“When I woke up just after dawn on September 28, 1928, I certainly didn’t plan to revolutionize all medicine by discovering the world’s first antibiotic, or bacteria killer. But I suppose that was exactly what I did.”

Alexander Fleming, writes Dr. Howard Markel as he recounts revolutionary incidents that changed the course of medicine.

What are Antibiotics and why do we use them?

Antibiotics are chemicals used to prevent the growth of bacteria or kill them. We humans use it as medicines to treat bacterial infections and diseases. Animals are also prescribed antibiotics for the same and also enhance growth. 

Bacteria, like other microorganisms,  can infect a host. A host is an organism where the bacteria enters, derives food from, and causes harm while doing so. This results in diseases. The host can combat the harm caused by antibiotics.

A Brief History of antibiotics

Fleming went on to win the Nobel Prize but wasn’t awarded one for his lack of organisational skills. He left the mucus he sampled from his nose in his lab clutter. He was keen to find out why bacteria didn’t grow in one clear space on a Petri plate. He found a chemical killing bacteria in that area, which he decided to call lysozyme. He further found lysozyme in nails, hair, skin, and tried to collect it. Scientists paid no attention to this bacteria killer on the loose. Lysozymes are antibiotic in nature, they kill bacteria. This was the groundwork for the discovery of penicillin.

During his work with staphylococcus bacteria, he discovered molds -a fungus that grows in multicellular forms, growing on contaminated plates of bacteria.  The bacteria around molds were being killed by something, he called mould juice. This too gathered little attention but he tried to extract this mould juice in large quantities. He didn’t have the skillset or access to equipment to make this possible.

Howard Florey, Ernst Chain, and Norman Heatley are important in this story because they made penicillin in large quantities. Mass production enabled its use as mainstream medicine. This was how antibiotic production started.

Bacteria pose a challenge to antibiotics.
Illustration by Namrata, developed for SciRio by Leeba.

What is Antibiotic Resistance?

With overuse and misuse of antibiotics, Antibiotic Resistance emerges. 

Bacterial populations stop being sensitive to antibiotics. They become resistant and can continue to grow even in the presence of an antibiotic. For the bacterial host, it means they would continue to succumb to infection and the antibiotic is rendered useless.

Bacteria modify old genes to make themselves resistant to antibiotics. They want to survive and want to be selected, by nature, from a population of bacteria that can be divided into resistant and non-resistant ones. They change their internal properties to resist the action of antibiotics. It takes a short time for a new resistant bacterial population to emerge. Resistant bacteria can transfer resistance genes to the same species of bacteria. Some bacteria resistant to multiple antibiotics are called Superbugs.

How do humans influence Antibiotic Resistance?

The spread of antibiotic resistance is also influenced by humans. Socioeconomic and behavioural factors in developing countries — mishandling of antibiotics, lack of informed choices by the public, poor hygiene and sanitation, and self-medication are some of the reasons responsible.

The environment becomes a reserve of antibiotics once it is used by humans and animals, and processed waste is generated. Continuous accumulation of antibiotics influences bacteria to evolve, as well, into resistant populations.

Why should the public care about Antibiotic Resistance?

Using alternatives to antibiotics in this era is costly and can prove to be more toxic. Current advancements in technology can synthesise specialised proteins that have antibacterial properties added to them. Scientists are also working on finding newer antibiotics to keep up with the rate of older antibiotics becoming unusable. Newer the technology, the costlier it becomes unless a frugal and accessible policy of distribution is decided upon by authorities.

Considering a developing country like India, prevention strategies work better than waiting for technology to become cheaper. Public health officials, doctors, and the public should be constantly reminded of this problem and educated at different levels about their role in tackling this crisis. 

Preventing resistance is the best chance we have, to fight antibiotic resistance, an emerging global health problem.

In the next article of this series, find out more about how these bacteria evolve themselves to gain resistance to certain chemicals/compounds.

References

1. Markel, H. (2013, September 27). The real story behind penicillin. PBS NewsHour. https://www.pbs.org/newshour/health/the-real-story-behind-the-worlds-first-antibiotic

2. Columbus, C. (2016, January 29). In a world with no antibiotics, how did doctors treat infections? The Conversation. https://theconversation.com/in-a-world-with-no-antibiotics-how-did-doctors-treat-infections-53376

3. Adedeji W. A. (2016). THE TREASURE CALLED ANTIBIOTICS. Annals of Ibadan postgraduate medicine, 14(2), 56–57.

4. Tan, S. Y., & Tatsumura, Y. (2015). Alexander Fleming (1881-1955): Discoverer of penicillin. Singapore medical journal, 56(7), 366–367. https://doi.org/10.11622/smedj.2015105

5. Davies, J., & Davies, D. (2010). Origins and evolution of antibiotic resistance. Microbiology and molecular biology reviews: MMBR, 74(3), 417–433. https://doi.org/10.1128/MMBR.00016-10

6. Manyi-Loh, C., Mamphweli, S., Meyer, E., & Okoh, A. (2018). Antibiotic Use in Agriculture and Its Consequential Resistance in Environmental Sources: Potential Public Health Implications. Molecules (Basel, Switzerland), 23(4), 795. https://doi.org/10.3390/molecules23040795

7. Source for featured image: https://commons.wikimedia.org/wiki/File:A_course_of_green_cefalexin_pills.jpg, Wikimedia commons