Penicillin: Changing Misconceptions To Improve The Antibiotic Industry

Penicillin 1


Penicillin: Changing Misconceptions to Improve the Antibiotic Industry

Michelle Gaynor Professor Silva Writing 50 September 14, 2009

Penicillin 2
 Abstract Penicillin has been prescribed for decades to help fight and treat bacterial infections. This antibiotic is easily accessed and these infections which before the discovery and production of antibiotics, often lead to death, could now be treated. Penicillin treats many infections such as strep throat, meningitis, syphilis, gonorrhea, and pneumonia. However, the literature does not focus enough on the fact that public misconceptions, myths, and lack of awareness has led to inappropriate use of the drug, an increase in resistant bacteria, and incorrect information about allergies. Further ignorance of the nature of the drug and continued participation in improper practices will increase bacterial resistance, decrease penicillin’s effectiveness, and may even result in the drug being taken off the shelves. In my research, I argue that the public has several misconceptions of penicillin regarding how it works, how it should be prescribed and taken, and how allergies are diagnosed. By informing people with facts and concrete evidence, many of these improper practices can be eliminated and the rate of bacterial resistance can be decreased. Having a better understanding of the drug can allow penicillin to become more effective, prevent overuse, and slow the process of microbial resistance.

Penicillin 3
 Introduction Penicillin is an antibiotic used to treat various types of infections due to bacteria. The public feels that this drug is the common answer to their daily diseases such as meningitis, strep throat, and pneumonia. It is thought of as a miracle drug because it treats patients from injuries and diseases that could be fatal. According to Bud (2007), a magazine in Washington DC found that in the last century, Alexander Fleming’s discovery was the sixth most important story and the highest-rated event not to have directly involved an American. Before the existence of penicillin, it was not uncommon for patients to die from bacterial infections. Imagine getting a scratch or cut one day, that suddenly became infected. Prior to penicillin this injury could lead to death if the immune system could not fight it off quick enough. Wong (2003) describes a situation in which a patient named Mortie fell on pavement and got a cut on his knee, which later became infected. He was diagnosed with blood poisoning as well as osteomyelitis, which is an infection of the bone caused by bacteria. A combination of Sulfa drugs, several hip surgeries, and months in the hospital allowed Mortie to return home with crutches. It took months before he could walk again with a limp. Throughout the process, the nurses did not think he was going to make it. A few years later, Mortie’s osteomyelitis came back, but this time penicillin was available to the public. The penicillin eradicated Mortie’s condition completely and he has not needed treatment since. This is a prime example of how penicillin transformed the treatment of infections and the medical field in general. When penicillin was available to the public, it suddenly became ‘the first miracle drug’. It was commonly for patients to think highly of this drug because so many people had access to it and were treated by it during their lifetime or had relatives or friends who were treated by

Penicillin 4
 penicillin. In the United States alone, since 1900, deaths from infectious bacterial diseases have decreased by 95% (Fogel, 2008), and this helps show why penicillin is thought of as a phenomenal discovery. Although penicillin has saved millions of lives over the last 80 years, there is a common misconception that this drug is miraculous. Many bacteria have become resistant to penicillin and the misuse of penicillin has helped spread resistance, making it difficult to treat infections. Public misconceptions have led to improper medical practices and have decreased the effectiveness of penicillin. This paper argues how myths and misconceptions of penicillin have affected the drug’s use in everyday society, and common practices have caused negative consequences. Both patient allergies and bacterial resistance have affected the medical field as well as forced researchers and doctors to find alternative methods and create new drugs to improve lives. These common misconceptions are confronted and facts about this drug are supported with evidence. Methods to make the public more aware of proper medical practices and general important information about penicillin are described. By informing the public, the continued spread of resistance and allergies can be addressed and changing the attitudes and practices of the public can help keep penicillin effective. What is Penicillin? Penicillin is an antibiotic used to treat various types of infections caused by bacteria. Antibiotics are chemicals produced by a mold, Penicillium chrysogenum,which kills other microorganisms and stops them from multiplying. They effectively treat bacterial infections by interfering with specific cell components or by disrupting cell metabolism (Byrne, n.d.; Derderian, 2007). In order for bacteria to function, their cell walls are essential for normal

Penicillin 5
 growth and development. Byrne (n.d.) and Goodman (2006) emphasize that the main component of bacterial cell walls is peptidogylcan. Penicillin inhibits the last stage in the synthesis of peptidoglycan, so these cell walls cannot be created. By preventing the cell walls from developing, the cell becomes weak and increased pressure causes cell lysis. Through this process, penicillin prevents bacteria from replicating and relieves the patient of their infection.

Figure 1. (The Chemical Structure of Penicillin). Retrieved from http://img.medscape.com/fullsize/migrated/583/8 36/japha583836.fig3.gif




Penicillin is made by the mold Penicillium chrysogenum. The mold forms 6-aminopenicillanic acid, which has a thiazolidine ring (1) connected to the central β-lactam ring (2) which is attached to a side chain (located on left) (Goodman, 2006). Hunt (2009) explains how every type of penicillin contains a beta-lactam ring, the site of penicillinase action, which is crucial for weakening the cell walls of bacteria. The various types of penicillins differ based on their chemical side chains. These chains are synthetically linked to the ring structures, producing the penicillin group of antibiotics, each having different properties in the host. Since penicillin is one of the most important groups of antibiotics, it continues to be the drug of choice for a large number of infections. Penicillin has the ability to treat a variety of infections, including: strep throat, pneumonia, meningitis, gas gangrene, diphtheria, syphilis, gonorrhea, urinary tract infections, septicemia, intra-abdominal infections, respiratory infections,

