Antibiotics, also called antibacterials,
are a type of antimicrobial drug used in the treatment and prevention of
bacterial infections. They may either kill or inhibit the growth of
bacteria. A limited number of antibiotics also possess antiprotozoal
activity. Antibiotics are not effective against viruses such as the common
cold or influenza; drugs which inhibit viruses are termed antiviral drugs
or antivirals rather than antibiotics. Sometimes the term antibiotic
(which means "opposing life") is used to refer to any substance used
against microbes, synonymous with antimicrobial. Some sources distinguish
between antibacterial and antibiotic; antibacterials are used in soaps and
disinfectants, while antibiotics are used as medicine.
Antibiotics revolutionized medicine in the 20th century. Together with
vaccination, antibiotics have led to the near eradication of diseases such
as tuberculosis in the developed world. However, their effectiveness and
easy access have also led to their overuse, prompting bacteria to develop
resistance. This has led to widespread problems, so much as to prompt the
World Health Organization to classify antimicrobial resistance as a
"serious threat [that] is no longer a prediction for the future, it is
happening right now in every region of the world and has the potential to
affect anyone, of any age, in any country". Substances with antibiotic
properties had been used for various purposes since ancient times.
Penicillin, the first natural antibiotic discovered by Alexander Fleming
in 1928. Before the early 20th century, treatments for infections were
based primarily on medicinal folklore. Mixtures with antimicrobial
properties that were used in treatments of infections were described over
2000 years ago. Many ancient cultures, including the ancient Egyptians and
ancient Greeks, used specially selected mold and plant materials and
extracts to treat infections. More recent observations made in the
laboratory of antibiosis between microorganisms led to the discovery of
natural antibacterials produced by microorganisms. Louis Pasteur observed,
"if we could intervene in the antagonism observed between some bacteria,
it would offer perhaps the greatest hopes for therapeutics".
In 1874, physician Sir William Roberts noted that cultures of the mold
Penicillium glaucum that is used in the making of some types of blue
cheese did not display bacterial contamination. In 1876, physicist John
Tyndall also contributed to this field. Pasteur conducted research showing
that Bacillus anthracis would not grow in the presence of the related mold
In 1897, doctoral student Ernest Duchesne submitted a dissertation,
"Contribution ŕ l'étude de la concurrence vitale chez les micro-organismes:
antagonisme entre les moisissures et les microbes" (Contribution to the
study of vital competition in micro-organisms: antagonism between molds
and microbes), the first known scholarly work to consider the therapeutic
capabilities of molds resulting from their anti-microbial activity. In his
thesis, Duchesne proposed that bacteria and molds engage in a perpetual
battle for survival. Duchesne observed that E. coli was eliminated by
Penicillium glaucum when they were both grown in the same culture. He also
observed that when he inoculated laboratory animals with lethal doses of
typhoid bacilli together with Penicillium glaucum, the animals did not
contract typhoid. Unfortunately Duchesne's army service after getting his
degree prevented him from doing any further research. Duchesne died of
tuberculosis, a disease now treated by antibiotics.
Alexander Fleming was awarded a Nobel prize for his role in the discovery
of penicillin. In 1928, Sir Alexander Fleming identified penicillin, a
molecule produced by certain molds that kills or stops the growth of
certain kinds of bacteria. Fleming was working on a culture of
disease-causing bacteria when he noticed the spores of a green mold,
Penicillium chrysogenum, in one of his culture plates. He observed that
the presence of the mold killed or prevented the growth of the bacteria.
Fleming postulated that the mold must secrete an antibacterial substance,
which he named penicillin in 1928. Fleming believed that its antibacterial
properties could be exploited for chemotherapy. He initially characterized
some of its biological properties, and attempted to use a crude
preparation to treat some infections, but he was unable to pursue its
further development without the aid of trained chemists.
Ernst Chain, Howard Florey and Edward Abraham succeeded in purifying the
first penicillin, penicillin G, in 1942, but it did not become widely
available outside the Allied military before 1945. Later, Norman Heatley
developed the back extraction technique for efficiently purifying
penicillin in bulk. The chemical structure of penicillin was first
proposed by Abraham in 1942 and then later confirmed by Dorothy
Crowfoot Hodgkin in 1945. Purified penicillin displayed potent
antibacterial activity against a wide range of bacteria and had low
toxicity in humans. Furthermore, its activity was not inhibited by
biological constituents such as pus, unlike the synthetic sulfonamides.
(see below) The discovery of such a powerful antibiotic was unprecedented,
and the development of penicillin led to renewed interest in the search
for antibiotic compounds with similar efficacy and safety.For their
successful development of penicillin, which Fleming had accidentally
discovered but could not develop himself, as a therapeutic drug, Chain and
Florey shared the 1945 Nobel Prize in Medicine with Fleming.
Florey credited Rene Dubos with pioneering the approach of deliberately
and systematically searching for antibacterial compounds, which had led to
the discovery of gramicidin and had revived Florey's research in
penicillin. In 1939, coinciding with the start of World War II, Dubos had
reported the discovery of the first naturally derived antibiotic,
tyrothricin, a compound of 20% gramicidin and 80% tyrocidine, from B.
brevis. It was one of the first commercially manufactured antibiotics and
was very effective in treating wounds and ulcers during World War II.
Gramicidin, however, could not be used systemically because of toxicity.
Tyrocidine also proved too toxic for systemic usage. Research results
obtained during that period were not shared between the Axis and the
Allied powers during World War II and limited access during the Cold War.
Synthetic antibiotics derived from dyes
Synthetic antibiotic chemotherapy as a science and development of
antibacterials began in Germany with Paul Ehrlich in the late 1880s.
