Re-Inventing Infectious Disease: Antibiotic Resistance and Drug Development at the Bayer Company 1945-80

This paper analyses how research on antibiotic resistance has been a driving force in the development of new antibiotics. Drug resistance, while being a problem for physicians and patients, offers attractive perspectives for those who research and develop new medicines. It imposes limits on the usability of older medicines and simultaneously modifies pathologies in a way that opens markets for new treatments. Studying resistance can thus be an important part of developing and marketing antibiotics. The chosen example is that of the German pharmaceutical company Bayer. Before World War Two, Bayer had pioneered the development of anti-infective chemotherapy, sulpha drugs in particular, but had missed the boat when it came to fungal antibiotics. Exacerbated by the effects of war, Bayer's world market presence, which had been considerable prior to the war, had plummeted. In this critical situation, the company opted for a development strategy that tried to capitalise on the problems created by the use of first-generation antibiotics. Part and parcel of this strategy was monitoring what can be called the structural change of infectious disease. In practice, this meant to focus on pathologies resulting from resistance and hospital infections. In addition, Bayer also focused on lifestyle pathologies such as athlete's foot. This paper will follow drug development and marketing at Bayer from 1945 to about 1980. In this period, Bayer managed to regain some of its previous standing in markets but could not escape from the overall crisis of anti-infective drug development from the 1970s on.

[Historical notes on the management of infection during the development of surgery]

Surgery and medicine have not evolved in parallel. There have been discrepancies, bellicosity, contempt and even separate university studies during a long time. The Saint Cosme Brotherhood, founded to supervise the professional practice of barbers (short robe surgeon-barbers) in France in 1260, was opposed by the Faculty of Medicine in Paris. The conflicting interests of the university, Brotherhood and Barbers, that persisted until the 18 th century, impaired the progress of surgery. In the first half of the 19 th century, the advance of surgery continued facing pain, hemorrhage and infection. The control of the latter had to consider antisepsis, asepsis and finally the appearance of antimicrobial substances, sulfonamides and antibiotics that allowed surgeons to approach and solve major problems of the specialty.

[Progress in antimicrobial therapy]

INTRODUCTION

Not so long ago, back in the 1900s, infectious diseases were the leading cause of death world wide. The doubling of our life span in the 20th century was achieved, first of all, by using bioactive natural products, their secondary metabolites or their derivates. These substances have prolonged our life span, reduced the pain and suffering and, at the same time, revolutionized medical science.

HISTORY OF ANTIBIOTICS

Antibiotics are among the most important classes of bioactive products and as much as 78% of antimicrobial drugs are extracted from nature. This paper follows the history of progress of antimicrobial drugs, which runs parallel to the history of a man's struggle against the diseases.The golden age of progress of antimicrobial drugs went on between the 1940s and 1970s. Thereafter, there is a gradual decrease in the number of newly discovered antimicrobial drugs. During the time period between 2003 and 2007 only four antibiotics were registered.

CONCLUSION

The current situation in the field of antimicrobial therapy should send off a global alarm .for the creation of a well coordinated, sound and all-encompassing monitoring of the resistance, consumption of antimicrobials and investment in the new trials.

Lobar pneumonia treated by Musgrave Park physicians

In the decade 1935-45 the treatment of lobar pneumonia in the developed and warring world underwent a series of evolutions-anti-sera, specific anti-sera, refinement of sulpha drugs, sulpha and anti-sera, the introduction of penicillin for bacteriology, then ophthalmology, and then for penicillin-sensitive bacterial infections such as lobar pneumonia with its many Cooper types of Streptococcus pneumoniae. Penicillin for civilian use was essentially banned in World War II, a ban that early in 1941 two Musgrave Park physicians tried to circumvent. Strict secrecy on the details of penicillin production was enforced. The treatment option chosen by the Musgrave Park physicians in 1941, and the non-availability of penicillin led to sequelae affecting the post-Belfast careers of both patient and physicians.

