Eighty years ago, when Alexander Fleming noticed the antibacterial properties
of a fungal spore in one of his petri dishes, he changed the course of
history. His discovery of penicillin in September 1928 allowed common
diseases such as tuberculosis and syphilis to be treated, surgery to become
less dangerous and medicine itself to become more decisive. The age of the
antibiotic was born.
Penicillin has since saved more lives than any other single drug, but as
Fleming himself was aware, its very success risked future failure.
When he received the Nobel prize for medicine in 1945, with Howard Florey and
Ernest Chain, the scientists who worked on the development of penicillin as
a drug, Fleming told the audience: “The time may come when penicillin can be
bought by anyone in the shops. Then there is the danger that the ignorant
man may easily underdose himself and, by exposing his microbes to non-lethal
quantities of the drug, make them resistant.”
Today, the scales have begun to tip as Fleming feared. Strains of “superbugs”
such as MRSA and C. difficile are serious public health issues, while even
tuberculosis has returned in isolated cases. The overuse and misuse of
antibiotics has contributed to the rise of resistant strains of bacteria,
but the development of new antibiotics is falling. Fleming’s work was a
breakthrough, but relatively few scientists are trying to emulate his
achievement.
“Drug companies have made the decision to go into areas where people will be
taking drugs for a long time — conditions like asthma, obesity and
Alzheimer’s,” says Dr Dominic Campopiano, a senior lecturer in organic
chemistry at Edinburgh University. “As we get older, people are living
longer, which means people are going to be on these drugs for 20 or 30 years.
“Infections, on the other hand, can come and go very quickly. Sales of
erythromycin, a good general antibiotic, are still huge, and drug companies
are still making money — it’s just whether or not they want to invest in new
compounds.”
The very strength of penicillin and the antibiotics that followed became a
weakness. The impact of Fleming’s work was so emphatic that complacency set
in during the following decades, as the misplaced conviction took hold that
the antibiotics already identified would continue to overcome all
infections. They still represent a powerful and effective medical tool, but
only if they continue to be renewed.
Jim Naismith, professor of chemical biology at St Andrews University, says
scientists need to keep one step ahead of bacteria. “If we don’t do the
basic research, we could run out of new antibiotics and then eventually we
would have a serious problem.
“But it’s unlikely to reach that stage. What’s more likely is that antibiotics
will cost more money and when people go into hospital, instead of assuming
that surgery is the risk, they’ll be hoping that they are not the one in 10
who suffers an infection that kills them.”
With pharmaceutical firms being driven by economics into different fields, it
is falling on university laboratories and academics to stimulate the
development of new antibiotics.
In work funded partly by the Scottish government, Naismith and his colleague,
Professor Ian Booth of Aberdeen University, recently discovered a
pressure-release valve in bacteria that could be targeted by new drugs,
allowing superbugs to be treated. Drugs that stimulate the immune response
can also be used in the fight against bacterial infections, but the
antibiotic age is not over.
“People will still be taking antibiotics in 80 years,” says Campopiano, “but
maybe we need to be more specific with what they are used to treat. People
go to the doctor because they feel unwell and they’re given antibiotics
without any tests to see if it’s a bacterial or viral infection. It is
resistance to antibiotics that will cause a recurring infection.”
The continuing relevance of antibiotics 80 years after their discovery
highlights the importance of Fleming’s groundbreaking work.
As a child playing in the fields at Lochfield Farm near Darvel in East
Ayrshire, he developed the curiosity and sharp observational skills that
proved crucial to his discovery.
In his laboratory at St Mary’s hospital in London, where he was professor of
bacteriology, Fleming realised that a bacteria-free circle had formed round
a mould that had contaminated one of his staphylococci cultures, and
immediately grasped the significance of his observation.
Yet the former Kilmarnock Academy pupil, who began his working life as a
shipping clerk before attending St Mary’s medical school, remained diffident
and unassuming, even in the midst of the attention that followed his
discovery. “Penicillin brought him fame,” says Kevin Brown, curator of the
Alexander Fleming Laboratory Museum at St Mary’s.
“Before, he was a fairly modest scientist — interesting, but a very poor
lecturer who didn’t shine in society because he was silent most of the time.
The students thought he was a bit of a joke because he tended to mumble and
they didn’t understand his lectures.
“After penicillin, he blossomed into this great man, somebody everybody wanted
to meet.”
But to maintain his legacy, others must keep following in his wake.
