200 million lives saved - but prognosis for penicillin is not healthy
Anne Sheafe Miller was very ill. The former nurse had been in hospital for a month, suffering from a bacterial infection. Doctors had tried everything but they knew death was the likely outcome. Then somebody suggested taking the risk of giving a new drug, barely past the experimental stage. Medical staff administered a small dose to Miller. The next day she was sitting up in bed and her delirium vanished. Soon she was eating meals and on her way to a full recovery. It was 1942 and she was the first person to be saved by the drug penicillin, as the New York Times wrote.
Years later, Scottish chemist Alexander Fleming noted: “When I woke up just after dawn on September 28, 1928, I certainly didn’t plan to revolutionize all medicine by discovering the world’s first antibiotic, or bacteria killer. But I suppose that was exactly what I did,” according to this academic study.
Penicillin has saved the lives of at least 200 million across the globe (newworldencyclopedia). In World War II, where keeping it safe was a serious consideration before D-Day, it saved 12 to 15 percent of Allied forces’ lives, (Durbin Usher), curing diseases such as pneumonia and sepsis (blood poisoning). The drug was harnessed by use on open wounds and sterilization of surgeries with antiseptics, so soldiers were saved and some could return to action.
Is the power of penicillin a thing of the past?
Birmingham University microbiology professor, Willem Van Schaik, told WikiTribune that penicillin now faces a degree of obsolescence. The “original penicillin as discovered by Sir Alexander Fleming will become increasingly obsolete, but we will probably use it in 100 years from now for … infections with bacteria that have not acquired resistance, ” he said.
However, Oxford University zoology professor Craig MacLean is downbeat. MacLean says that if we continue using penicillin like drugs, the way we are now, it could no longer be effective as soon as 10 years from now. “I’m not massively optimistic for penicillin,” he says.
Staphylococcus aureus bacteria strains resistant to penicillin emerged in 1950, only six years after it was first mass produced. Even after methicillin was introduced in 1960 to solve the problem, it only took one year for methicillin resistant Staphylococcus aureus, or MRSA to be identified. (academic study)
And while penicillin is a story of humankind conquering bacteria, bacterial resistance to penicillin was first detected (academic study) over 75 years ago, in the same year Miller’s life was saved.
In 1945, Fleming warned with foresight, “there is the danger that the ignorant man may easily underdose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant.” That’s exactly what happened. But that is just part of the problem.
Patients failing to finish their antibiotics course, a lack of new medicinal drugs, and doctors over-prescribing, has caused resistance to rise.
Globally, 700,000 people die every year because of drug resistance and by 2050 this is expected to rise to 10 million, according to a report by The Review on Antimicrobial Resistance.
In the UK, a 2014 Public Health England study found 51 percent of patients were prescribed antibiotics for coughs and colds by their GPs (general practitioners). This was despite the fact that these ailments are generally caused by viruses, rather than bacteria, so antibiotics would be largely ineffective. Similarly, in the U.S., a 2016 study revealed doctor’s prescriptions were “inappropriate” up to 30 percent of the time.
Van Schaik says “patients actually expect to receive antibiotics, and it’s sometimes quite difficult to convince a patient that they are better off without it … in some countries people essentially shop around GPs to finally find a GP that will prescribe them antibiotics”.
Jeremy Hawker, who led the Public Health England study, suggests doctors offer their patients antibiotic resistance leaflets instead, as well as delayed prescribing – when patients can only collect their prescription for antibiotics several days later, in the hope that many will have improved by then. (Motherboard article).
Diagnosis weaknesses cause fall back on antibiotics
Over-prescribing antibiotics is also partially down to doctors not having the technology to diagnose with certainty whether your illness has been caused by a bacteria or virus, says MacLean.
He told WikiTribune “an ear infection is a classic example … It’s probably caused by a virus but there’s a small chance that it’s caused by bacteria.” “If it’s caused by virus and you just leave the kid, the ear will get better in a few days but if it’s caused by bacteria then it actually might develop into a serious infection that could result for example in loss of hearing”, so the doctor has to prescribe an antibiotic just in case, which drives antibiotic resistance.
In other words, “doctors prefer to be safe, rather than sorry,” says Van Schaik.
Couldn’t vaccinations be used to prevent these illnesses in the first place? MacLean says it’s harder for bacteria to evolve resistance to vaccines because “a vaccine attacks bacteria as soon as they invade your body, when the bacterial population is still small and easy to wipe out. Whereas with antibiotics, we give them to somebody when the infections are already established, so there’s lots of bacteria, and this increases the risk of the resistant mutants.”
However, he says that vaccines aren’t possible for many of the illnesses that penicillin is used to treat. “Many of the bacteria which would make us sick are actually bacteria that are kind of normal inhabitants of our body and so we can’t really vaccinate against them.”
For example, MRSA originates from a strain of bacteria, Staphylococcus aureus, which is found inside us and is normally harmless. But Van Schaik says if you did develop a vaccine you could use it to target high risk groups, such as U.S. prisoners, who he says have a “high risk of developing MRSA infections”.
However, even without vaccines, there is hope. In periods where antibiotics are used less, some studies have shown bacterial resistance goes away. MacLean says “antibiotic resistance very often comes at a fitness cost. So what this means is that when there’s no antibiotics around, the bacteria that are resistant pay a penalty for this … this then leads the idea that if we stop using antibiotics that the sensitive strains can out compete the resistant ones.”
If we use less of the antibiotics we already have, and develop new ones, “hopefully we’re going to regain the initiative in this arms race that we have with bacteria,” he says.
Penicillin was discovered in 1928 by Alexander Fleming when he realized a petri dish that had been mistakenly left open was contaminated by mold. He noticed the mold had a ring around it without a type of bacteria (Staphylococcus) and concluded the mold must produce something to prevent the bacteria from growing.
However, he didn’t revolutionize medicine until decades later. According to author Eric Lax, Fleming was unable to get chemists to help him extract penicillin, so, apart from his own experiments, little of his research was pursued.
That was until 1939 when Australian scientist Howard Florey, biochemist Ernst Boris Chain and a team of researchers picked up Fleming’s researchand managed to produce it in much larger quantities.
After successful trials in mice, Anne Miller was the first person to be saved, in 1942.
However, the UK team still couldn’t produce enough supplies so recruited U.S. help to make more in time for the 1944 Normandy invasion.
For their efforts, 72 years ago, Fleming, Florey and Chain were jointly awarded the Nobel Prize in Medicine (although many others played an important role).
However, Andrew Moyer, an American scientist leading a team working on new methods to produce penicillin in larger quantities, ended up patenting penicillin. This was because Florey decided not to do so, thinking it was unethical (academic study.) See The Guardian’s article for discussion over whether medical advancements should be patented.