Penicillin 6
 ear, nose, and throat infections, and skin and soft tissue infections (Griffith, 2009; Bud, 2007). Penicillin is prescribed by a doctor and comes in the form of tablets or capsules, chewable tablets, oral suspension, or through injections. Dosage is based on the infection and the directions of the prescriber. There are five major types of penicillin, which have been created due to their various characteristics and pharmaceutical properties that help treat patients in numerous ways. These classes consist of penicillin G and penicillin V, the penicillinase-resistant penicillins, the aminopenicillins such as ampicillin and amoxicillin, the antipseudomonal penicillins such as carboxypenicillin, and the ureidopenicillins such as mezlocillin and piperacillin (Goodman, 2006). The History of Penicillin Penicillin has been an active antibiotic in the medical field since its mass production in the 1940s. Its early success has led the general public to assume that it is a miraculous drug, when in reality it has good and bad characteristics. The history of penicillin has helped create these common myths and misconceptions surrounding the drug. This section addresses how the discovery and advancements of penicillin have led to false beliefs of an antibiotic that in some cases is still considered a miracle. Alexander Fleming discovered penicillin by chance in 1928. Prior to the production and use of penicillin, the medical field was very unreliable and misleading. Bud (2007) informs readers that in the early 1900s, the main idea behind preventing infections was not due to medicine, it was attributed to hygiene. Even with methods of efficient sewage disposal and personal responsibility for one’s own cleanliness, a common health-related theme during the 1930s involved physical suffering from infection.

Penicillin 7
 Fleming discovered penicillin while working in a laboratory at St. Mary’s Hospital in London. He was studying the bacteria staphylococcus in Petri dishes. He left out some of the dishes for several weeks and came back to find that the staphylococcus colonies had become transparent and a mould-like substance had developed. This meant that bacterial cells in the dish had gone through a process called lysis, the killing off of microorganisms. Fleming named the active ingredient in the mold penicillin because it belonged to the genus Penicillium. (Brockmann et al., 1970; Bud, 2007; Byrne, n.d.; Derderian, 2007). Although penicillin had been discovered in 1928, it was not until May of 1940 that penicillin proved a valuable medical aid. A research group at Oxford University led by Florey and Chain, developed penicillin into a systematic therapeutic agent. When these investigators experimented on mice diagnosed with hemolytic streptococci infections, they tested penicillin’s therapeutic effects. The mice treated with penicillin survived, while the untreated control group of mice died (Brockmann et al., 1970; Bud, 2007; Goodman, 2006). On December 17, 1941, a meeting was called in New York among the USDA, the National Research Council, and supporting pharmaceutical companies Merck and Squibb, Pfizer, and Lederle. After proof was presented that the production processes were improving, these various companies helped fund the research to continue advancing production. Once the United States Army saw the effects of penicillin and how it could treat infections and potentially save thousands of lives, it requested the War Production Board to do all that it could to accelerate the production of penicillin. Soon the Army Air Command was on board (Brockmann et al., 1970). Goodman (2006) describes how a vast research program started in the United States during 1942 when 122 million units of penicillin were made available for clinical trials. During this time, the production process was still being improved in order to yield more product. Two

Penicillin 8
 hundred patients had been treated with this antibiotic by the spring of 1943, and these impressive results convinced the Surgeon General of the US Army to authorize trials in a military hospital. Brockmann et al. (1970) stresses the importance of the collaboration required between scientists, biologists, chemical engineers, and other workers in various scientific fields, in order to isolate crystalline penicillin. He claims that the day these doctors knew they succeeded in reaching their goal occurred in early 1944, when a Pfizer plant in Brooklyn containing multithousand-gallon fermentors were producing 100,000-unit vials of penicillin at extremely fast rates. This long process emphasized that patients cannot benefit from discoveries of new drugs until the industry first figures out how to produce it and put it on the shelves of pharmacies. The process of deep fermentation for the biosynthesis of penicillin proved to be extremely effective in creating this drug on a large-scale basis. Goodman (2006) indicates that in the early days, a few hundred million units were produced in a month, and gradually by 1950, this quantity rose to over 200 trillion units (about 150 tons) per month. The first marketable penicillin cost about $20 for 100,000 units of crude material. In comparison, the price in 1970 for five million units of pure crystalline penicillin G could be bought for 65 cents (Brockmann et al., 1970). As more advancements within the industry produced mass amounts of penicillin, the availability led to cheaper costs, and focused on treating the individual patient. According to Bud (2007), in the United States alone, between 1900-1980, the death rate due to infections fell more than twentyfold. Back in 1900 about 800 deaths in every 100,000 occurred due to infectious diseases, and surprisingly by 1980, this number decreased to 36 in every 100,000.

Penicillin 9
 Antibiotics impacted society and patients were no longer fearful of relying on drugs. This pharmaceutical contribution provided a way to manage health, but this also led to the negative effects of the drug. Resistance came in two major forms. The first form was from an enzyme called penicillinase, produced by certain bacteria which break down penicillin, making it ineffective for treatment. The second resistance method was based on the type of bacteria that are comprised of a capsule or cell wall with a membrane that prevents penicillin form affecting the cell by blocking it from weakening the walls, or by pumping the penicillin out of the cell once it entered with the use of protein (Byrne, n.d.). Since bacterial resistance was inevitable, in order to combat resistance, the main method scientists used involved the introduction of new products and variations of the common penicillin. Throughout the late 1950s to the early 1970s a number of new branches of penicillin were created. In 1959, the first semisynthetic penicillin was released on the market called phenethicillin. Methicillin was another form of penicillin with a different structural shape that treated staphylococci infections, because this drug prevented the enzyme penicillinase from being produced. Semisynthetic penicillins were able to carry common features of the original drug and treat those when other forms of penicillin became resistant. All of these new developments were used to counter bacterial evolution and attempted to manage the consequences of resistance, ensuring that this group of chemicals would dominate the world of antibiotics. Ampicillin and amoxicillin proved extremely effective and by the end of the century, they were the most popular antibiotics for outpatient care in America (Bud, 2007). One drawback of penicillin is the fact that many people are allergic to this drug, and symptoms can range from common instances such as nausea or vomiting to life-threatening instances when hives and rashes form. According to MedicalWorld.org (2005), approximately

