Antibiotics

by

Scott Podolsky

• LAST MODIFIED: 17 April 2025
• DOI: 10.1093/obo/9780197768723-0016

Introduction

Whether framed as “miracle drugs,” “wonder drugs,” or “magic bullets,” antibiotics revolutionized medical care and agriculture alike. Yet almost from the beginning, their seemingly indiscriminate usage led to concerns about overuse, embodied by the rise of antibiotic resistance and fears of a “post-antibiotic” era. Antibiotics have thus served as a rich source of inquiry for a wide range of historical questions, with topics ranging from the development and regulation of the pharmaceutical industry to the application of antibiotics by clinicians (as well as farmers and veterinarians), to the policies and measures (at local, national, and global levels) developed to encourage the “rational” application of antibiotics and ensure their ongoing utility. Primary actors (especially clinicians and researchers involved during the early decades of antibiotic development and usage), historians, political scientists, sociologists, and anthropologists have all contributed to a rich and expanding historiography concerning these many facets of “antibiotic” history. This article begins with a brief “general overview” listing a handful of texts that can bring the reader unfamiliar with this historiography quickly up to speed. It then generally proceeds through the clinical “life cycle” of antibiotic development, marketing and usage, dissemination, and regulation, before turning to the usage of antibiotics in agriculture, antibiotic resistance, and infection control measures designed to forestall the spread of antibiotic-resistant organisms. It then concludes with brief sections on tuberculosis (which has often been considered distinctly from other antibiotic-susceptible infectious diseases) and the application of more general theory to consider the social and cultural contexts in which antibiotics are deployed (or not) and regulated.

General Overviews

This selection of books covers the wide range of clinical antibiotic development, usage, marketing, dissemination, and regulation, with extensions to concerns over antibiotic resistance and antibiotics in agriculture. Greenwood 2008 provides a very useful reference tool, enabling the reader to focus on particular drugs and drug classes. Dowling 1977 offers an entrance (through the viewpoint of a leading 20th-century infectious disease expert and therapeutic reformer) into the experience of treating infectious diseases with antimicrobials throughout the twentieth century. Bud 2007 is a seminal text that while ostensibly focused on penicillin, extends to larger considerations concerning the impact of antibiotics on clinical practice, the global dissemination of pharmaceuticals, and the rise of concerns regarding antibiotic resistance. Podolsky 2015, largely focused on the United States, examines the antibiotics that came after penicillin and the impacts of drug marketing, therapeutic reform, and drug regulation on antibiotic usage and antibiotic resistance from the 1940s through the present. Kirchhelle 2020 not only examines the history of the incorporation of antibiotics into agriculture in both the United States and Great Britain, but also explores the differing notions of “risk” that have characterized national responses to such incorporation over time.

• Bud, Robert. Penicillin: Triumph and Tragedy. Oxford: Oxford University Press, 2007.

  Bud’s seminal account begins with penicillin’s “triumph,” examining the drug’s discovery and the role of penicillin in the very rebranding of a newly powerful Anglo-American orthodox medicine at the middle of the twentieth century before turning to the worldwide dissemination of the wonder drug. It then considers the more recent, “tragic” aspects of the history, particularly the advent of concerns of antibiotic resistance as well as the technological attempts to counter such resistance.

• Dowling, Harry F. Fighting Infection. Cambridge, MA: Harvard University Press, 1977.

  DOI: 10.4159/harvard.9780674330399

  Written in 1977, by a central infectious disease researcher (and antibiotic reformer) who had “fought infection” both before and after the advent of sulfa drugs and antibiotics, this provides a well-written, birds-eye view of the advent of antimicrobials in the twentieth century.

• Greenwood, David. Antimicrobial Drugs: Chronicle of a Twentieth Century Medical Triumph. Oxford: Oxford University Press, 2008.

  DOI: 10.1093/oso/9780199534845.001.0001

  A wide-ranging account of the origins of nearly all classes of existing antimicrobials, generally arranged chronologically. Dependent on existing published work as sources but well written and an excellent reference source.

• Kirchhelle, Claas. Pyrrhic Progress: The History of Antibiotics in Anglo-American Food Production. New Brunswick, NJ: Rutgers University Press, 2020.

  DOI: 10.2307/j.ctvscxrvf

  A seminal account of the incorporation of antibiotics into Anglo-American food production and of the differential response in the United States and Great Britain to regulating such antibiotic usage over time. Based upon extensive archival and primary research across multiple domains, it uses the antibiotic story to examine the manner by which varying notions (epistemes) of risk are constructed and confronted over time. Also cited under Antibiotics and Agriculture.

• Podolsky, Scott H. The Antibiotic Era: Reform, Resistance, and the Pursuit of a Rational Therapeutics. Baltimore: Johns Hopkins University Press, 2015.

  Podolsky first focuses on the parallel revolutions in pharmaceutical discovery and marketing embodied by the advent of the broad-spectrum antibiotics in the late 1940s and early 1950s. He then turns to the role of the FDA in the 1960s in shaping antibiotic—and broader pharmaceutical—development and marketing in a system in which few constraints were placed on the seemingly “irrational” prescribing of approved (“rational”) drugs.