How Antibiotics and Antibiotic Resistance Transformed Medicine

October 17, 2022 - Although the development of antibiotics was a significant revolution in medicine, antibiotic education has become increasingly important as the rates of antibiotic-resistant bacteria have risen. As a result, providers are encouraged to educate patients on the appropriate uses and protocols for antibiotics to avoid antibiotic resistance.

An article published by the University of Michigan Health states that, in the United States, almost 270 million antibiotic prescriptions are written annually. This high prescription rate may be associated with multiple factors. To ensure that prescriptions are being written, filled, and used properly, healthcare professionals and consultants should comprehensively understand antibiotic development, use, and misuse.

Early Antibiotic Use

Researchers in the Frontiers of Microbiology stated that the first use of antibiotics came far before the understanding of the medication or modern iterations of the drugs.  

“Contrary to the common belief that the exposure to antibiotics is confined to the modern ‘antibiotic era,’ research has revealed that this is not the case. The traces of tetracycline, for example, have been found in human skeletal remains from ancient Sudanese Nubia dating back to 350–550 CE,” revealed authors in the article.

The Modern Antibiotic Era

For centuries, antibiotics were used but poorly understood until the modern antibiotic era, beginning in the late 19th century. Its development and progression inspired the current use of antibiotics in healthcare.

Arsphenamine

According to the Microbiology Society, antibiotics were first observed in action in the late 19th century by Paul Ehrlich. At the start of his discovery, he found that some dyes penetrated bacterial cells without disrupting other cells. In 1909, he developed the first modern antibiotic, arsphenamine, used to treat syphilis.

According to a publication in the Frontiers of Microbiology, “Ehrlich argued that chemical compounds could be synthesized that would ‘be able to exert their full action exclusively on the parasite harbored within the organism.’”

Based on information found in the publication, Ehrlich and his colleagues, Alfred Bertheim and Sahachiro Hata, began a large-scale study in 1904 to find a treatment for syphilis, which, at the time, ran rampant. Prior to their discovery of this medication, this sexually transmitted infection (STI) was treated with inorganic mercury salts, which were ineffective and led to adverse side effects.

Authors in the Frontiers of Microbiology note, “despite the tedious injection procedure and side effects, the drug, marketed by Hoechst under the name Salvarsan, was a great success and, together with a more soluble and less toxic Neosalvarsan, enjoyed the status of the most frequently prescribed drug until its replacement by penicillin in the 1940s.”

At the time, Ehrlich referred to the medication as chemotherapy, and the term antibiotic was not coined until nearly 30 years later by Selman Waksman.

Penicillin

The accidental discovery of penicillin was another significant milestone in antibiotic history. In 1928, Alexander Fleming accidentally contaminated a Staphylococcus bacteria plate with penicillium notatum, yielding bacteria-free zones.

After multiple iterations of the accidental experiment with diluted forms of penicillium notatum, Fleming concluded that penicillin effectively prevented bacterial growth.

The Frontiers in Microbiology states, “for 12 years after his initial observation, A. Fleming was trying to get chemists interested in resolving persisting problems with purification and stability of the active substance and supplied the Penicillium strain to anyone requesting it.”

In 1940, a team at Oxford composed a paper outlining the purification of penicillin. The publication of this paper eventually facilitated the mass production and distribution of the drug in 1945.

These two significant developments marked the start of the modern antibiotic era. Since then, multiple antibiotics have been developed.

The Frontiers of Microbiology states that multiple different antibiotics were developed between the 1950s and the 1970s. This is referred to as the golden era of discovery for novel antibiotic classes.

Antibiotic Resistance

While the development of antibiotics was a major benefit for healthcare, it comes with its own set of challenges, including antibiotic resistance. Researchers observed that some bacteria could destroy penicillin via enzymatic degradation. However, the ability of antibiotics to treat syphilis for decades without antibiotic resistance made researchers optimistic about penicillin.

Unfortunately, while syphilis-causing bacteria have managed to — miraculously — not become antibiotic-resistant, many other bacteria have become resistant. According to the Frontiers of Microbiology, Enterobacteriaceae, a large family of Gram-negative bacteria, have become resistant to original penicillin, semi-synthetic penicillin, cephalosporins, and carbapenems.

Impacts of Antibiotic Resistance

The publication also states that, each year, 25,000 individuals in the European Union die from multidrug-resistant bacteria. In the United States, the number of people who die from hospital-acquired bacteria is more than double that (63,000 individuals).

According to the CDC, antibiotic-resistant drugs add a $4.6 million financial burden on the US healthcare system each year.

Addressing Antibiotic Resistance

There are multiple methods to address antibiotic resistance issues, with public health organizations and healthcare facilities working tirelessly to prevent further antibiotic resistance.

The Frontiers of Microbiology states that antimicrobial stewardship “is not a single grand challenge; it is rather a complex problem requiring concerted efforts of microbiologists, ecologists, healthcare specialists, educationalists, policymakers, legislative bodies, agricultural and pharmaceutical industry workers, and the public to deal with.”

In addition to systemic changes to prevent antibiotic resistance, clinicians note that hygiene and treatment regimens may contribute to resistance rates.

Looking Ahead

The development of antibiotics has become a powerful tool for healthcare professionals while treating patients. Beyond that, antibiotic development has also contributed to additional discoveries in the healthcare industry.

“The discovery and use of antibiotics, antibiotic-resistance markers, and mobile elements such plasmids were at the foundation of genetic engineering and molecular biology that eventually resulted in spectacular successes of the human genome and other sequencing projects. These tools were also indispensable for shaping modern biotechnology ranging from the production of recombinant proteins to construction of entire metabolic pathways.,” concluded researchers in the Frontiers of Microbiology.

Despite the benefits, more research and development need to be done. Current resistant strains of bacteria will not have a treatment until new antibiotics are developed. Additionally, considering the rising rates of antibiotic resistance, providers should receive proper training on when to prescribe antibiotics and how to properly educate patients on the appropriate use of these medications.