Penicillin 10
 seven percent of the population has a penicillin allergy. There are different levels of allergic reactions that occur when patients are exposed to penicillin and other antibiotics. Many patients experience a minor rash, but for a small portion of the population, allergic reactions can be fatal. Although the number of deaths from drug reactions is unknown, penicillin causes anaphylactic reaction in 32 out of every 100,000 patients (MedicalWorld.org). Allergies to one type of penicillin make a patient more susceptible of being allergic to any beta-lactam antibiotic, because they contain similar ingredients (Yates, 2008). Since certain patients have become allergic to some types of penicillin, doctors have created and continue to research more strains of penicillin in order to aid these patients. According to Yates, there are four major classifications of penicillin allergies based on specific symptoms, Type I through Type IV. Each type results in different clinical signs, for example Type I involves reactions such as anaphylaxis, while Type IV involves contact dermatitis and some organ inflammation. The study was conducted on the Type I group in order to find out whether patients could be desensitized. She found that desensitization is usually successful, and reoccurring symptoms only come back in about 30% of cases. Up to this point, since the public has perceived antibiotics as a great drug in treating infections, they were often careless in their medical practices and highly misinformed about resistance and allergies. Koenig (2009) reported an interesting study by doctors at the University of Cincinnati College of Medicine who focused on the allergies of patients. The doctors claim that the only way to accurately detect penicillin allergy is by the confirmation of a healthcare professional. Taking this into consideration, they conducted a study on patients who claimed to be allergic and found that a shocking 91 percent of patients did not react to penicillin when their

Penicillin 11
 skin was tested. This discovery could help thousands of people who believe they are allergic to antibiotics figure out whether their belief is accurate. Recent studies on penicillin have provided new information on advancements within the industry and the hope of new ways to fight infections. Bryant (2007) describes a study that began at the University of Southern Mississippi, involving the use of penicillin as a coating to help treat infections. It is difficult to sterilize surgical instruments because bacteria has built up resistance in medical environments. Therefore, millions of patients get infections while in the hospital that is often not related to their medical condition. These researchers have discovered a way to manipulate the structure of penicillin in order to make coatings that can attach itself to a surface. Developments have proved promising and if this technique works, this coating could be used on medical instruments to prevent bacteria from infecting patients. A four-year project conducted by Dutch researchers on penicillin DNA sequences has led to the discovery of the penicillin genome sequence. With this new information, they hope to improve manufacturing techniques and hopefully create new drugs within the industry. These researchers realize that resistance is becoming problematic, and since one billion people take penicillin yearly, modification of more advanced versions of penicillin and other antibiotics can further help society (redorbit.com, 2008). It is evident that this drug has had a major impact on our society, and antibiotics have transformed the medical industry. Since the induction of penicillin during WWII, it has undoubtedly saved millions of lives over the last eight decades and continues to today. Deadly bacterial infections could now be treated, and this transformed society’s view of medicine and health. A medical movement began, encouraging scientists and doctors to improve and create other drugs to help improve the lives of patients (Derderian, 2007). Unfortunately, misuse of

Penicillin 12
 penicillin has lead to a greater yield in microbial resistance by relying on the drug too often, and by the evolution of bacteria. As a result, scientists and doctors have been working to modify antibiotics in order to fight resistance. Due to resistance, Bud (2007) believes that doctors have changed their methods and patients have lowered their expectations. Penicillin was discovered during a time when medicines were not very effective, and it was the first of its kind to work on treating infectious diseases and saving lives. Therefore, penicillin has been perceived as a “miracle drug” that can cure all illnesses, when in fact antibiotics can only treat infections caused by bacteria. Public misconceptions have led to improper use of the drug and must be addressed so further resistance does not occur. The history of the drug helps describe why the public has formed these misconceptions and inaccurate beliefs. Niche: Changing Misconceptions and Informing the Public Since the discovery of penicillin, it has been viewed as the answer, the solution, and the miracle to treating infectious diseases. But is it all it’s hyped up to be or is there more to this antibiotic? Misconceptions about penicillin have been accumulating over the years as the public becomes less and less informed of the true nature and facts about the drug. Since penicillin is cheap, easily produced and prescribed, common attitudes and expectations have brought about major issues. This antibiotic is very trusted and often taken for granted, leading to inappropriate prescribing and increasing resistance (Belongia et al., 2002). Taking this into consideration, the true facts of penicillin must be focused upon instead of overlooked. In this section, the good, the bad, and the ugly details surrounding penicillin will be addressed. In situations regarding health, it is important to be aware of what a medicine can do to the body and how it can affect a person. By eliminating myths and misconceptions as well as dispensing the significant information

