Siobhan: In fact, at the end of this episode, Diane and other pharmacists will join me at Lifeline’s press night and give us their take on the show.
All coming up, so please take your seats.
[Bell]
[Music]
Siobhan: I’m Siobhan Chan, senior features editor and this is PJ Pod, brought to you by The Pharmaceutical Journal, the Royal College of Pharmacy’s official journal.
Now, as all pharmacists will know, antimicrobial resistance is a growing issue, both in the UK and globally.
This musical is a novel way of communicating key messages about AMR to the public — one of many, which we’ll touch on later. For now, here’s playwright Becky Hope-Palmer, to tell us what the musical’s story is based on.
Becky [on recording]: Yeah. So, Lifeline… we started as it being the story of Alexander Fleming and his discovery of penicillin back in 1928, almost by accident. And then it developed into a story about communicating the issue of AMR, of antimicrobial resistance, and how this amazing thing that Alexander Fleming discovered — as soon as it was discovered — then became at risk of being overused and abused and lost, and that’s kind of where we find ourselves in the world now. That we are at a huge risk of losing these precious antibiotics.
And we mirror that with a contemporary storyline of a junior doctor called Jess Irvine, who is also struggling with her place in her career, in her life, and trying to regain the love of her childhood sweetheart — one of her best friends — who they’ve grown apart for multiple reasons. And she’s looking to rediscover her love for this person, but also the risk of maybe losing him because of an illness. So, there’s a mirroring of both stories.
Siobhan: So, Lifeline covers some big themes, that I’m sure you’re all familiar with, around antimicrobial resistance, alongside a healthy dose of romance and drama. But the other exciting thing about this musical, as you heard up top, is that it’s performed by a cast of healthcare professionals and scientists, taking their AMR outreach to a new level.
Siobhan [on recording]: When walking into this space, it feels very busy, and it’s full of equipment. How does that compare to being in a hospital setting?
Shay [on recording]: I mean, it’s chaotic but in a different way. It’s similar to being in a hospital. I mean, you’re surrounded by people that are incredibly competent, really lovely, and everyone comes together, so people are always helping each other out, especially the principal cast. So, it’s been a really nice learning curve, and actually getting to see behind the scenes is really exciting.
Marsha [on recording]: Yeah. Well, the equipment here is completely different to the equipment we have at the hospital, and I would say it’s quite hectic, but yeah, it is in a different way. I work in A&E, the emergency department, so that’s hectic in a more stressful way, whereas this is hectic in an exciting way. So, I’m really enjoying being part of it, and it’s been lovely to meet the professional actors and working with them.
Siobhan [on recording]: Just one more question from me because we’ll catch up properly later in the week. But what does it mean to you to be part of this musical?
Shay [on recording]: I’m quite passionate about AMR in my job on a day-to-day basis, so it’s just really nice to use some different muscles, ones that I don’t normally use, to spread the same message that we do, every single day at work, which is making sure that we’re protecting each other, that antimicrobial resistance is everyone’s job, not just the healthcare professionals’ jobs, but patients, relatives. So actually, this is just a new way to spread the message to a different core audience, and it’s really nice.
Marsha [on recording]: Yes, I’m also really passionate about spreading the word about antimicrobial resistance to the public. With my friends and family, I always stress the importance of taking antibiotics carefully. I’m on them like a hawk for not taking them or not taking them at the right time or not completing the course, they must complete the course. I’m glad they all reach out to me, my friends and family, to ask for advice, and it’s amazing to be part of this, where a lot of them will come to see it, and a lot of the other public will come to see it. So, it’s just amazing.
Siobhan: Eventually, I left the cast and chorus to rehearse on their own. But I did catch up with Shay and Marsha properly a few days later. And I started by asking them for their formal introductions.
Marsha [on recording]: I’m Marsha Boltova. I’m a pharmacist for the emergency department at Queen Elizabeth Hospital, Lewisham and Greenwich NHS Trust. I support antimicrobial stewardship by advising on the prescribing of antibiotics, helping to treat infections effectively whilst protecting these vital medicines from antimicrobial resistance.
Shay [on recording]: My name is Shay Khan. I’m a specialist infection pharmacist and advanced clinical practitioner. I diagnose and treat patients with complex infections in hospital, and I also help write hospital policy on how best to use antibiotics to combat antimicrobial resistance.
