Prior to the beginning of the twentieth century, disease ravaged the world. Even in industrialized countries, it remained a nightmare. In 1900, the average global life expectancy stood at a mere thirty-two years, yet by the end of the century–a century that was characterised by widespread warfare and severe disease–it had more than doubled. One discovery was responsible: antibiotics.

Perhaps the most significant holiday in the history of science was that taken by Sir Alexander Fleming in September 1928. Upon returning to his lab, he found that an uncovered Petri dish, which he had forgotten to place in the incubator, was contaminated with mould. Having originally filled the dish with colonies of Staphylococcus––bacteria that cause boils, sore throats and abscesses––Fleming observed that the zone immediately around the mould (a rare strain of Penicillium Notatum) was clear. By accident, Fleming had enabled a medical revolution. He had discovered a ‘mould juice’, later known as Penicillin, that could kill bacteria: the world’s first identified antibiotic. Subsequently, Howard Florey, Ernst Chain and their colleagues at the Sir William Dunn School of Pathology at Oxford University transformed penicillin from a laboratory curiosity into a life-saving drug that would transform medicine and become the foundation of modern pharmacology.

Sir Alexander Fleming

Before penicillin’s introduction, there was no effective treatment for infections such as rheumatic fever, tuberculosis or pneumonia. Many died due to food poisoning and even a papercut was potentially fatal. This is because pathogenic bacteria can enter and disrupt normal bodily functions by secreting toxins, leading to paralysis or severe immune responses that are themselves toxic. Penicillin and other antibiotics are compounds that inhibit or kill bacteria, and by using them, doctors became able to dramatically reduce deaths by bacterial infections. Subsequently, in the period between the 1940s and the 1970s, over forty antibacterial compounds were discovered and introduced, leading to this period becoming known as the ‘golden era of the discovery of novel antibiotics’. In the US during the mid-twentieth century, as a consequence of the use of antibiotics, the leading causes of death shifted from communicable diseases to non-communicable diseases (cancer, stroke, heart disease). The agricultural industry also benefitted greatly as antibiotics meant that bacterial infections in livestock were able to be effectively treated. Soon the benefits were no longer restricted to developed countries, and consumption became ubiquitous. Antibiotics had become the saviours of humanity.

However, this era of optimism did not last. From 1987 to the present day–a period commonly known as the ‘discovery void’, no new classes of antibiotics have been successfully introduced for treatment; existing antibiotics have only been modified. Even more troubling: antibiotic resistance.

Even during the initial optimism, Fleming himself had urged caution about possible resistance to the new drug. Two years after his announcement in 1945, the first case of Penicillin resistance was recorded, marking the beginning of an unprecedented antibiotic resistance crisis. Resistance to antibiotics develops as bacteria mutate and evolve through a process of natural selection. However, over the past few decades, they have done so at a staggering speed–mainly due to misuse, over-prescription and unnecessary employment in agriculture. Antibiotic laden soil, waterways and farms have been identified as the perfect breeding ground for ‘superbugs’ (drug-resistant strains of bacteria) as the small dosages only kill non-resistant bacteria, favoring those with resistant mutations. Some of these resistant bacteria are then ingested by people, whilst others spread first to local communities and then rapidly around the world, exacerbating the crisis.

Antibiotic resistance (credits to SeeYourImpact.org, Steve Greenberg)

According to a report published by the Interagency Coordination Group (IACG) on Antimicrobial Resistance in 2019, deaths caused by antibiotic resistance will become the leading cause of death by 2050, killing an estimated ten million every year. Currently, 190,000 deaths are due to tuberculosis, which was once easily treatable. However, this disease has since evolved into a ‘superbug’. Fear that the conditions of the pre-antibiotics age might return is slowly becoming a reality and, in the words of England’s chief medical officer Sally Davies, ‘the world is facing an antibiotic apocalypse’. However, there is still hope, provided that sufficient resources are devoted to research and governments more stringently regulate the use of antibiotics.

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