Penicillin 13
 concerning this drug, naïve perceptions will be stripped away and the true important facts will be understood. Erskine (2002) believes that the number one myth surrounding antibiotics such as penicillin is that people think antibiotics eliminate infections. It is true that antibiotics help treat diseases due to infection, but complete elimination of the infectious agent is due to a person’s immune system. While the drugs work to weaken and slow bacterial growth, it is a combination of both antibiotics and the body’s immune system that ultimately treat an infection. Therefore, it is important that patients are diagnosed properly, that their immune system is healthy, and that good nutrition is practiced in order to combat diseases. According to Koo (2008), there are five major misconceptions about antibiotics. Since the general public misunderstands what antibiotics do and how they work, these misconceptions have impacted the antibiotic industry in negative ways. Koo presents these myths and realities from greatest to least importance in order to decrease misuse and inform patients about correct practices that should be followed. The first false belief is that antibiotics can basically cure all infectious diseases. In reality, antibiotics can only fight against infections caused by bacteria. Viruses cause many infectious diseases, and taking antibiotics for these types of illnesses will not help the patient. It is important to understand what types of infections antibiotics cure because incorrect prescriptions can physically harm a patient and increase the bacterial resistance of this patient. The second myth surrounding penicillin is that once symptoms subside, patients can stop taking the prescribed drug. This misconception is common among the medical industry. Doctors are experts in their field and there is a reason that they prescribe patients a certain amount of drugs with specific directions. Therefore, it is essential for patients to follow the

Penicillin 14
 medical orders given, because failure to do so can lead to reinfection or cause antibiotic-resistant bacteria to form. This outcome can be deadly and more difficult to treat. The third myth on Koo’s (2008) list is that people can take antibiotics in order to prevent infections. Unfortunately, if this prescribed drug is taken when no infection is involved, antibiotics can harm the body more by wiping out crucial body fluids, making the patient more susceptible to infection. In the long run, when penicillin is misused, resistant bacteria will survive during treatment and continue to affect a patient. When many patients believe they are sick, they tend to want treatment as soon as possible, but they must make it a priority to get the correct diagnosis in order to treat their condition. The fourth myth is that patients believe doctors can diagnose a bacterial infection based on a physical exam and quickly prescribe antibiotics. In reality, detecting whether a bacteria or a virus causes an infection is extremely difficult without performing several tests. Doctors are at fault in this situation because they have the authority to prescribe antibiotics. If they do not have sufficient evidence that an infection is caused by bacteria, they should not prescribe a patient antibiotics because using antibiotics against a viral infection can lead to negative effects, such as an increase in resistance or the breakout of a body rash. The last myth on Koo’s list, involves the idea that it is better to use items that are “antibacterial”, such as soap. Although most antibacterial items are safe to use daily, items that contain antibiotics cause overuse and misuse and can result in the creation of resistant strains of bacteria. It is important to understand how products work before buying and using them in daily life in order to keep bacterial infections and resistance form occurring.

Penicillin 15
 Table 1 Common Misconceptions About Antibiotics (Koo, 2008) Myths 1 2

Antibiotics can cure virtually any infectious disease Patients can stop taking prescribed antibiotics when symptoms subside

Facts Antibiotics only treat infections that are caused by bacteria. This does not include viruses. When it comes to taking antibiotics, it is essential to follow the doctor’s orders, because failure to do so can result in reinfection or the bacteria may become resistance to the antibiotic. Taking antibiotics when you are not infected is harmful and can result in the patient being more prone to infections and resistance. In the long run, bacteria that are resistant will survive during treatment and continue to affect the patient.

3

Antibiotics can be taken to prevent infections before they occur

4

During a physical examination, doctors can diagnose a bacterial infection and prescribe antibiotics

It is difficult to distinguish between a viral and a bacterial infection unless tests are conducted. Before antibiotics are prescribed, it should be confirmed that the patient has a bacterial infection, because using antibiotics for a viral infection can result in unnecessary side effects.

5

It is more beneficial to use products that are “antibacterial” such as hand soap

As long as items do not contain antibiotics, they are mainly fine to use. But overuse and misuse results in the antibiotic-resistant strains of bacteria, which create more problems.

Aside from these misconceptions involving what antibiotics do and how they work, there are some major misconceptions regarding patient allergies. Harvard Health publications (2008) addresses the misconception that people often believe they cannot take antibiotics because they are allergic to all of them. When dealing with any medication, allergies will occur among patients. In the case of antibiotics, since most are made with beta-lactam ingredients, it is common to “cross-react” among various medications within a certain field, which is due to their similar chemical structures and compositions. However, Harvard Health publications stresses that being allergic to more than two families of antibiotics is unusual because they are chemically unrelated. Separating out non-allergic side effects of a medicine versus a true allergy is extremely important in certain situations because this information can help cure a patient. Another issue involving allergies is that many people believe they are allergic to penicillin based on insufficient evidence. A study conducted by doctors at the University of Cincinnati College of Medicine, found that 91 percent of patients tested who claimed to be allergic to penicillin, did not react when their skin was tested (Koenig, 2009). Many of these

Penicillin 16
 patients thought they were allergic based on information from family members or from negative reactions to other medications in the past. Now, with proper testing, this large percent of patients in the study can be treated with antibiotics to help them in the future. By getting properly tested, this information can help other patients who believe they are allergic find out if they can use penicillin to treat their bacterial infections. Another way to help patients with allergies is the process of desensitization. Yates (2008) recently conducted a study on managing patents with a history of allergy to beta-lactam antibiotics. Among the four classifications of allergic reactions mentioned earlier, the Type I group were the subjects of the study and were tested to see if desensitization could make them immune to their previous allergy. Testing was administered intravenously or orally and started with .1 to one percent of the therapeutic dose. The dose is gradually increased two to ten-fold if no adverse reaction occurs. These new doses are administered over intervals of minutes to days until the full dose is reached. Results indicated that desensitization was successful, and mild treatable reactions were only seen in about 30 percent of patients. Serious reactions occurred in five percent of patients, while none proved fatal. Therefore, she found that this group of patients could be treated with an antibiotic when they are desensitized to its effects. Another factor that helped aid misconceptions as well as resistance is the cost of penicillin. Due to the fact that this drug has been around for decades, doctors, engineers, and scientists have had plenty of time to perfect the production process. They have found ways to produce mass amounts of penicillin efficiently, keeping the costs low. In the present, penicillin and other antibiotics have been created in the generic form. According to Atlantic Information Services (2009), the average patient’s copay in the United States in 2007 ranged between nine to thirty four dollars. Since the same product can be produced without the association of a brand

