Collateral Damage

For most of the infectious diseases on the wards of the Boston City Hospital in 1937, there was nothing to be done beyond bed rest and good nursing care. Then came the explosive news of sulfanilamide, and the start of the real revolution in medicine. I remember the astonishment when the first cases of pneumococcal and streptococcal septicemia were treated in Boston in 1937. The phenomenon was almost beyond belief. Here were moribund patients, who would surely have died without treatment, improving in their appearance within a matter of hours of being given the medicine and feeling entirely well within the next day or so … we became convinced, overnight, that nothing lay beyond reach for the future.

Lewis Thomas, The Youngest Science: Notes of a Medicine Watcher (1)

In his splendid memoir, Lewis Thomas movingly describes what must have been the prevailing optimism at the time. Bacterial infections had been a tremendous scourge for young and old alike, and physicians had become accustomed to watching helplessly as patients succumbed to community-acquired infections caused by Streptococcus pyogenes, Staphylococcus aureus, Streptococcus pneumoniae, and Mycobacterium tuberculosis. In relatively short order, however, therapeutic failures due to the emergence of antibiotic resistance were recognized. Patients whose tuberculosis had responded to streptomycin therapy returned months later with progressive disease due to streptomycin-resistant M. tuberculosis. Resistance to penicillin in Staphylococcus aureus spread rapidly, and within a few years more than 50% of nosocomial Staphylococcus aureus isolates were penicillin resistant.

The emergence and spread of antimicrobial resistance over the ensuing decades, first in the hospital and more recently in the community, led to a concerted effort on the part of academia and industry to understand the mechanisms underlying resistance and to develop new antimicrobial agents effective for treating resistant strains. By any measure, efforts in both areas have been an enormous success. We …