As we celebrate the 90th anniversary of the discovery of penicillin, it is appropriate to take a look at the current state of modern medicine since the discovery penicillin and the other antibiotics that followed. Here are seven ways that penicillin changed modern medicine.
1. Pneumonia and other respiratory infections
Looking at mortality data from the USA in 1928, respiratory tract infections such as pneumonia and tuberculosis caused 18% of all deaths. Without access to efficient antibiotics, pneumonia is a killer – with efficient antibiotics, community acquired pneumonia is generally cured within a week or two.
Similarly tuberculosis has been almost eradicated in high income countries thanks to antibiotics. But it is still a major scourge in low- and middle income countries claiming the lives of more than a million people every year.
Again in the year 1928, diarrhea and other gastrointestinal infections had dropped from the third most common cause of death in the USA in 1900 to causing 30,000 deaths. By the mid-30s, diarrhea had disappeared from the top 10 list. Largely thanks to access to clean water and sanitation, the amount of infections has decreased dramatically even after that.
At the same time, low and middle income countries still struggle with access to clean water and sanitation, and diarrheal diseases are way too common causes for antibiotic use, also because they often are caused by viral infections.
Wounds can become infected and require antibiotic treatment. It doesn’t even have to be a large wound, like a loss of limb in battle. Sometimes even the smallest wounds caused by for example by stepping on a sharp stone or getting stung by a wasp are enough to cause a life-threatening infection.
4. Maternal and child health
In low income countries, getting pregnant and having a child might be the two of the most dangerous things that a woman can do. 10% of maternal deaths are due to bacterial infections that could be treated with antibiotics, and one child dies every three minutes due to an infection that could have been cured with antibiotics.
Advances in hospital hygiene and sterile techniques have brought down the risk of surgical site infections in high income countries, but the risk is not completely eliminated. Surgery still relies heavily on the existence of antibiotics, especially when implanting a foreign body, like a shunt or a prosthetic heart valve. In lower income countries and crisis zones, these risks are often not possible to mitigate and antibiotics are a crucial component of all surgical care. Without antibiotics, many surgeries would be deeply unethical to perform.
6. Intensive care and critically ill patients
Intensive care units are the largest users of antibiotics in hospitals. The patients have often suffered traumas or burns that result in infections. Also, medical devices like intubation tubes and catheters pose a significant risk for hospital acquired infections. It is safe to say that our intensive/critical care would not be nearly as advanced, had it not been for antibiotics.
7. Patients with immunosuppression
Immunosuppression may be caused by either a disease or as a result of medical care. Many cancer therapies and all organ transplants cause immunosuppression – as unintentional adverse effects in the case of cancer or as intentional therapy that is crucial in the case of transplants. Patients with immunosuppression are more prone to acquire an infection and will become more seriously ill unless treated with antibiotics. Therefore access to effective antibiotics is a prerequisite for these therapies.
Penicillin changed the world
Penicillin was indeed an innovation that changed the world, and will keep doing so if we are able to provide universal, sustainable access to antibiotics over the globe.