Penicillin 17
 name, those with insurance only pay the amount of their copay, and based on the statistics in 2007, patients would pay a maximum of $34 for a prescription of penicillin. Since those with easy access to penicillin have been able to obtain the drug for cheap amounts of money, this has led to misuse and overuse. Belongia et al. (2002) conducted a survey of parents and adults in Wisconsin and Minnesota about their knowledge, attitudes, and experiences with antibiotic use. They concluded that the public’s misconceptions of antibiotics has led to inappropriate prescribing and about half of the people surveyed were prescribed antibiotics for a nonbacterial infection. When patients expect penicillin to treat their infections and doctors prescribe patients without full knowledge of whether the infection is bacterial, resistance is bound to occur. Therefore, it is crucial for doctors to prescribe medicine properly and for patients to learn the facts about penicillin and antibiotics in general, so this drug will no longer be abused. Over the last few years, there has been deep concerns regarding resistant bacteria and as a result, measures have been taken to inform the public. In May of 1998, the World Health Assembly proposed a strategy to manage the use of antibiotics, and three years later, they published a global strategy in hopes to contain antimicrobial resistance (Bud, 2007). Another major action that was taken to manage antibiotic use started in California. After a resolution made by the Medical Association House of Delegates identified that resistance was becoming a major problem among the community, a program was started titled ‘Alliance Working for Antibiotic Resistance Education’ (AWARE). Bud describes how through the support of professionals, parents, schools, and organizations, awareness was spread throughout the states. In 2004 important information was presented through media campaigns on NBC, Bill Nye ‘The Science Guy’, newspapers and radio interviews. These media influences were used to inform the

Penicillin 18
 public and extensive measures were taken in order to make people aware about antibiotics and change behaviors in order to make society less susceptible to resistance. Some of these activities included the tracking of streptococcus pneumoniae resistance, health partnerships working together to reduce infection and increase public awareness, hand washing curriculums and educational material advertisements, the creation and enforcement of clinical guidelines, and the introduction of antibiotic awareness week once a year (Bud, 2007). Another campaign, although not as extensive, took place in Britain. These methods need to be used throughout the world in order to improve the antibiotic industry. Walk down a busy street and most of the surrounding people have probably taken penicillin or another antibiotic sometime during their lifetime. This drug has gained various reputations since the beginning of its existence, and most of them remain to be positive. The fact that penicillin has been around for eight decades has hindered the public from gaining the truth about the drug and has led to the creation of several misconceptions and myths. These false beliefs have harmed not only the public but also the nature of the drug itself. The public’s lack of general knowledge about penicillin has aided bacterial resistance, led patients to believe they are allergic without proof, and allowed doctors to perform harmful medical practices when the wrong drugs are prescribed. In addition to these misconceptions, cheap costs of penicillin as well as easy access have led to further misuse of the drug. Just because something has been around for a long period of time does not mean that the public will know the appropriate information regarding that thing. Therefore in the case of penicillin, new measures must be taken to ensure that antibiotics will no longer be misused due to ignorance. Conclusion Public awareness is essential to the use of penicillin. Being naïve and misinformed

Penicillin 19
 about drugs can be detrimental to anyone’s health. Not only does it affect the consumer because they may be allergic, have a viral infection, or not take the proper prescribed dose, but it also affects the public when these antibiotics are misused and bacterial strains become more resistant due to improper practices. Therefore, it is important to understand what penicillin is and how it works against bacteria, how it should be taken and what it should be taken for, and how to help reduce resistance by following certain techniques. In order to make the general public more aware of the important information about penicillin, several measures can be taken to ensure that the people become informed. The first is obvious, media attention. With the combination of technologies such as the television, the Internet, and the radio, the media has a significant impact on our society. The general population will often watch a television program or read an article and accept the information at face value. Taking this into consideration, the media must present true concrete evidence to the audience. Just like California’s AWARE program that was initiated back in 1998, a plan similar to this must be put into action across the world. Popular television stations should present reports about penicillin, and information should be integrated into school curriculums, as well as proper practices and uses of the drug should be addressed. The United Nations should get involved. This international organization has influence throughout the world because a majority of nations are members of this association. By using their influence, the UN should ensure that pamphlets and other forms of advertisement are put in all medical offices and made easily accessible, so patients can read up on penicillin and become properly informed before and during clinical visits. The UN should also make sure that doctors are prescribing antibiotics based on concrete evidence of bacterial infections, versus the belief that the patient may have an infection. By doing so this will decrease the number of

Penicillin 20
 inappropriate prescriptions. With information on proper dosage and daily regimens, misuse and overuse will be abated, ultimately aiding the fight against microbial resistance. On a local scale, awareness can be improved by taking small but effective measures to help defend against resistance. In order to help decrease the amount of infections, the importance of personal hygiene should be emphasized, patients who can tolerate minor conditions instead of immediately prescribing drugs can decrease the amount of incorrect prescriptions and overuse, and using both vaccinations and antibiotics to treat patients can help prevent infections and shorten the recovery period. With doctors and scientists working daily to improve various strands and alternative forms of penicillin, it is important for the general public to follow the correct procedures and become aware. By implementing these few actions concerning this antibiotic, there will be no reason for penicillin to be improperly used and for misconceptions to continue to exist. Essential information that can be easily accessed and easily learned should help societies understand the importance of penicillin in order to help keep the drug effective and around for a longer period of time. Decreasing the number of infections, using penicillin only when absolutely needed, and being informed will help slow the process of microbial resistance and keep antibiotics a top medicine used to treat patients. In order for penicillin and antibiotics to prevail, they must continue to treat patients for infection. As long as new and old forms of penicillin are still treating patients at a quicker rate than bacterial resistance is building up, there will always be a need for antibiotics to save lives. Millions of lives have already been saved; hopefully this number will increase to billions.

