Rational Use of Antibiotics: Nearly A Hundred Years War

When I discuss antibiotic resistance, a point I am sure to make is that these compounds are to be treated like precious commodities. In the modern era, that strikes many people as odd because they have taken countless courses of different antibiotics and have always recovered. There always seems to be a new antibiotic released that their PCP may try them on if their symptoms are particularly recalcitrant to the first course. Medicine will always develop new antibiotics, they assume. 

Last week, I had the pleasure of listening to Harvard University's Dr. Scott Podolsky discuss the topic of antibiotics, not from the usual perspective that is focused on a prophecy of a post-antibiotic era (a valid concern), but from a historical perspective. Such a perspective allows one to place antibiotics and their overuse into a much larger context that is informed by an understanding of how antibiotics rose to such prominence that today prescriptions for them are literally demanded of physicians.

In his talk, part of C.F. Reynolds Medical History Society's annual lecture series at the University of Pittsburgh, Dr. Podolsky highlighted an important of the pre-antibiotic era that is often overlooked--and may hold the key to combating infectious diseases more rationally in the future: serum therapy. Serum therapy was a means of using products manufactured by the immune system against specific microbes in another individual.  It was the opposite of broad-spectrum and was largely supplanted by the much simpler use of broad-spectrum antibiotics. Today, we have anti-serum therapies for diseases like botulism and tetanus. But, there is a lot of effort to develop modernized serums, aka monoclonal antibodies, which we saw used experimentally against Ebola in the form of ZMapp and which already exist for anthrax and RSV. Moving back to specific therapies is a sure means to not only delimit antibiotic resistance but to avoid the collateral damage to the microbiome that is probably just as important.

Another aspect of Dr. Podolsky's talk I found fascinating was the prescience of those at the dawn of the antibiotic age, such as the first president of the Infectious Diseases Society of America (IDSA) Dr. Maxwell Finland, who realized the dangers of injudicious use of antibiotics and established early principles for antibiotic stewardship.

One of the themes from Dr. Podolsky's lecture that resonated with me was that the current debates on rational use of antibiotics we are in reaches back several decades and understanding the terms of the debate, at its inception, is an important and over-looked task. Thanks to Dr. Podolsky for doing the intellectual work needed to make these facts easily accessible and able to be integrated into the modern context.