How Alexander Fleming predicted antibiotic resistance in 1945

The scientist who discovered penicillin predicted a time when antibiotics could become less useful due to frequent or improper use.

Alexander Fleming shared his vision as a cautionary tale when collecting the Nobel Prize for his seminal work in 1945.

Now England’s chief medical officer Dame Sally Davies will repeat the warning about antibiotic resistance while discussing the response of the health and scientific communities to the problem and the need for further action.

England's Chief Medical Officer Dame Sally Davies at The Huxley Summit
Dame Sally Davies (Frantzesco Kangaris/PA)

In his Nobel lecture, Fleming set out a hypothetical tale when members of the same family became ill one-by-one with the moral: “If you use penicillin, use enough.”

The story was recently shared by @NobelPrize on Twitter as it prepared to announce this year’s winners.

Fleming, who received his award with Ernst Chain and Sir Howard Florey, said that overdosing was unlikely.

“There may be a danger, though, in underdosage,” he said. “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.”

He then sets out his example.

“Mr X has a sore throat. He buys some penicillin and gives himself, not enough to kill the streptococci but enough to educate them to resist penicillin. He then infects his wife.

“Mrs X gets pneumonia and is treated with penicillin. As the streptococci are now resistant to penicillin the treatment fails. Mrs X dies. Who is primarily responsible for Mrs X’s death? Why Mr X whose negligent use of penicillin changed the nature of the microbe. Moral: If you use penicillin,
use enough.”

Guide to Edinburgh University collections launched
A sample of mould that enabled Fleming to discover the antibiotic power of penicillin (Jane Barlow/PA)

The exact concerns have changed somewhat since Fleming’s time but the issue of resistance is the same.

Antimicrobial drugs are those which destroy harmful microbes. Antibiotics, such as penicillin, are the best known of these drugs, but there are others, such as antivirals, antimalarial drugs and antifungals.

Over time, the microbes have become resilient.

Antibiotic Research UK, which has organised the October 11 event with Dame Sally, is working to combat the resistance and develop new therapies. It fears “if we don’t act now, in 10-15 years’ time many routine medical procedures will become impossible”.

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In September, the World Health Organisation described antimicrobial resistance as “a global health emergency”.

One of the issues is the lack of new antibiotics in development.

In the same month, the UK Government and British research charity the Wellcome Trust joined Germany, Luxembourg, the Netherlands, South Africa and Switzerland to pledge more than 56 million euro to the Global Antibiotic Research and Development Partnership.

Later this week, government ministers and scientists will be among those meeting in Berlin at an international conference on the topic.

Life, HealthWeb editor