Penicillin 21


References Allergy Statistics (2005). Retrieved September 5, 2009 from http://medicineworld.org/medicine/allergy/allergy-statistics.html

Atlantic Information Services (2009). Pharmacy benefit management: Prescription drug copay trends. Retrieved August 29, 2009 from http://www.aishealth.com/MarketData/Pharm BenMgmt/PBM_copay01.html

Belongia, E.A., Naimi, T.S., Gale, C.M., Besser, R.E., (2002). Antibiotic use and upper respiratory infections: A survey of knowledge, attitudes, and experience in Wisconsin and Minnesota. Preventive Medicine, 34 (3), 346-352.

Brockmann, M.C., Coghill, R.D., Dunn, C.L., Greene, A.J, Kaiser, H.R., Lein, J., et al. (1970). The history of penicillin production. New York: American Institute of Chemical Engineers.

Bryant, J. (2007, September 7). New coating could prevent infection from surgical tools and implants. Retrieved August 21, 2009 from http://nsf.gov/discoveries/disc _summ.jsp?cntn_ id=110645&org=NSF

Bud, R. (2007). Penicillin: Triumph and tragedy. New York: Oxford University Press.

Penicillin 22
 Byrne, K. (n.d.) Penicillin production and use. Retrieved August 7, 2009 from http://www.pdfcoke.com/doc/8638290/176-Penicillin-Production-and-Use

Chandel, A.K., Rao, L.V., Narasu, M.L., and Singh, O.V. (2008). The realm of penicillin G acylase in β-lactam antibiotics. Enzyme and Microbial Technology, 42(3) 199-207.

Derderian, S.L. (2007, Fall). Alexander Fleming’s miraculous discovery of penicillin. Retrieved August 17, 2009, from http://www.rivier.edu/journal/ROAJ-Fall-2007/J109Derderian.pdf

Erskine, R. (2002, January). Myths and misconceptions in antibiotic use. Retrieved August 28, 2009 from http://www.pfizerah.com/pahimages/pdfdocs/842_Erskine_Myths.pdf

Fogel, R. (2008, December 6). Penicillin: the first miracle drug. Retrieved September 2, 2009 From http://herbarium.usu.edu/fungi/FunFacts/penicillin.htm

Goodman, L.S. (2006). Penicillin, cepthalosporins, and other β-lactam antibiotics. In 11th ed., Goodman and Gilman’s the pharmaceutical basis of therapeutics(pp. 1127-1158). New York: Macmillin.

Griffith, H.W. (2009). Penicillin. In 2009 ed., Complete guide to prescription & nonprescription drugs (pp. 652-655). New York: Penguin Group.

Penicillin 23
 Harvard Health publications (2008, April 12). Four common myths about allergies. Retrieved August 28, 2009 from http://www.livestrong.com/health-article/four-common-mythsabout-allergies_18f2d725-fc39-bff8-9ff3-8049f4c5f407/

Hunt, R (2009, May 5). Bacteriology chapter five: antibiotics that affect the cell envelope. Retrieved September 5, 2009 from http://pathmicro.med.sc.edu/fox/antibiotics1.htm

Koenig, A. (2009, February 26). UC Healthline: Penicillin allergy not always accurate. Retrieved August 21, 2009 from http://insciences.org/article.php?article_id=2804

Koo, I. (2008, November 6). The truth about antibiotics: What are 5 common misconceptions?. Retrieved August 28, 2009 from http://infectiousdiseases.about.com/od/ prevention/a/antibiotic_myth.htm

Penicillin DNA sequence brings hope for new antibiotics (2008, October 2). Retrieved August 20, 2009 from http://www.redorbit.com/news/science/1575425/penicillin_dna_sequence _brings_hope_for_new _antibiotics/

Rodríguez-Sáiz, M., Diez, B., and Barredo, J.L. (2005). Why did the Fleming strain fail in penicillin industry? Fungal Genetics and Biology, 42(5), 464-470.

Wong, G. (2003, Fall). Penicillin. Retrieved September 2, 2009 from http://www.botany.hawaii.edu/faculty/wong/BOT135/Lect21b.htm

Penicillin 24


Yates, A.B. (2008). Management of patients with a history of allergy to beta-lactam antibiotics. The American Journal of Medicine, 121(7), 572-576. Appendix Annotated Bibliography Brockmann, M.C., Coghill, R.D., Dunn, C.L., Greene, A.J, Kaiser, H.R., Lein, J., et al. (1970). The history of penicillin production. New York: American Institute of Chemical Engineers. Brockmann, Coghill, Dunn, Greene, Kaiser, Lein, et al., describe the history of penicillin production and how the development of large-scale fermentation was able to transform the history of the drug. Many individuals in various fields of science helped attribute to the creation of new production techniques and what the industry has become today. Basic steps of the process include the culture used to produce the drug, the conditions required for growing and recovering penicillin, and the preparation in order to use the drug. Since this antibiotic served such a useful purpose, the United States government started a penicillin program, but the one lacking detail was how to manufacture the product. With the collaboration of chemical engineers, biochemists, biologists, and other scientist various methods were tested in order to find a solution to the production problem. Through the process of fermentation and crystallization, penicillin was produced for the masses, meeting their goal. Bryant, J. (2007, September 7). New Coating Could Prevent Infection from Surgical Tools and Implants. Retrieved August 21, 2009 from http://nsf.gov/discoveries/disc _summ.jsp?cntn_ id=110645&org=NSF At the University of Southern Mississippi, a study is being conducted within the polymer science department using penicillin as a coating that could protect medical implants and surgical tools against the infection of bacteria. The research team believes that this development could save thousands of lives by preventing the occurrence of infections during surgeries. By manipulating both the chemistry and shape of penicillin, their studies have shown that antibiotics can be attached to a surface, which appears like a sponge. These coating would disrupt the process of bacteria from infection. Laboratory experiments show that this technology is highly effective against the most deadly causes of staph infection. Due to the fact that sterilization of surgical tools is not 100 percent effective, it is reported that nearly two million people in the United States alone get an infection at the hospital and more than 90,000 die due infections separate form their condition. The research team hope that this coating technique can be expanded to other antibiotics as well as prevent blood clotting on implants. Results are promising as the university waits for a patent and commercial partners who can further advance and support this new technology within the industry.

