The first antibiotic steward’ warned this day would come
Fleming’s prediction included a macabre example
A Scotsmen named Alexander Fleming, the discoverer of penicillin, could well be the first antibiotic steward — at least in theory. In a 1945 speech accepting the Nobel Prize, Fleming warned about the rise of antibiotic pathogens and became the first to call for a kind of antibiotic stewardship approach to preserve penicillin efficacy.
"I would like to sound one note of warning," he said. "Penicillin is to all intents and purposes non-poisonous so there is no need to worry about giving an overdose and poisoning the patient. There may be a danger, though, in under-dosage. It is not difficult to make microbes resistant to penicillin in the laboratory by exposing them to concentrations not sufficient to kill them, and the same thing has occasionally happened in the body. The time may come when penicillin can be bought by anyone in the shops. Then there is the danger that the ignorant man may easily under-dose himself and by exposing his microbes to non-lethal quantities of the drug make them resistant."
To illustrate his point, Fleming told a rather charmingly chilly anecdote as a hypothetical illustration of the problem: "Mr. X. has a sore throat. He buys some penicillin and gives himself, not enough to kill the streptococci but enough to educate them to resist penicillin. He then infects his wife. Mrs. X gets pneumonia and is treated with penicillin. As the streptococci are now resistant to penicillin the treatment fails. Mrs. X dies. Who is primarily responsible for Mrs. X’s death? Why, Mr. X, whose negligent use of penicillin changed the nature of the microbe."