[Hexa-sabbath. Foreign matter and vital substances, experts and the critical consumer in the FRG during the 1950s and 1960s]

In the late Fifties and early Sixties the regulation of food additives represented a remarkable turning point in German consumer politics, establishing a debate about decision making and policy advice, altering the discourse of purity and contamination, and inaugurating a new political actor, the organized critical consumer. The amendment of the Food Law in December 1958 functioned as a negotiation process between representatives of science, industry and the state, which was institutionalized in the Senate Commissions of the German Research Foundation. While these Commissions for preservatives, foreign matter and colorants worked behind closed doors, a public discourse about the "toxic condition" of modern life and the negative role of the pharmaceutical and chemical industry gained strength. The debate about the admission of hexamethylenetetramine (hexa) took part at a crucial moment. Hexa was used as a preservative in the fish industry. But its anti microbial effectiveness was caused by the decomposition of hexa to formaldehyde. Despite the commission's verdict against hexa, the lobbying activities of the industry granted it a reprieve. In the media, the case of hexa was seen as a touchstone for the capacity of negotiated decision making and the ability of rational scientists to resist the demands of industry. Finally, in 1963 it was the new political actor of the organized critical consumer, heir and successor to the housewife federations as well as to "purists" advocating life reform, who, supported by the media, enforced the prohibition of hexa as a preservative.

Aqueous ethanolic extract of the roots of Pelargonium sidoides--new scientific evidence for an old anti-infective phytopharmaceutical

Among the PELARGONIUM-based herbal remedies that are widely used in traditional medical systems in the Southern African region is a highly valued root medicine (commonly termed UMCKALOABO) of initially unknown botanical origin for the treatment of infectious conditions of the respiratory tract including tuberculosis. Nowadays, a modern aqueous-ethanolic formulation of the roots of Pelargonium sidoides (EPs 7630), developed from this traditional medicine, is successfully employed for the treatment of bronchitis. The article summarizes the fascinating story of this herbal medicine including its way to Europe, identification of the botanical origin, and provides background information of the many profound anti-infectious actions and clinical studies. In spite of considerable effort, the underlying chemical principle is still not clear.

Ozone and its usage in general medicine and dentistry. A review article

Ozone, an allotropic form of oxygen, is successfully used in the treatment of different diseases for more than a hundred years. It is highly valued for various effects, such as antimicrobial, antihypoxic, analgesic, immunostimulating etc. on biological systems. These mechanisms of action supported with a lot of case reports and scientific studies allow using it in different fields of medicine. This review of literature is another attempt to summarize different modalities of ozone application in dentistry. Further studies are necessary to standardize indications and treatment protocols of this promising medical agent.

Review article: the history of acute infectious diarrhoea management--from poorly focused empiricism to fluid therapy and modern pharmacotherapy

BACKGROUND

Acute diarrhoea management has progressed from largely ineffective measures in the early years to a more effective physiologic approach in recent years.

AIM

To review the history of acute diarrhoea management.

METHODS

Citations in PubMed were reviewed on 'acute diarrhoea treatment' along with an extensive file maintained by the corresponding author.

RESULTS

Freedom from diarrhoea was equated in early military conflicts with bravery and strength where diarrhoea-free soldiers had the 'guts' to fight. Until early 20th century, colonic irrigants, purgatives and emetic drugs were used to help eliminate undesired intestinal contents. Only a few early authorities suggested the need for replacement of fluids and salt, now standard treatment. Drugs aimed at diarrhoea symptom control have been broadly used for more than 100 years. The evolving history of one of those drugs, kaopectate is unappreciated. Once understanding the pathophysiology and infectious aetiology of acute diarrhoea, new oral fluids, pharmacologic agents designed to block specific secretory alterations and anti-infective drugs have been identified.

CONCLUSIONS

Physiologic and antimicrobial approaches to controlling diarrhoea can lead to reduction of stool number and enteric complaints, important in industrialized areas, with the potential for decreasing threat of fatal illness among infants in developing regions.

[Dyes, indispensable tools for the 19th century's biologic and therapeutic revolution]

Born from growing organic chemistry laboratories, dyes were extensively used par textile industry before to be applied in field of biology and therapeutics. Besides their interest for diagnostic techniques due to cell visualization (Virchow, Papanicolaou), dyes allowed scientists to propose scientific hypothesis founding, in conjunction with new microscopy tools, modern basis for biology : tissue constitution, cellular and sub cellular structure, s.o. One of the brightest illustrations of these progresses is the birth of neuronal theory which due to silver print of brain tissue allowed to see intimacy of cerebral structures et propose an operating scheme (Golgi, Cajal). Therapeutic progresses born from dyes chemistry are multiple. First concentrated on the research of antimalarial drugs (Ehrlich) following the use of methylene blue, then generally, anti-infectious drugs, they gave birth to various chimiotherapeutic families: antiseptics, antiparasitic drugs, antibacterial, among which one of the most spectacular illustrations remain sulphonamides preparation.

