An upcoming issue of The Medical Letter will include an article on Penicillin Allergy, which made me start thinking, not so much about penicillin allergy, but about penicillin itself. If I had to rank the greatest drug discoveries in medical history, I guess I would put morphine first, ether second, and penicillin third.  The funny thing is, I truly wonder whether penicillin would be approved for use by the FDA in today’s regulatory climate, which is influenced so much by the media thirst for one more story about medical errors and the dangerous drugs we inflict on our unsuspecting patients. I can see it now: “Patient Dies in Seconds after Injection with New ‘Wonder Drug’!”

The beginning was awfully slow. Alexander Fleming noticed the clear areas among the bacteria on his Petri dish in 1928. Penicillin did not become available to the general public until after World War II, which ended in 1945.

In the early 1940’s, penicillin was tried on a few patients here and in England, where most of the development of the drug took place. The first edition of Goodman and Gilman’s textbook of pharmacology included a case report of a postpartum Yale professor’s wife with an unrelenting streptococcal bacteremia. She said she felt little hope when a messenger arrived in her hospital room carrying a small brown paper bag. The figure illustrating what happened to her fever chart after the contents of the bag were added to her intravenous fluids brought tears to my eyes.

Nevertheless, there was not enough penicillin to go around, to say the least. Many thousands of soldiers died of infected wounds that penicillin could have healed. Wendell Willkie, the Republican candidate for President in 1944, died of progressive strep throat in 1945. One problem was that penicillin seemed to be impossible to produce in large quantities, until late in the war when the mold on a cantaloupe in Peoria, Illinois proved to be a variant that could be produced in bulk.

No one needs to die of a strep throat anymore in the United States. If the Internet had been around the first time a patient injected with penicillin died of anaphylaxis, the story might have been entirely different. Among all the speed and convenience of our electronically-connected world, we still need to worry about the baby and the bath.

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  1. Hervy Kornegay MD CMD says:

    Your blog is awesome! I wish I could have said that!

    Hervy Kornegay MD CMD

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