Siobhan: I was interested to know how a pair of clearly busy, working pharmacists could wind up in the cast of a musical in the first place.
Marsha [on recording]: It was my colleague; she told me about it. And because she knows that I’m part of the Lewisham and Greenwich NHS Trust choir, she encouraged me to apply for it. So, I did my audition, which was extremely nerve-wracking, but managed to do it, and then I was successful.
Siobhan [on recording]: Shay, how about you? Why did you want to get involved?
Shay [on recording]: I just like being on stage. I essentially saw it come through the British Society of Antimicrobial Chemotherapy. They, I think it was their transmission letter or newsletter. I’ve always wanted to do a bit of theatre work. I didn’t grow up in the UK, I didn’t really have the opportunity to learn about it, like theatre, art, singing, in Pakistan. So, it was always kind of like a missed opportunity, and I wish I could do something like that. And then I really, really like my job, I love the field of infection. So, when this sort of came up, I was like, “This is perfect” because actually it’s not too far removed from my day-to-day to feel like I’m stepping into a completely different world. Yeah, it was just the right time, right place.
Marsha [on recording]: I mainly see patients that first come into A&E. At that point, usually we don’t know about whether they have any resistant bugs causing their infection. But what I do see is a lot of sepsis and infection, and the initiation of antibiotics. So, A&E is the first port of call, where the doctors will give them the first antibiotics. And I have a unique opportunity because I can intervene at the point of prescribing or soon after antibiotics have been prescribed to ensure that the antibiotics they’ve chosen are the correct ones, to make sure they’re following guidelines where they need to, and to challenge them when they are using antibiotics inappropriately.
Siobhan [on recording]: And how about you, Shay?
Shay [on recording]: I’m in the opposite end of the hospital to Marsha, so I see people that have been in hospital with complex infections or come into hospital with complex infections. I’m also an advanced clinical practitioner, so I diagnose and treat and see patients on my own. We come across a range of patients in pretty much every setting, and that’s what I like about my job is that it’s not tied to a particular area or a unit. Some people prefer that, but I much prefer that fact that we are seeing the most complex in every area. As we all know, resistance is rising nationally, and if we are not using the right antibiotic, at the right time for the right patient, we’re not doing ourselves any justice, and we’re not helping each other.
We have had infections that cannot be treated with any oral antibiotics because of resistance, so we have to put them on a service that I help run called the OPAT [Outpatient Parenteral Antimicrobial Therapy] service. So, we’ll often have to send patients home on long-term IV antibiotics to deal with complex or chronic infections. We have patients that have no options, so sometimes you need to think about novel ways or multiple antibiotics working together to have some effect on a patient’s specific organism.
Siobhan [on recording]: Was there anything about the kind of message of the musical that made you want to get involved, or was it just the idea of being able to sing to a big audience?
Marsha [on recording]: I worry about antimicrobial resistance, and I know that so many people in the public don’t even know what antimicrobial resistance is. So, it was lovely to get that message across by being in the musical, and I feel like anyone that comes to see it is definitely going to think a bit more carefully about the antibiotics that they take or requesting antibiotics when they don’t really need to. Hopefully, this will send a message across to them not to request antibiotics unnecessarily and to use them carefully and properly.
Shay [on recording]: It’s difficult because being worried about something like antimicrobial resistance or climate change, for example, people don’t see it, so people don’t necessarily believe it or think it’s there. And I hope that a production like this and real-world examples, people working in the AMR setting, kind of brings it to the front of their mind and makes it a priority for other people. We need to give people the right facts and give them the right information, especially in this age of a lot of misinformation out there.
Siobhan: I think most pharmacists out there would agree how important it is that people have the right information and can make decisions based on evidence and facts, even if they might not take to the stage themselves.
So, what is the impact of antimicrobial resistance right now, and what can pharmacists do about it?
The Access to Medicine Foundation’s AMR Benchmark report, which came out in March 2026, says that one million people around the world die each year as a direct result of drug-resistant infections, and they indirectly lead to four million deaths in total. By 2050, this could double.
To find out about the status of AMR in England, specifically, I spoke to Diane Ashiru-Oredope, from the UK Health Security Agency or UKHSA.
