Penicillin has single-handedly revolutionized the medicinal process. When it was first utilized during the World War II, it rapidly vanquished the biggest wartime killer-infected wounds. As a direct result of its use, millions of lives have been saved since it became widely available during World War II (Lewis 11). Penicillin's discovery led to other breakthroughs in the field of antibiotics. However, many bacteria have become increasingly resistant to penicillin and other antibiotics. The resistance of bacteria to penicillin is threatening and will continue to threaten humans as more and more viruses begin to become antibiotic-resistant. If this trend continues, simple infections of cuts could once again threaten the lives of men (Smith 39).
Alexander Fleming's "accidental" discovery of penicillin is a story worthy of the label "fairy tale." It is well known that Fleming kept his lab in less than pristine condition; in fact, Nathaniel Comfort states that Fleming followed "what Max Delbruck would later call the 'principle of limited sloppiness' " (2), with a majority of his culture dishes lying around for weeks after their intended experiment was over. Penicillin was discovered in much the same way: Fleming left a culture dish lying on the lab bench and then gone away on vacation. When he returned a few spores of an unusual mold had germinated on the plate. When he cultured the bacteria on the plate he found that they grew up to within a few centimeters of the mold, but then were killed. A crude extract of the mold was then shown to have antibacterial properties. By 1929 Fleming had named it penicillin and discovered its formula, C16H18N2O4S (Comfort 2).
Penicillin was immediately heralded as a miracle drug (Kiester 175). By preventing the formation of the stiff cell walls that bacteria need to survive, penicillin thus prevents the spread of bacteria. However, even from the beginning, some bacteria-particularly Staphylococcus aureus, which causes blood poisoning, pneumonia, and many other disorders-were resistant to penicillin (Jackson 1). That problem was at first dealt with by producing other kinds of penicillins-penicillin V, ampicillin, and amoxicillin-in addition to the original penicillin G (Holzman 11). However, recently bacteria are becoming resistant to even these high-powered bacteria (Nash 62).
In the United States, antibiotic-resistant bacteria have not caused large epidemics-yet. For example, tuberculosis is one of the diseases getting the most publicity for fighting back against antibiotics. The number of cases of tuberculosis reported in 1993 was 26,283, up from a low of 22,000 in 1984, but still well below the 84,000 recorded in 1953. However, scientists are still worried about the future (Nash 62).
In the world's poorer countries, the fight against infectious disease is already a disaster. Diseases such as malaria, tuberculosis, cholera, Dan dysentery claim more than ten million lives each year. While poor medical care and worse sanitation conditions are largely responsible for the large number of casualties, the rise in the number of antibiotic-resistant bacteria is making an already bad situation worse. For instance, the anti-malarial drug chloroquine is no longer broadly effective, and even the best substitute, mefloquine, is encountering resistance from the hardier strains of malaria (Nash 1-2).
Bacteria are expert at the game of survival; the natural selection concept of Darwin is manifested in bacteria colonies. If a colony of bacteria were to be placed in a hostile environment-a hot spring, for example-one of the little bugs would more than likely turn out to posses the critical trait that would enable it to survive. It would then divide, divide again, again and again, until there are trillions of the unicellular beasties that are able to survive in their new environment (Nash 2).
The same concept holds true for another hostile environment-a human body filled with antibiotics that are designed to kill bacteria. If one bacteria has a mutation in his DNA that allows him to survive the bombardment of penicillin G, then he is left to multiply and spread to infect others. Penicillin G will not work on this strain of bacteria, so penicillin V is used. Before long, one bacteria will develop a resistance to penicillin V as well as penicillin G. This process can continue until there are no antibiotics left to fight the bacteria.
Another way for infections to become antibiotic-resistant involves a form of microbial sex called transformation. In this process, one bacterium may take up DNA from another bacterium. Penicillin-resistant gonorrhea results from this transformation. Most frightening, however, is resistance derived not from evolution or transformation. The final method of transferring resistance is acquiring it from a small circle of DNA called a plasmid. The plasmid can dart from one type of bacterium to another. A single plasmid can provide a slew of different resistances. In 1968, 12,500 people in Guatemala died in an epidemic of Shigella diarrhea. The microbe harbored a plasmid carrying resistances to four antibiotics (Lewis 13).
Antibiotic resistance is inevitable, say scientists, but there are measures that can be taken to slow it. There are four major areas where efforts are underway to combat antibiotic resistance-improving infection control, developing new antibiotics, identifying new antibiotic-resistant strains, and using existing drugs more appropriately (Lewis 14).
Simple measures can be taken to improve infection control. More frequent hand washing by health-care workers, quick identification and isolation of patients with drug-resistant infections, and improving sewage systems and water purity in developing nations are concepts that would go a long way toward improving world health if they are implemented. The only obstacle to the implementation of these excellent ideas is the possible high costs that are involved (Lewis 14).
In the area of developing new antibiotics, great strides are already being taken. Drug manufacturers are once again becoming interested in developing new antibiotics. These efforts have been spurred by both the emergence of new bacterial illnesses, such as Lyme disease and Legionnaire's disease, and the resurgence of old foes, such as tuberculosis, due to drug resistance. Even the government is trying to help. The Food and Drug Administration (FDA) is doing all it can to speed the development and ability of new antibiotic drugs (Lewis 14).
The largest problem may be the fact that no one really knows the extent of antibiotic resistance. Every hospital is responsible for monitoring the resistance to antibiotics at their hospital, but there is no national system for watching the developing family of antibiotic-resistant drugs. But this may change soon. The Centers for Disease Control and Prevention (CDC) is encouraging local health officials to track resistance data, and the World Health Organization has initiated a global computer database for physicians to report outbreaks of drug-resistant bacterial infections (Lewis 14-15).
Using existing drugs more appropriately is more than likely the best way to provide antibiotics which will be effective longer. Antibiotics should be restricted to patients who can truly benefit from them-that is, people with bacterial infections. Already this is being done in the hospital setting, where the routine use of antibiotics to prevent infection is being reexamined. This trend must be continued in the outpatient dimension of medicine as well. Often sick patients who will receive no help from an antibiotic demand one. The doctor relents and provides the patient with a prescription that the patient does not need. As a result of that, the patient is allowing the bacteria that are harmless and ever-present in his body to develop resistance to the antibiotic. A final misuse problem is that patients often discontinue taking the drug too soon because symptoms improve. However, this merely encourages the more resistant microbes to proliferate. The infection returns a few weeks later, and this time a different drug must be used to treat it (Elash 57).
If the four areas listed above are developed to their potential, millions of lives will be saved. Doctors are still hopeful and optimistic but no longer overconfident. "I do believe we're intelligent enough to keep ahead of things," says Yale epidemiologist Dr. Robert Shope (qtd. in Lemonick 57). Still, neither he nor any of his colleagues will ever be able to claim complete victory over bacteria.
This article was submitted in my high school chemistry class on March 21, 1997.