[The birth of modern surgery]

In ancient India and Persia surgeons were highly respected and their operating skill with nose plastic and catatact couching is documented. In mediaeval Europe surgery was classified as a handicraft profession and belonged to the barbers guild with the soapcup as symbol, much inferior to the academic trained medical doctors. In war surgery leg amputation after shotwounds demanded great rapidity, since no anestetic but alcohol was available. In the 18th century surgeons becamea accepted as medical doctors e.g. John Hunter in London and OlofAcrel in Stockholm. A great step in the development of surgery was Mortons introduction of eter narcosis 1846. Now surgeons could work carefully without hurry. The next step took Joseph Lister. Born in 1827 he studied medicine in London and then qualified as surgeon at the famous James Syme's clinic in Edinburgh- In 1860 he became professor of surgery in Glasgow. His clinic like all others was afflicted with suppuration, septicemia, erysipelas and gangrene. He happened to read a thesis by Louis Pasteur, who proved that fermentation and putrefaction in wine production were caused by bacteria. Lister saw the similarity with wound suppuration. Carbolic acid was used in wood industri to prevent putrefaction and Lister now introduced this as a mean to cure or prevent suppuration and septicemia. He washed the wound and soaked the bandage with carbolic acid, which he also sprayed in the air of the operation theatre to prevent air carried infection. In 1867 he published his experiences in the Lancet: Out of 11 complicated fractures (where the bone-ends penetrated the skin) 9 healed without complications. Earlier such fractures ended with dead or amputation. The wards were now free from infected wounds. Abroad Listers findings were received with entusiasm, Ernst von Bergmann i Berlin modified the antiseptic method into a aseptic one and sterilized the room, the instruments and clothes and could so avoid the carbolic acid spray, which was irritating for the surgeons breath. Lister applied the aseptic method from 1887. Abdominal and thoracic surgery now became possible and developed rapidly. In England his ideas were accepted with some delay. In 1877 he was appointed professor in London, was made a peer and president of the Royal Society nad was celebrated all over the world. He died 1912, 85 years old.

Joe Burchenal and the birth of combination chemotherapy

When Joe Burchenal started studying medicine at the University of Pennsylvania in 1934, antibiotics had not been discovered and the survival of patients diagnosed with acute leukaemia was < 4 months. By the time he retired in 1983, 58% of children with acute lymphoblastic leukaemia survived 5 years with the majority being cured of their disease. His early work in infectious diseases and antimicrobials equipped him well, both clinically and scientifically. The approach to developing antibiotics to conquer previously incurable infection was an inspiration and model for his pioneering work when searching for drugs with activity against cancer. Trials of sequential and then combination chemotherapy followed. Success in treating lymphoid malignancies in children led him to develop treatment regimens for other more resistant cancers, and as an advocate of collaborative working he introduced multimodal therapy to tackle bulky or metastatic cancers, replacing inevitable relapse with a chance of true cure.

The history of qing hao in the Chinese materia medica

Artemisinin is currently used for treating drug-resistant malaria. It is found in Artemisia annua and also in A. apiacea and A. lancea. Artemisia annua and A. apiacea were known to the Chinese in antiquity and, since they were easily confused with each other, both provided plant material for the herbal drug qing hao (blue-green hao). This article shows, however, that since at least the eleventh century Chinese scholars recognized the difference between the two species, and advocated the use of A. apiacea, rather than A. annua for 'treating lingering heat in joints and bones' and 'exhaustion due to heat/fevers'. The article furthermore provides a literal translation of the method of preparing qing hao for treating intermittent fever episodes, as advocated by the eminent physician Ge Hong in the fourth century CE. His recommendation was to soak the fresh plant in cold water, wring it out and ingest the expressed juice in its raw state. Both findings may have important practical implications for current traditional usage of the plant as an antimalarial: rather than using the dried leaves of A. annua in warm infusions, it suggests that fresh juice extraction from A. apiacea may improve efficacy.

