Eighty-five years ago this fall, when the Scottish biologist Alexander Fleming, returning to his lab following a month’s long holiday with his family, discovered that one of his cultures of staphylococci, carelessly stacked in glass containers on a bench in a corner, had become contaminated, he could easily have missed the most important health care discovery of the 20th century.
Fleming, a man obsessed with finding a “bacteria killer” after witnessing the excruciating sepsis deaths of World War I soldiers, examined the contaminated culture and found that a mold spore, a simple fungus from the Penicillium genus, trapped in the petri dish among the deadly bacterium, had secreted a compound that killed the surrounding staphylococci. Within weeks, Fleming, growing the fungus into a pure culture and harvesting the “mold juice”, discovered lysozyme, an enzyme that attacks the cell walls of bacterium. Seven months later, on March 7, 1929, penicillin was released on the market.
Fleming’s discovery, which he openly acknowledged as a happy accident, revolutionized medicine, making diseases of nightmares such as scarlet fever, pneumonia, meningitis, diphtheria, and even gonorrhea treatable and curable. Penicillin, and its derivative antibiotics, was a giant leap forward, saving millions upon millions of lives.
But even as the world celebrated Fleming, he warned in his 1945 Nobel Prize acceptance speech, that the murderous bacterium could, eventually, evolve, developing their own countermeasures to antibiotics. Today, with the dramatic proliferation of antibiotic resistant bacterium, Fleming’s warning appears prophetic, with the editors of the Lancet Infection Disease journal recently writing, “In the very near and rapidly approaching future, the wonder drugs of the 20th century, antibiotics, may cease to be useful.”
This week the Centers for Disease Control is sponsoring “Get Smart About Antibiotics Week” to raise awareness of antibiotic resistance and to educate Americans about appropriate antibiotic use. The CDC estimates that more than 50 percent of all antibiotic prescriptions are unnecessary. Antibiotics do not work on illnesses caused by viruses, but many of us, when the first signs of illness begin to manifest, run to our physicians demanding antibiotics against the chance that we might have a bacterial, rather than viral, infection.
Physicians, ever responsive to patient demands, have all too happily obliged, flooding antibiotics into our medicine cabinets and circulatory systems, thinning the bacterial hoards but leaving behind the mutated, drug-resistant strands, accelerating the evolutionary process. Each time we unnecessarily use antibiotics, we contribute to their obsolescence.
This year, the CDC estimates that more than 23,000 Americans will die from antibiotic resistant bacterium. Should the trend continue, and super-bugs, like the carbapenem-resistant enterobacteriaceae which already infests 4 percent of all hospitals nationwide and kills nearly 50 percent of those it infects, continue to proliferate, mortality rates for even routine surgeries could return to levels from 100 years ago when 1 in 6 surgeries resulted in death.
While every effort should be made to accelerate the development of new antibiotic treatments, we cannot count on science to come to the immediate rescue. Chemists and biologists have not discovered a new class of antibiotic medicines since 1987, and there are very few promising lines of research.
We, as a society, must buy as much time as possible for the next Alexander Fleming to figure out how to combat far more sophisticated organisms that are now producing their own enzymes to break down the antibiotics we deploy against them.
So the next time you catch a cold, or develop a cough, or feel under the weather, by all means consult with your physician, but do not demand antibiotics when they are not medically indicated. You will want them to work when you really need them.
Dan Liljenquist is a former state senator and U.S. Senate candidate.