Diane [on recording]: If I were to put it simply, I would say there’s been some progress when we think about antibiotic use, but antimicrobial resistance still remains a major and growing threat in England. The latest ESPAUR report, so that’s the English Surveillance Programme for Antimicrobial Utilisation and Resistance, our national surveillance report, shows that resistant bloodstream infections has increased by 13% from 2019 to 2024. There were nearly 400 resistance cases every week, which brings home the scale of it. At the same time, antibiotic use was what we call 17.5 defined daily doses per inhabitants, which is slightly lower than 2019. So, we’ve seen some progress in antibiotic use, but the resistance is still so high.
Siobhan: So, what could help to turn the tide of antimicrobial resistance? One of the most effective ways to reduce these deaths would be to develop new classes of antibiotics, but while the AMR benchmark report found that some smaller pharmaceutical companies are developing promising options, the pipeline for antimicrobial development is “worryingly sparse”.
There’s also a need to change people’s behaviour around antimicrobials. More than one in three parents think that when their children get an ear infection, they always need antibiotics — that’s according to a survey published in the British Journal of General Practice in February 2026.
This is where antimicrobial stewardship comes in, by which I mean educating the public and clinicians about the judicious use of antimicrobials. The World Health Organization says that antimicrobial stewardship programmes are “one of the most cost-effective interventions to improve patient outcomes and reduce AMR”.
And this is something we know is hugely important for pharmacists and their teams to be involved in. Here’s Diane on the role that pharmacy teams can play.
Diane [on recording]: The role of pharmacy is extremely important in tackling antimicrobial resistance. When I say pharmacy, it’s pharmacists, pharmacy technicians, dispensers, medicines counter assistants because we have regular patient contact, we have patient-facing responsibilities, and we have close working relationships with other healthcare professionals. So, this puts the whole pharmacy workforce in a very strong position to influence antimicrobial use and to promote stewardship.
We know that one of the major drivers for antimicrobial resistance is misuse and overuse of antimicrobials, so pharmacy is a big part of that solution. Preventing infections in the first instance is critical, but then we also have that misuse and overuse. So, pharmacy teams, we’re often the safety net at every step of the medicines pathway. We can help in assessing whether the antibiotic is needed. We check the dose, the duration and the choice. We can identify allergies and interactions, and then we can reinforce with the patient’s adherence and explaining when antibiotics may not be necessary. We have the national prescribing and stewardship competency framework, which explicitly applies to both medical and non-medical prescribers. And in this case, as you know, from 2026, pharmacists will graduate as being able to prescribe.
Community pharmacy is accessible and trusted and has that throughput of patients and members of the public. So, there is that important part we can play in terms of educating members of the public.
And then in hospital settings, we have a key role around, for example, intravenous-to-oral switch, as I mentioned. So, in hospital practice, pharmacists can support the 48 to 72-hour antimicrobial review, which is part of the start smart then focus toolkit. They can help with dose optimisation, renal dose adjustments, de-escalation based on microbiology, and then also prompting stopping of treatment if an infection is unlikely.
There are many trusts and hospitals across the UK where the stewardship leads are pharmacists in collaboration with microbiology teams. In primary care, pharmacists can lead on auditing, prescribing and providing feedback, and promoting adherence to guidelines. They can also use their local surveillance and prescribing data and have targeted action.
[Music]
Siobhan: So how can pharmacists get started with antimicrobial stewardship, if they’re not already? I asked Shay and Marsha for their thoughts.
Shay [on recording]: I guess the most important thing is recognising the setting that you’re working in. So, for example, community pharmacies are now offering Pharmacy First as a scheme. So, making sure you’re familiar with all the relevant governance structure around it, so making sure that you are looking at the inclusion/exclusion criteria properly and are feeling empowered to be able to have those difficult consultations with patients, because patients will expect antibiotics and it’s about managing those expectations using evidence-based knowledge.
Things like, there’s short courses on AMR. If you look at the NHS website, there’s a couple of easy-to-access informational short courses around AMR resistance for junior pharmacists. There’s also, if you’re a trainee pharmacist, AMR is also embedded to a certain extent. I think it’s a toolkit that NHSE [NHS England] came up with for learning more about antimicrobial resistance as a trainee.
Also simply using the right resources online, so relying less on AI, but looking at NICE [National Institute for Health and Care Excellence] guidance and looking at national guidance is helpful. And just speak to your friendly neighborhood antimicrobial pharmacist or infection pharmacist.
