Antibiotics in use: not accidental

I’m going to tell you a story from the early days of antibiotics. And boy, is this a story to be shared? It is the story of a precious antibiotic. And it includes the painstaking process and sacrifices made to get penicillin in production. We have all heard the glorious story of how Fleming made the discovery that probably many had made before him, but Fleming acted upon it. Florey and Chain and colleagues followed up with studies on side effects and correct dosage. And not many people took antibiotics serious before World War II. Mix chemicals into the patient? Sounded absurd at the time. Also penicillin was difficult to produce. So how could they win the Nobel Prize in 1945?

That was because something had happened prior to 1945. And these were incidents that were not in the hands of Fleming, Florey, and Chain. There was a big fire in Boston. It killed hundreds and injured more. They knew how to party back then. But to make sure everyone paid their entrance, the emergency exits were blocked. When the blaze occurred, the revolving doors were no good exit. If a person tripped or fainted inside the door, everyone left inside were trapped. Here’s a fun fact. This fire is the reason why modern revolving doors collapse on forced impact. Merck and Company had produced a 32-litre penicillin culture based on their trust in the potential of Fleming, Florey, and Chain’s new chemical.

They rushed it up to Boston and had sufficient to prevent infection in 13 skin graft recipients. The dosages they received were much lower than what we would recommend today. But resistance was low at the time. The treatment succeeded. And this was not common at that time. This woke the mighty War Production Board up. They saw the value in treating US soldiers in the Pacific with penicillin. They initiated a major investment, industrial investment, and built large factories that produced penicillin for the soldiers. Penicillin was now in mass production. Soldiers were treated for war wounds, and lives were saved. The war ended, and penicillin became known as the wonder drug. It also cured other diseases more or less connected to war activities.

Other companies started producing penicillin, Upjohn, Squibb, Heyden, Park Davis. Competition grew. And innovative applications resulted. Pomade is only one example. In Journal of American Medical Association in 1945, this correspondence warns against the commercialization of patent medicine. We must not find penicillin in chewing gum, cough drops, mouthwash, skin creams, laxatives, et cetera. More groups of antibiotics were developed through the ’40s, ’50s, and ’60s. Above this timeline, you can see when major antibiotic groups were developed. And below the timeline, you can see when resistance was first described against them. After the ’60s, few new antibiotics have been developed.

Who wants to invest in a product you are not supposed to sell as much as possible of and that may turn ineffective after a short time on the market? So antibiotics were not an accident. We needed a discovery with the follow-up studies and description. We needed a bold and optimistic company to try it out. We needed a tragic fire. And we needed a World War and the War Production Board that launched an industrial investment rarely seen. So my take-home message is, antibiotics did not come easy. We need special economic models to develop new ones. And this is not a commercial product. Take care of them. And prevent AMR from developing and spreading. And use antibiotics correct.