The history of antibiotics and antimicrobial resistance
Infectious diseases have been a feature of life and death throughout history. Humans have been treating infections for millennia, including use of materials with antimicrobial properties such as herbs, honey and even topical applications of mouldy bread. In Aotearoa New Zealand, rongoā Māori (the traditional Māori healing system) involves a variety of plants (for example, kawakawa and mānuka) and other natural resources as medicine, including to treat infectious diseases.
Mānuka
Mānuka has been used as medicine by Māori for centuries. The leaves and oil of the mānuka tree are used to treat a wide range of ailments, including infection.
Today, mānuka is also known for its honey, which is produced by bees that feed on the nectar of the mānuka tree’s flowers.
Mānuka honey is commonly used topically to treat wounds, burns and other skin conditions. It is believed to help promote the healing process by reducing inflammation, preventing infection and stimulating the growth of new tissue.
Early in the 20th century, antibiotics were discovered, which revolutionised modern healthcare. In 1928, Scottish physician Alexander Fleming discovered penicillin, a naturally occurring antimicrobial produced by a type of mould. Fleming’s discovery paved the way for the development of antibiotics.
From the 1940s, streptomycin and many other antibiotics were discovered by studying soil microbes. These new antibiotics were effective against a wide range of bacterial infections.
The widespread use of antibiotics in the 1950s and 1960s led to a significant decrease in infectious disease mortality rates and contributed to the rapid increase in life expectancy.
However, the overuse and misuse of antibiotics have led to the emergence of antibiotic-resistant bacteria. Antibiotic resistance (AMR) has become a major public health concern, and scientists are searching for new ways to combat antibiotic-resistant infections.
Methicillin-resistant Staphylococcus aureus (MRSA) bacteria
Staphylococcus aureus is a type of bacteria that is commonly found on the skin and in the nose of healthy individuals. While it usually does not cause any harm, it can cause infections if it enters the body through a cut or other opening. Methicillin-resistant Staphylococcus aureus (MRSA) is resistant to several common antibiotics, including methicillin, penicillin and amoxicillin. This means that these antibiotics are not effective in treating MRSA infections.
Digitally coloured micrograph by National Institute of Allergy and Infectious Diseases (NIAID).
MRSA (methicillin-resistant Staphylococcus aureus) is an example of an infection that has become resistant to some commonly used antibiotics. Prevention measures for MRSA include good hygiene practices such as washing hands regularly with soap and water, using alcohol-based hand sanitisers, keeping cuts and wounds clean and covered and avoiding sharing personal items.
Supporting animal and plant health
Antibiotics are also an important part of animal health. Antibiotics like tetracyclines are used in farmed animals (pigs, chickens, sheep and cows) with smaller amounts used for companion animals like cats and dogs and aviary birds. Streptomycin is used in horticulture to treat blight and bacterial diseases in tomatoes, pipfruit and stone fruit. The use of antibiotics in agriculture and horticulture in New Zealand is low by international standards, but antimicrobial resistance is still a concern.
Timeline
The interactive timeline below outlines some of the historical developments related to the development and discoveries of antimicrobials and antibiotics and the subsequent development of antimicrobial resistance (AMR). It also shows how scientific thinking has changed as modern science developed. A full transcript is underneath.
Antibiotics and antimicrobial resistance – a timeline
- Discovery and use of antimicrobials
- Scientific discoveries
- Antimicrobial resistance develops
Ancient civilisations use antimicrobials in medicine
Humans have been using medicines since prehistoric times to treat various ailments – primarily herbs and other natural substances with healing properties. Ancient civilisations such as the Egyptians, Greeks and Chinese develop sophisticated medical systems that rely heavily on plant-based remedies.
Antibiosis described
Public domain, copyright expired
Antibiosis, a biological process where one organism inhibits the growth of another, is observed by Louis Pasteur and Robert Koch. They observe that microbes can secrete material to kill certain bacteria.
Image: Painting of Louis Pasteur by Albert Edelfelt.
Search begins for chemicals with antibiotics
Wellcome Images, CC BY 4.0
During the late 1800s, German physician and scientist Paul Ehrlich begins to systematically search for a chemical agent that will selectively kill bacteria, leaving humans unharmed. His search comes to fruition in 1907 with the synthesis of the arsenic-containing organic molecule arsphenamine, which has activity against the causative agent of syphilis (Treponema pallidum).
Image: A Salvarsan treatment kit for syphilis, Germany, 1909–1912.
First synthetic antimicrobial used in humans
Paul Ehrlich develops the first antimicrobial treatment used to treat humans – Salvarsan. It has severe side-effects, partly because it contains arsenic, a poison.
Penicillin discovered
Public domain
Alexander Fleming discovers the first modern antibiotic. He observes that the growth of the Staphylococcus aureus bacteria living in Petri dishes is inhibited by substances produced by the fungus Penicillium chrysogenum. This leads to the creation of the first antibiotic, penicillin.
Image: Professor Alexander Fleming in his laboratory at St Mary's, Paddington, London in 1943.
Resistance identified
Some bacteria become resistant to the antimicrobial Salvarsen.
Sulphonamides discovered
Sulphonamides are a group of synthetic antibacterial medicines. They are the first truly effective, broad-spectrum antimicrobials used for treating infection in humans and animals. They are still in use today but were largely superseded by the discovery of penicillin.
Introduction of antibiotic use in animals
Antibiotics are initially used to only treat sick animals. Later, it is discovered they can be used to promote growth.
More resistance appears
Certain bacteria become resistant to sulphonamides.
Soil bacteria testing for antibiotic properties
Soil bacteria testing for antibiotic properties begins in the 1940s, when researchers discover naturally occurring antimicrobials like streptomycin and cephalosporins from soil microbes. This leads to the discovery of many major antibiotic families that we know today.