Siobhan [on recording]: Any additional tips from you, Marsha?
Marsha [on recording]: Yeah, I mean, I think, yeah, the resources are great. I think there’s a resource called ‘Antimicrobial stewardship: start smart then focus’, and that’s a good one that I always recommend to my trainee pharmacists and junior pharmacists.
Siobhan [on recording]: Great. We’ll add details of those to the show notes.
Siobhan: So, what difference can pharmacists make exactly? Back to Diane to give us more of a national picture about pharmacy involvement.
Siobhan [on recording]: You’ve covered so much ground there about what pharmacists can do. I’m just wondering if you have any solid examples or case studies of where pharmacists and their wider teams, as you say, have made that real difference by supporting AMR efforts.
Diane [on recording]: I think if we think within hospital settings, for example, in the UK, most of those who lead on stewardship or co-lead on stewardship are pharmacists. When we talk about what has happened with antimicrobial use and the policy levers, it’s pharmacists who are often leading on making that happen in terms of implementing those measures or supporting, educating, doing the assessments and also developing interventions locally. So, pharmacists across the UK have had such a strong leadership role within that. And I think if you think nationally as well, within NHS England, the Antimicrobial Prescribing and Medicines Optimisation team, which is led by Dr Kieran Hand, who is a pharmacist, and they’re all pharmacists and pharmacy technicians across the regional teams in NHS England.
Going beyond that I’ve heard about colleagues in Northern Ireland, for example, where they created a roadshow across the trusts in Northern Ireland, and their roadshow included shopping centers, health and care centres, a leisure centre, and they took quizzes out to members of the public. They branded fortune cookies with individual AMR messages. And really that roadshow was then promoted through social media.
Siobhan [on recording]: Amazing. There’s some really nice examples of public awareness raising that you said there, including fortune cookies, which sounds very novel. So, obviously we’ve been speaking to some pharmacists who are in a musical about antimicrobial resistance, which is called Lifeline. So, we’re wondering what you make of that musical and whether it could help meet the goal to increase public awareness by 10%.
Diane [on recording]: Yeah, I think that the musical is a really innovative way of helping members of the public to think about antimicrobial resistance. One of the key things we have to think about is there are many members of the public who don’t even know why they should care about antimicrobial resistance. So, I think opportunities and activities, such as the musical, really provide a way to start to seed the idea to members of the public. But I think that raising awareness and increasing awareness is an important first step for us to be able to change behavior.
It’s really interesting, when we had the “Keep Antibiotics Working” song, I am not going to sing that song, but many people will remember the song which says, “Antibiotics are wonderful pills, they don’t cure all of your ills”. And till today, those children who were in primary school in 2017, 2018, up to 2020 when that was running are now teenagers, and they’re still talking about the song from the Keep Antibiotics Working Campaign. So, it’s really interesting that as part of Andy-biotic, which is our new public awareness campaign, which uses a mascot-style approach, we have brought back the song.
But yes, I think innovative approaches for members of the public to have a consciousness or an awareness about antimicrobial resistance in a way that is relatable is a really useful way.
Siobhan [on recording]: Diane, we’re making a podcast about a musical about AMR, so I [chuckles] really want to hear the song that you’ve mentioned, or if you’ve got any lyrics you remember, I definitely want to hear them.
Diane [on recording]: I cannot sing the song. [laughs] Um, okay. It’s, “Antibiotics are wonderful pills…”
[Song clip]
Siobhan: Amazing work there from Diane, and that was quite the earworm. And that was a really nice point about communicating in a way that’s both memorable and relatable. This is something that Becky, the playwright, bought up in my chat with her as well — she thinks music is a great way to get complicated ideas across.
Becky [on recording]: I think there’s something about music that is very emotive and very transformational. I don’t think really you have to be a huge musicals fan to come and see this show. On a really basic level, I think it helps us both transport in time and helps lift difficult subject matter sometimes into a more emotional place rather than a very cerebral, scientific place. Which of course has its place and should be a method for also communicating these issues. But I think what we’ve tried to do is maybe bridge the gap between the science and the personal and the emotional. And I think, I hope we’ve achieved it. I hope anyone can come and see it, whether it be someone that has absolutely no idea or any previous knowledge of AMR, but also people that whether it be pharmacists, whether it be medical professionals or policymakers or scientists who have a lot of things to say or experience in any of that AMR world. And I hope that it maybe gives them a bit of a new perspective on it through the music, through the drama.