Penicillin 25
 Bud, R. (2007). Penicillin: Triumph and tragedy. New York: Oxford University Press. Bud writes about many important aspects of penicillin over the course of history. He sees it as a triumph and a tragedy that has helped save many lives, but misuse has led to some serious issues. He highlights the main creators of the drug, how it has been produced across the world, the family of chemicals, as well as the resistant bacteria, and how penicillin is used and viewed today. He claims that although the drug has revolutionized the field of medicine and made many great impacts to society, there are bad effects of the drug as well. Bud takes a look at this brand and family of chemicals from various viewpoints and tells the facts of this miracles drug, the good and the bad. The drug has changed overtime, with increasing methods of production, widening range of activity, effectiveness, and resistance. With the success of curing common diseases that were once feared and previously fatal, penicillin transformed society and the medical world. Negatively, overtime the drug has become less effective due to the emergence of resistant bacteria and abuse. Overall, Bud discusses how this antibiotic has socially and culturally changed society in positive and negative ways. Byrne, K. (n.d.) Penicillin Production and Use. Retrieved August 7, 2009 from http://www.pdfcoke.com/doc/8638290/176-Penicillin-Production-and-Use Byrne offers a fact sheet about penicillin and the chemistry of the drug. He introduces the drug, describes the structure, as well as the production process. Penicillin is a secondary metabolite, which makes it more difficult to produce. Pictures and graphs illustrate the bacteria and how certain processes work. It continues by discussing how penicillin kills bacteria by inhibiting synthesis of bacteria cells walls called peptidoglycan. Since the drug is able to weaken the cell walls, this lead to increased pressure within the organisms and it eventually bursts. Resistance to antibiotics occurs by an enzyme that is able to breakdown penicillin or when bacteria are able to inhibit the drug from penetrating its outer surface. This article is designed to inform the reader about Penicillin and includes some questions and answers to reinforce the important information. Chandel, A.K., Rao, L.V., Narasu, M.L., and Singh, O.V. (2008). The Realm of Penicillin G Acylase in β-lactam antibiotics. Enzyme and Microbial Technology, 42(3) 199-207. Chandel, Rao, Narasu, and Singh present a study of how penicillin G acylase has opened up new insights for β-lactam antibiotic development on a large scale. Penicillin G acylase is an enzyme used to produce β-lactam antibiotics and intermediates. These intermediates can be used to create semi-synthetic antibiotics such as amoxicillin. The sales of these antibiotics yield around $15 billion and make up 65% of the market for antibiotics. Annual consumption of these drugs is estimated to fall between 10-30 million tons. Through a submerged fermentation process the high demand for these drugs has been met and new discoveries could enhance the production even further. The article emphasizes the new technologies being tested and the advancement in biotechnology involving the β-lactam antibiotics. Through the use of new technologies

Penicillin 26
 and improvement to existing practices, less expensive fermentation processes will allow for a less pricey product in the future. Derderian, S.L. (2007, Fall). Alexander Fleming’s Miraculous Discovery of Penicillin. Retrieved August 17, 2009, from http://www.rivier.edu/journal/ROAJ-Fall-2007/J109-Derderian.pdf Derderian discusses the importance of penicillin and how it has transformed our society. The author starts out by defining antibiotics and proceeds with a description of Alexander Fleming’s background before and after the drug was discovered. The politics surrounding 1928, when the drug was discovered, was unstable due to many wars, but WWII was the first time penicillin was mass-produced and this helped treat soldiers nationwide. Derderian continues with a description of the discovery of penicillin and points out how Fleming designed the experiment and correctly deduced that it had the ability to prevent bacteria growth. The author highlights nine major results due to penicillin research such as the time and temperature it takes to reach its maximum potential, certain bacteria that penicillin fought against, and the types of application such as oral or injections. Penicillin is furthered discussed in a positive light when Derderian concludes the importance of this antibiotic and its effectiveness against fighting bacteria. This article is summed up with major impacts of the discovery such as the drug’s ability to fight bacterial infection, the impact it had on scientists to find other antibiotics and more advancements in the medical field, the negative impact of misuse and overuse which can lead to resistance, and lastly the fact that millions of lives have been saved. From a time when influenza and pneumonia were the leading causes of death, this miraculous drug changed the fate of millions of lives forever. Goodman, L.S. (2006). Penicillin, cepthalosporins, and other β-lactam antibiotics. In 11th ed., Goodman and Gilman’s the pharmaceutical basis of therapeutics(pp. 1127-1158). New York: Macmillin. Goodman’s detailed and pictorial styled chapter about penicillin touches base with many important aspects of this class of antibiotics. He starts out by introducing penicillin as one of the most important groups of antibiotics and how it is the drug of choice for a range of infections. The history is briefly described mentioning important scientist’s contributions and dates of discovery. For the visual learners, many pictures and charts are located throughout the chapter to emphasize the chemical structures of the types of penicillin, the processes of creation, and how these antibiotics work, and specific gene diagrams. Goodman writes about the units used, mechanisms of action, and mechanisms of bacterial resistance followed by gram-positive and gram-negative (resistant bacteria) diagrams, comparing and contrasting the two types. He classifies the pharmaceutical properties of the five types of penicillin in general terms, and then proceeds to describe each type more specifically based on their structures and characteristics. These informational sections as well as the various charts and diagrams sum up how penicillin works structurally and are applied to the medical field and industry. Griffith, H.W. (2009). Penicillin. In 2009 ed., Complete guide to prescription & nonprescription drugs (pp. 652-655). New York: Penguin Group.