Penicillin approved for clinical use in humans
Public domain
US scientists optimise penicillin production via fermentation and are able to produce enough for the Allied Armed Forces.
Image: World War II poster extolling the use of penicillin.
Streptomycin discovered
Streptomycin is the first antibiotic to be successful against tuberculosis.
Golden age of antibiotics
Public domain
The discovery of natural product antibiotics peaks in the mid-1950s – including streptomycin, cephalosporins, tetracyclines, vancomycin and methicillin. Most of the antibiotics discovered in this ‘golden age’ – 1944 to 1966 – are still in use, but their effectiveness has been eroded by antimicrobial resistance. The rapid and relatively easy discovery of natural product antibiotics during a relatively short period leads to the excessive use of these drugs.
Image: X-ray of a patient diagnosed with tuberculosis.
Penicillin resistance identified
Public domain
Shortly after the introduction of penicillin, resistance is identified in the bacteria Staphylococcus aureus, a common cause of serious infection in people and animals.
Image: Scanning electron micrograph of methicillin-resistant Staphylococcus aureus bacteria (yellow) and a dead human white blood cell (coloured red). National Institute of Allergy and Infectious Diseases (NIAID)/NIH, released into the public domain.
First antibiotic licensed for use in animal feeds
In the United States, the antibiotic sulfaquinoxaline becomes the first antibiotic to be routinely administered in poultry feed to prevent disease.
Antibiotics used to promote animal growth and prevent plant disease
During the 1950s, antibiotics are first used as growth promoters in animal feed. Horticultural sprays of antibiotics are used to combat disease in fruit trees.
Antibiotic use increasing in global food production
In the 1960s, antibiotics are widely used to promote growth in farm animals. Some countries restrict veterinary prescription of medically important antibiotics and warn of the risk of antibiotic resistance.
Methicillin resistance identified in the bacteria <i>Staphylococcus aureus</i>
The resistant bacteria are described as MRSA (methicillin-resistant Staphylococcus aureus). These bacteria are resistant to all antibiotics in the penicillin class of antibiotics so infection is difficult to treat.
Vancomycin resistance identified in the bacteria <i>Enterococcus</i>
Vancomycin-resistant gram-positive bacteria can become resistant to all antibiotics.
Lipopeptides discovered
The last class of clinically used antibiotics is discovered.
Resistance to different antibiotics continues to emerge
Public domain
Resistance to common antimicrobial drugs increases, and readily treatable infections are becoming increasingly challenging to manage.
Read about the presence of antibiotic-resistant bacteria in New Zealand in the article Is the post-antibiotic era now here?
Image: Two Petri dish culture plates growing bacteria in the presence of discs containing various antibiotics.
Some countries restrict use of growth-promoting antibiotics
The European Union bans the use of certain antibiotics used as growth promoters in animals.
New Zealand bans use of antibiotics as growth promoters
Concerns about the development of antibiotic-resistant bacteria and the potential impact on human health lead to a ban on the use of antibiotics as growth promoters in animal feed in New Zealand. The ban applies to all antibiotics that pose an antimicrobial resistance risk to animals or humans.
Global AMR emergency declared
Antimicrobial resistance is declared a global emergency by the World Health Organization. The World Health Assembly adopts a global action plan on AMR.
Read about the first global report on antimicrobial resistance.
2023 onwards
In just over 100 years, antibiotics have drastically changed modern medicine and extended the average human lifespan by 23 years. The dangers of a post-antibiotic era have prompted policy makers to acknowledge this threat to human health. Appropriate use of antibiotics and preventing infection by vaccination and good hygiene are critical.
Antibiotics and antimicrobial resistance – a timeline
This timeline follows the historical events related to the development and discoveries of antimicrobials and antibiotics and the growth of antimicrobial resistance (AMR).
A full transcript is underneath the timeline.
Antibiotics and antimicrobial resistance – a timeline
This timeline follows the historical events related to the development and discoveries of antimicrobials and antibiotics and the growth of antimicrobial resistance (AMR).
A full transcript is underneath the timeline.
Nature of science
We often think of science with a modern . However, the processes of science – observation, inquiry and the use of evidence – have been used to combat disease over the span of human existence.
Related content
We have many antimicrobial resistance resources you can use – they are all organised in this handy interactive, part of this associated PLD article.
Take a closer look at antimicrobial resistance in this article.
Find out what you can do to reduce the risks of antimicrobial resistance.
Watch our webinar The science of superbugs – teaching antimicrobial resistance awareness in Aotearoa with Dr Siouxsie Wiles.
The Hub team created the collection Antimicrobial resistance resources to support teaching and learning about AMR. It is ready for you to use and customise as you choose.
Fighting infection – timeline looks at some of the historical aspects of fighting infection, covering early discoveries on germs, vaccination, how our bodies help us to get better and more. Explore the history of vaccination and immunisation in New Zealand.
Useful links
Royal Society Te Apārangi has produced a of articles and videos about antimicrobial resistance, including te reo Māori resource He uaua ake te rongoā i ngā whakapokenga ātete rongoā.
Find out more about the Infectious disease and antimicrobial resistance report from the Office of the Prime Minister’s Chief Science Advisor released in March 2022. There are a ss of recommendations under six themes to help Aotearoa New Zealand unite against the threat of infectious disease and antimicrobial resistance.
The Ministry of Health has information and links on its website – Resources for antibiotic awareness.
Listen to Dr Siouxsie Wiles as she discusses the rise of resistant superbugs in this Radio New Zealand interview.
Acknowledgment
This content has been developed in partnership with New Zealand Food Safety.