Siobhan: Becky’s point about new perspectives made me wonder whether Shay and Marsha’s involvement in Lifeline has made them approach the antibiotic resistance part of their roles any differently.
Marsha [on recording]: Yeah. I think it’s more in my mind now. In A&E, there’s so many different things that I’m involved in not just antibiotics. So being part of the musical, I feel like it’s always constantly at the back of my mind, more so than it was before.
Shay [on recording]: It’s certainly helped me understand the power of using a different medium to educate people. And actually, it inspired something that we’re potentially doing at our own hospital, which is doing an AMR fashion show. So, to reach slightly harder-to-reach populations or populations who would otherwise not be very much interested. Bringing together science and art is something that I’ve always liked. So, it’s reinvigorated in me, and helped me come up with ideas and work with the rest of our team to say, “Look, it is possible. If you can make a play about AMR, you can certainly do a fashion show about AMR.”
Bringing about change is so hard and influencing behavior is so hard. But when you can tug at people’s heartstrings and use art as a medium, I think it’s wonderful and it feels bright. So, it’s inspired me to do that.
Siobhan [on recording]: That sounds incredible. I definitely want an invite to that, please.
Shay [on recording]: Maybe you guys can cover it when we go live.
Siobhan [on recording]: It was brilliant to chat to both of you. I’m sending you so much luck for the shows that you’re in. I can’t wait to see you on stage. Shay, I know you’re performing on the day that I’m seeing the musical, so come and find me afterwards. I’ll be the crazy fan girl with a microphone waiting to get your autograph.
Shay [on recording]: Only on autograph per person.
Siobhan [on recording]: I can make that work.
[Music]
Siobhan [on recording]: Hi, Siobhan here. I’ve come into central London to see Lifeline the musical being performed today. I’ve been thinking about all the people that we’ve spoken to about this, so obviously Shay and Marsha being involved in the chorus. We’ve got Becky, who wrote the dialogue and the storylines, and we’ve got Diane, whose work obviously revolves a lot around helping to resolve the antimicrobial resistance problem in the UK. Really excited to see everything culminating together tonight, and I’m very excited to get Diane’s take on the performance and see whether she thinks it could make a real difference in the world of antimicrobial resistance.
[Crowd noise, bell]
Siobhan: Unfortunately, I couldn’t bring you into the show with me, but afterwards I caught up with some of the folks who joined me, starting with fellow member of The PJ Pod team, Joanna.
Joanna [on recording]: It was so good. I don’t know what I was expecting, but it was amazing. Like, really well-performed, amazing, incredible singing. Like, really moving storyline. And then, oh, like, at the end all the people came out that were in the chorus, like the different healthcare professionals, the pharmacists of course all said what they do to steward antimicrobials in their jobs. And it was really inspiring.
Siobhan: And what did Diane make of the musical?
Diane [on recording]: Absolutely amazing. I really loved the story around the soldier and also Aaron and pan-resistant. The fact that it’s a reality that can happen now, and has happened, and there are patients who have that. Thankfully we don’t have many, many patients going through that process, but the reality is that this can happen. I really loved the fact that they brought in all aspects of tackling antimicrobial resistance, the one health element, which is what we mean by the environment, the animal health, but also the responsibilities we have as human beings to make better use of antibiotics, not to demand antibiotics from our healthcare professionals, to listen to the healthcare professionals. The fact that infections can happen and resistance can naturally happen, but if we do our part to keep the antibiotics working, then we are going to be able to protect our health both now and in the future.
Siobhan: So, a really different episode from us there, but hopefully, you’ll agree on a really important issue. Let us know if it inspires any creative ideas on your part, about how to talk to patients and colleagues about antimicrobial resistance. And if any of you are planning a fashion show or similar, we want an invite.
You’ll find details in the show notes about the resources that Shay and Marsha mentioned, as well as a link to information about the recent run of the musical Lifeline.
Please like, share and subscribe to The PJ Pod wherever you get your podcasts.
Until next time, thank you for tuning in. I’m Siobhan Chan. Bye.