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What Lies Beyond?

1-14 POST-ANTIBIOTIC ERA_FLEMING IMAGE.jpgBased on his laboratory observations, the famed penicillin discoverer Alexander Fleming had predicted in 1945 that misuse of this discovery could lead to the selection and propagation of mutant forms of bacteria resistant to the drug.  He warned that too small doses that fail to completely clear the infection would breed microbes trained to resist the drug, which could then eventually be passed on to other susceptible individuals. Against this warning, penicillin was eventually made freely available to the public, driven by the public clamor for this “miracle drug” and the business opportunities that came along with this medical breakthrough.  Various preparations of salves, lonzenges, nasal ointments and even cosmetic creams were sold over-the-counter.  And true enough, as Fleming correctly foretold, bacterial resistance to penicillin slowly but steadily built up over the years, to the point that by 1955, most countries restricted the use of penicillin as “by prescription” only.  However, the uncontrolled usage was already widespread, and so is the observed resistance in several bacterial pathogens, particularly staphylococci. 

A concerted effort was exerted by pharmaceutical companies to thwart this resistance, which eventually led to the discovery and introduction in the early 1960s of a semisynthetic penicillin, called methicillin, which was insensitive to the bacterial enzymes that degrade penicillin.  Although this seemed to have initially controlled penicillin resistance in the years that followed, the subsequent emergence of resistance to methicillin, such as that seen in methicillin resistant Staphylococcus aureus (MRSA), is now a current problem faced in hospitals worldwide.

This resistance phenomenon is not restricted to penicillin alone.  The same was observed for the other antibiotics which were subsequently discovered  and made commercially available to the public in the latter half of the 20th century. In the recent years, this was made even more complicated by the fact that the observed development of antimicrobial resistance has superseded the pace at which discoveries and development of better antibiotic treatments are made.  It is feared that if this is not addressed properly in time, the world will be back to the pre-antibiotic era when currently treatable infectious conditions such as pneumonia, diarrhea, or even wound infections, will eventually be considered as life-threatening due to  the lack of available effective treatment in the medical arsenal.  This has become one of the major medical issues of concern in the 21st century.

Just a few years after the golden age of antimicrobials, warning signs of developing resistance were observed. It has now become clear that microorganisms are countering the impact of antimicrobial resistance at an often alarming speed.  More and more bacteria with multiple drug resistance are also being observed. Although still surrounded by a number of controversies and debates as to the nature and gravity of this resistance phenomenon, various reports support the contention that the abuse and misuse of antibiotics is largely responsible for the developing resistance problem1, 13, 17, 18, 26.  The advent of molecular biological approaches proved that resistance genes are also horizontally transferred among bacteria at a rate that was greater than previously expected.  This poses a grim scenario for the generation to come when most antimicrobials might no longer be effective, bringing human and veterinary medicine back again to the pre-antibiotic era where common bacterial infections could once more prove lethal.

Not losing hope, the fight against microbes continues.  Several government agencies, international groups, pharmaceutical industries and other stakeholders in various countries and continents continue to work to mitigate further emergence and spread of antimicrobial resistance genes. Alternative drugs are being explored, some antimicrobials have been banned for use in food animals and regulations such as those requiring antimicrobial prescriptions are often used to promote appropriate use for both people and animals.  Worldwide, health professionals are being re-educated about the responsible and judicial use of antimicrobials. 


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