Penicillin 27


Griffith provides an informational, up-to-date and specific guide to prescription and nonprescription drugs. For each drug, such as penicillin, a list of headings and following information describe important aspects of the drug that a patient should know before using. These topics include the generic and brand names of the drug if they exist, basic information such as whether it is habit forming, if you need a prescription, and the drug’s classification. Dosage and uses tells the patient how, when, and at what time and doses the drug should be taken. Possible adverse reactions and side effects are listed consisting of different levels of severity of symptoms and overdose information is bolded. To sum up the description of the drug, possible interactions with other drugs and substances are mentioned and combined effects are listed. Overall, this book gives any reader important detailed information that is important to learn and understand before consuming prescription and nonprescription drugs of any kind. Koenig, A. (2009, February 26). UC Healthline: Penicillin allergy not always accurate. Retrieved August 21, 2009 from http://insciences.org/article.php?article_id=2804 Doctors at the University of Cincinnati College of Medicine have conducted a study involving penicillin skin testing to test for allergies among patients. The only accurate way to detect if you are allergic to penicillin is by the confirmation of a healthcare professional. Yet studies show that people often base their allergy off of what a parent may tell their child or a reaction of a rash to the antibiotic. By looking at the inaccuracy of self-reported penicillin allergies, the researchers found that about 91 percent of patients who report an allergy to penicillin did not react when their skin was tested. This is an increase from prior studies, which yielded an 85 percent inaccuracy rate. Out of the 150 patients tested, 137 did not react to penicillin. Penicillin is less expensive, clinically effective, and lessens the use of other antibiotics which attribute to resistance. Therefore, Doctors Moellman and Bernstein conducted this study to find out the facts of the issue. Their results concluded that a majority of the population who believe they are allergic, may actually be tested and treated for penicillin. Penicillin DNA sequence brings hope for new antibiotics (2008, October 2). Retrieved August 20, 2009, from http://www.redorbit.com/news/science/1575425/penicillin_dna_sequence _brings_hope_for_new _antibiotics/ Dutch researchers have been working on a four-year project that investigates the DNA sequence of the mold that produces penicillin. They have been able to discover the genome of penicillin chrysogenum, which is used to manufacture several antibiotics such as ampicillin. These researchers believe that the genome sequence can improve manufacturing techniques but they warn against the overuse of antibiotics and see a need for the creation of new drugs within the industry. Since one billion people take penicillin yearly, resistance is becoming problematic and experts such as Professor Pennington of the University of Aberdeen thinks that this sequence could lead to new and improved antibiotics. Due to the fact that penicillin has now been around for about 80 years, many antibiotics have been created, and scientists are focusing on modifying current treatments in order to help overcome the problems of resistance. The genome sequence has revealed

Penicillin 28
 new information about the biosynthesis of penicillin and the researchers hope this will lead to quicker antibiotic development. Overall, these findings have brought hope to this group of scientists, who believe that it is time for the creation of new antibiotics. Rodríguez-Sáiz, M., Diez, B., and Barredo, J.L. (2005). Why did the Fleming Strain Fail in Penicillin Industry? Fungal Genetics and Biology, 42(5), 464-470. Rodríguez-Sáiz describes how Alexander Fleming’s strain of penicillin has been transformed and changed in the industry. Fleming discovered Penicillium notatum and after many tests and trials, it was eventually replaced by the strain called Penicillin chrysogenum. This article shows how the strains differ through gene encoding, and how the Penicillium chrysogenum is more promising than its predecessor. Due to overproduction of penicillin some strains have been transformed. By cloning five different forms of penicillin and comparing the results after various test were conducted, Rodríguez-Sáiz describes how P. chrysogenum is one of the best resources of penicillin production because it yields the greatest results. The goal of the article is to show the significance of the change overtime and how gene encoding has transformed that creation of penicillin. Yates, A.B. (2008). Management of Patients with a History of Allergy to Beta-Lactam Antibiotics. The American Journal of Medicine, 121(7), 572-576. Yates conducts a study on patients who are allergic to beta-lactam antibiotics. She introduces the study with the statistic that about ten percent of patients with a history of penicillin allergy actually have allergic reactions when treated with penicillin. Considering this dilemma, Yates studies those patients allergic to penicillin and based on their symptoms within a period of time proceeds to test those who show positive signs of a false allergy to the drugs. Patients who are allergic to penicillin are often allergic to any beta-lactam antibiotic because ninety-five percent of the composition of penicillin is metabolized with benzylpenicilloyl-polylysine, often referred to as “major determinants”. Patients who are allergic to the common beta-lactam antibiotics can be more susceptible to other more toxic drugs, higher costs, and development of resistance. Testing initially occurs with small doses of the penicillin until the therapeutic dose is reached. The results of the skin testing help indicate the severity of the allergy and from there a patient may test negative for allergies, be desensitized in order to be able to receive the drug, be given alternative drugs, or test positive for an allergy and completely end all testing. Overall, this study helps establish strategies for treating those who appear allergic to penicillin and has the ability to aid those who test positive and inform those who test negative.