On penicillin

Today, we have a guest post by Philip Lederer, an Infectious Disease fellow at Massachusetts General Hospital and Brigham and Women’s Hospital, and a former Epidemic Intelligence Service Officer at the Centers for Disease Control and Prevention (CDC). His views do not represent any of those organizations.

Bright and alert, the elderly woman sat in a chair in the corner of her hospital room. Snow fell lightly outside. An IV ran into her arm, giving her antibiotics for a bloodstream infection. Meanwhile, she told me her story:

“I started nursing school in 1943 and soon after we first started giving penicillin. I don’t remember my first patient who got it, but we ended up giving it to many people. We didn’t realize at the time that penicillin would turn out to be so amazing. What I remember most clearly was the size of the 18-gauge needle we used. It was so big. We had to inject intramuscularly, into the patients’ buttocks, every four hours. It would turn their buttocks black. And the injections were so painful. 

When I would walk into a patient’s room, I would think, ‘Oh God, do I really have to do this again?’ 

But before penicillin, people died, and afterwards, they lived. The patients loved it and hated it at the same time. It was wonderful and horrible.”

Now, more than seventy years later, we are heading towards an era of untreatable bacterial infections. The penicillin miracle may someday be a memory. As an infectious disease physician-in-training, I see antibiotic resistant bacterial infections every day. I believe the writing is on the wall.

While the Centers for Disease Control and Prevention (CDC) and the White House have issued reports and launched initiatives, little is changing in the trenches, our hospitals and clinics. Antibiotics are prescribed widely and often carelessly. There are no easy solutions, other than a wholesale change in the practice of medicine and an emphasis on antibiotic stewardship.