Ehrlich noted certain dyes would color human, animal, or bacterial cells,
whereas others did not. He then proposed the idea that it might be
possible to create chemicals that would act as a selective drug that would
bind to and kill bacteria without harming the human host. After screening
hundreds of dyes against various organisms, in 1907, he discovered a
medicinally useful drug, the first synthetic antibacterial salvarsan now
Dr. Paul Ehrlich and Dr. Sahachiro Hata : The era of antibacterial
treatment began with the discoveries of arsenic-derived synthetic
antibiotics by Alfred Bertheim and Ehrlich in 1907. Ehrlich and Bertheim
experimented with various chemicals derived from dyes to treat
trypanosomiasis in mice and spirochaeta infection in rabbits. While their
early compounds were too toxic, Ehrlich and Sahachiro Hata, a Japanese
bacteriologist working with Erlich in the quest for a drug to treat
syphilis, achieved success with the 606th compound in their series of
experiments. In 1910 Ehrlich and Hata announced their discovery, which
they called drug "606", at the Congress for Internal Medicine at
Wiesbaden. The Hoechst company began to market the compound toward the end
of 1910 under the name Salvarsan. This drug is now known as arsphenamine.
The drug was used to treat syphilis in the first half of the 20th century.
In 1908, Ehrlich received the Nobel Prize in Physiology or Medicine for
his contributions to immunology. Hata was nominated for the Nobel Prize in
Chemistry in 1911 and for the Nobel Prize in Physiology or Medicine in
1912 and 1913.
The first sulfonamide and the first systemically active antibacterial
drug, Prontosil, was developed by a research team led by Gerhard Domagk in
1932 or 1933 at the Bayer Laboratories of the IG Farben conglomerate in
Germany, for which Domagk received the 1939 Nobel Prize in Physiology or
Medicine. Sulfanilamide, the active drug of Prontosil, was not
patentable as it had already been in use in the dye industry for some
years. Prontosil had a relatively broad effect against Gram-positive cocci,
but not against enterobacteria. Research was stimulated apace by its
success. The discovery and development of this sulfonamide drug opened the
era of antibacterials.
Antibiotics are used to treat or prevent bacterial infections, and
sometimes protozoan infections. (Metronidazole is effective against a
number of parasitic diseases). When an infection is suspected of being
responsible for an illness but the responsible pathogen has not been
identified, an empiric therapy is adopted. This involves the
administration of a broad-spectrum antibiotic based on the signs and
symptoms presented and is initiated pending laboratory results that can
take several days.
When the responsible pathogenic microorganism is already known or has been
identified, definitive therapy can be started. This will usually involve
the use of a narrow-spectrum antibiotic. The choice of antibiotic given
will also be based on its cost. Identification is critically important as
it can reduce the cost and toxicity of the antibiotic therapy and also
reduce the possibility of the emergence of antimicrobial resistance. To
avoid surgery, antibiotics may be given for non-complicated acute
Antibiotics may be given as a preventive measure (prophylactic) and this
is usually limited to at-risk populations such as those with a weakened
immune system (particularly in HIV cases to prevent pneumonia), those
taking immunosuppressive drugs, cancer patients and those having surgery.
Their use in surgical procedures is to help prevent infection of incisions
made. They have an important role in dental antibiotic prophylaxis where
their use may prevent bacteremia and consequent infective endocarditis.
Antibiotics are also used to prevent infection in cases of neutropenia
There are different routes of administration for antibiotic treatment.
Antibiotics are usually taken by mouth. In more severe cases, particularly
deep-seated systemic infections, antibiotics can be given intravenously or
by injection. Where the site of infection is easily accessed, antibiotics
may be given topically in the form of eye drops onto the conjunctiva for
conjunctivitis or ear drops for ear infections and acute cases of
swimmer's ear. Topical use is also one of the treatment options for some
skin conditions including acne and cellulitis. Advantages of topical
application include achieving high and sustained concentration of
antibiotic at the site of infection; reducing the potential for systemic
absorption and toxicity, and total volumes of antibiotic required are
reduced, thereby also reducing the risk of antibiotic misuse. Topical
antibiotics applied over certain types of surgical wounds have been
reported to reduce the risk of surgical site infections. However, there
are certain general causes for concern with topical administration of
antibiotics. Some systemic absorption of the antibiotic may occur; the
quantity of antibiotic applied is difficult to accurately dose, and there
is also the possibility of local hypersensitivity reactions or contact
Health advocacy messages such as this one encourage patients to talk with
their doctor about safety in using antibiotics. Antibiotics are screened
for any negative effects before their approval for clinical use, and are
usually considered safe and well tolerated. However, some antibiotics have
been associated with a wide extent of adverse side effects ranging from
mild to very severe depending on the type of antibiotic used, the microbes
targeted, and the individual patient. Side effects may reflect the
pharmacological or toxicological properties of the antibiotic or may
involve hypersensitivity or allergic reactions. Adverse effects range from
fever and nausea to major allergic reactions, including photodermatitis
and anaphylaxis. Safety profiles of newer drugs are often not as well
established as for those that have a long history of use.
Common side-effects include diarrhea, resulting from disruption of the
species composition in the intestinal flora, resulting, for example, in
overgrowth of pathogenic bacteria, such as Clostridium difficile.
Antibacterials can also affect the vaginal flora, and may lead to
overgrowth of yeast species of the genus Candida in the vulvo-vaginal
area. Additional side-effects can result from interaction with other
drugs, such as the possibility of tendon damage from the administration of
a quinolone antibiotic with a systemic corticosteroid.