Defensins and other antimicrobial peptides: a historical perspective and an update

Antimicrobial peptides are effectors of innate immunity in phagocytes, body fluids and epithelia. In mammals, defensins, peptides with a characteristic six-cysteine framework, are particularly abundant and widely distributed in various animal species and tissues. The first part of this review provides a historical overview of the ideas that led to the current state-of-the-art in antimicrobial peptides, and the second part is an update on mammalian defensins and their role in host defense to infections.

Tularemia

Tularemia is a complex clinical disorder caused by the ubiquitous intracellular parasite Francisella tularensis, which has many mammalian and insect hosts. The peak observed incidence of tularemia occurred in 1939, and most present-day clinicians have never seen a case of this disease. Tularemia manifests several different clinical syndromes, depending on the portal of entry. F. tularensis has been used in biological warfare experimentation and it has been weaponized and stockpiled in the past by the United States and other countries. It is classified as a category A critical biological agent by the Centers for Disease Control and Prevention. This article reviews the history, clinical features, diagnostic evaluation, and treatment of this organism with an emphasis placed on its potential role as an agent of biological warfare.

Chemistry and biology of roseophilin and the prodigiosin alkaloids: a survey of the last 2500 years

The pyrrole alkaloids of the prodigiosin family make up an unusual chapter in the chemistry of natural products. Owing to the characteristic red color of these secondary metabolites, colonies of the Gram-negative-producing bacteria may strikingly resemble droplets of blood. This phenomenon caused considerable confusion in the past and was likely responsible for many seemingly miraculous (prodigious) events. After the eventual transition from superstition to science, the prodigiosins started to attract considerable attention because of their promising physiological properties. Most interesting are the immunosuppressive activities at doses that are not cytotoxic, in particular since in vivo studies suggest that the prodigiosins act synergistically with cyclosporine A or FK 506, which are presently the dominant drugs in clinical immunosuppressive regimens. Furthermore, the chemistry of the closely related and structurally rather unique alkaloid roseophilin is summarized, a cytotoxic agent that recently became the focal point of many innovative total syntheses.

History of quinolones and their side effects

Fluoroquinolone development from 1985 to the present was reviewed. Severe drug adverse events were noted for enoxacin, pefloxacin and fleroxacin, which were phototoxic. Temafloxacin was associated with severe hemolytic-uremic syndrome, lomefloxacin caused phototoxicity and central nervous system (CNS) effects, and sparfloxacin was associated with phototoxicity and QTc prolongation. Tosufloxacin caused severe thrombocytopenia and nephritis, and hepatotoxicity was reported for trovafloxacin. Grepafloxacin was withdrawn due to cardiovascular effects, and clinafloxacin was associated with phototoxicity and hypoglycaemia. The structure of the quinolones directly relates to both their activity and side-effect profiles. The relationship among specific substituents attached to the quinolone nucleus are clarified. The incidence of specific adverse events associated with individual fluoroquinolones was reviewed in a five-year post-marketing surveillance (PMS) study in Japan, in which a total adverse drug reaction (ADR) rate of 1.3% was found for levofloxacin, compared to total ADR rates of 3.3% for pazufloxacin, 3.6% for tosufloxacin, 4.5% for gatifloxacin and 5.4% for balofloxacin. Gastrointestinal effects were the most common adverse events for all fluoroquinolones. Levofloxacin had the lowest rate of CNS effects and skin adverse events among the agents listed.

Historical perspective on the use of otic antimicrobial agents

Treatment of otorrhea has been described in the literature since 1500 BC. A multitude of therapeutic options have been described, including the use of astringents, antiseptics, alcohol, benzoin and various powders. Since the middle of the 20th century, antibiotic usage has been promoted as the most effective means of therapy. Until recently none of the agents that were used was found to be safe for middle ear use. Since 1990 there have been publications describing the safety and efficacy of fluoroquinolone drops for acute and chronic otorrhea. This article details the transition from treatment of otorrhea with nonspecific means to an era of antimicrobial therapy based on sound scientific evidence.

From chloroquine to antineoplastic drugs? the story of antibacterial quinolones

Chemotherapy has not only proved valuable in treating many diseases but the history of discovery of some drugs makes exciting reading. The aim of this article is to outline one such story.