Antibiotics in the Beer, 1,500 Years Early
The earliest known use of antibiotics is not a 20th-century laboratory. It is northern Sudan, somewhere between 350 and 550 CE.
Chemical analysis of Nubian skeletons from that period shows consistent, high levels of tetracycline, which is a genuinely powerful antibiotic. This was not trace contamination or an accident of burial. The levels are steady across the population.
Researchers believe they were brewing drinks from grain fermented with Streptomyces, a bacterium that naturally produces tetracycline. In other words, an entire society was systematically taking an effective antibiotic as part of its daily diet, and doing so routinely enough to leave a signature in the bones.
As the summary of the finding puts it, given the amount of tetracycline present, they had to know what they were doing.
Elsewhere, later evidence from Egypt, China, Serbia, Greece and Rome shows mouldy bread being applied to infections. The first person to document using moulds this way was John Parkinson, who died in 1650.
What the Word Actually Means
An antibiotic is an antimicrobial substance active against bacteria, and it is the most important weapon medicine has for bacterial infections. It either kills bacteria or stops them multiplying.
The single most useful thing to know about them is what they cannot do. Antibiotics are not effective against viruses or fungi. A limited number also work on protozoa, but that is the boundary.
The name is bleak and literal. Antibiotic comes from Greek roots meaning "against life". The related term antibiosis was coined by the French bacteriologist Jean Paul Vuillemin, and the underlying effect was first described in 1877, when Louis Pasteur and Robert Koch noticed that an airborne bacillus could hold back the growth of the anthrax bacterium.
Strictly, in medical usage, antibiotics are substances produced naturally by one microorganism fighting another, while fully synthetic antibacterials such as sulfonamides are a separate class. In everyday use the word now covers both. Selman Waksman coined the modern term in 1942.
The Century That Changed Medicine
Antibiotics transformed medicine in the 20th century, and the transformation had several parents rather than one.
Synthetic antibacterial chemotherapy began as a science in Germany with Paul Ehrlich in the late 1880s. Alexander Fleming discovered modern penicillin in 1928, and its widespread use proved enormously valuable in wartime. The first sulfonamide and the first systemically active antibacterial drug, Prontosil, was developed by a team led by Gerhard Domagk in 1932 or 1933 at the Bayer laboratories.
That sequence matters because the popular story collapses into a single moment in a single petri dish. The reality was a forty-year build across at least two countries and two quite different chemical approaches: harvesting what microbes already make, and synthesising new compounds from scratch.
The result was that infections which had reliably killed people became treatable, and surgery became survivable in a way it had never been before.
The Part We Are Using Up
The same effectiveness and easy availability led to overuse, and bacteria have been evolving in response.
Antimicrobial resistance is a natural process, but it is driven primarily by the misuse and overuse of these drugs. Resistance can be built into a bacterial strain from the start, or acquired through mutation or by picking up extra DNA. Penicillin and erythromycin, once highly effective across many species and strains, have become less so.
The scale is already serious. The World Health Organization classifies resistance as a widespread threat that is "no longer a prediction for the future, it is happening right now in every region of the world". Nearly 5 million deaths a year are associated with antimicrobial resistance globally, and 1.27 million deaths in 2019 were directly attributable to it.
There is a second injustice folded into this. While some of the world overuses antibiotics, many people elsewhere still cannot get hold of essential ones at all.
