Antibiotic awareness: How did we get here?

In 1927 Alexander Fleming (1881 - 1955) a Scottish biologist, physician, microbiologist, and pharmacologist, spent part of August 1928 with his family on a holiday. He returned to his lab on 3 September, finding that a stack of cultures of staphylococci left in a corner of his work bench became contaminated. Looking at the damaged cultures he was reported to have exclaimed: “That’s funny!”[1] He found that one culture was contaminated with a fungus and the colonies of staphylococci immediately surrounding the fungus has been destroyed. He identified the mold from the genus Penicillium. Fleming published his discovery in 1929 in the British Journal of Experimental Pathology. Little attention was paid to his article. Clinical trials to treat infection were inconclusive and the mold was difficult to produce in larger quantities. In the 1930s Fleming largely abandoned his work on penicillin and left Howard Florey and Ernst Boris Chain to research mass production methods. The rest is history: by 1944 enough penicillin was produced to treat all the wounded in the Allied forces.

Penicillin and other antibiotics have become a cornerstone of modern medicine. They enabled complex surgery, organ transplantation, protection from weakened immune systems, and saved patients from life-threatening infections. Antibiotics facilitated global food production, including health maintenance of farm animals.

Now this vital infrastructure of medical and health care is at risk: through overuse, microbial evolution has created a population of bacteria that has become increasingly effective in resisting our antibiotics. Fingers are being pointed at medical practitioners for overprescribing this medicine, at the public for expecting antibiotic treatment of inappropriate conditions, and at farmers for using it to control easily spreading diseases in overcrowded animals.

One problem has not been much talked about. According to two researchers posting in a recent issue of the Internet source The Conversation[2], new antibiotic development has not kept pace with the microbial evolution. Global investment in antibiotic research has stalled since the 1980s. The researchers suggest that private companies are unwilling to invest in the development of drugs that are prescribed for short time administration. Investments are more lucrative in cancer-related medications or for example statins, which are prescribed for long periods. Given the almost infrastructure status of antibiotics in the health care system, public ownership of antibiotic research, development, and production might be an effective response to the global antibiotic resistance problem. One interesting and relevant example of public financing is the not-for-profit independent Pasteur Institute developing vaccines since 1887.

The antibiotic resistance problem poses a global threat to human well-being. Time for some fresh thinking.
—George Szasz, CM, MD


1. Wikipedia. Alexander Fleming. Accessed 21 November 2019.

2. Kirchhelle C, Roberts A. Big Pharma has failed; the antibiotic pipeline needs to be taken under public ownership. The Conversation. Accessed 21 November 2019.

This post has not been peer reviewed by the BCMJ Editorial Board.