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One of the most significant anniversaries in human history just passed with no celebration or fanfare: the discovery of penicillin.
Almost everyone alive today has grown up in the age of antibiotics, and so it’s easy to forget how world-altering this breakthrough was. Most of us wouldn’t make it to adulthood if it weren’t for the work of Sir Alexander Fleming, who shared the 1945 Nobel Prize in physiology or medicine with Ernst Boris Chain and Howard Walter Florey, but is widely credited for his discovery on Sept. 28, 1928.
I came to appreciate this anniversary the hard way, having recently flirted with disaster after disobeying the most common of doctor’s orders when prescribed an antibiotic: Finish all medication unless directed otherwise by your physician.
This is advice I will never again ignore.
But a few days into a 10-day course of an antibiotic I’d been prescribed for strep throat at the beginning of summer, I decided I’d had enough. The consequences arrived several weeks later.
There was a sudden swelling of my feet and a strange rash on my legs and feet. Soon, my calves, too, ballooned. I took to wearing long, flowing pants and my daughter’s larger shoes, and stopped eating sugar and salt, fearing a sudden onset of Type 2 diabetes. Nothing changed. When my feet went numb, I went to urgent care.
There, a quick medical history and another positive strep test revealed that the bacteria had been romping throughout my body all month. It had been merely chastened, not obliterated, because I didn’t finish all of the medication. The diagnosis was strep-induced vasculitis, the prescription for which was — you guessed it — more antibiotics.
The doctor didn’t have to tell me to finish the pills this time.
Indeed, I hobbled into the CVS and greeted the pharmacist with the enthusiasm of Ebenezer Scrooge on Christmas morning. Halloo, my fine fellow! Have you any antibiotics? What delightful things they are! Such a pleasure to take! What a remarkable drug!
Waiting for him to fill the prescription, I looked around, marveling at all the wonderful products that promised to improve or restore my health. I have been vaccine reluctant of late, but seized upon a brochure showing all that were available to me at no cost. A flu vaccine? Glorious! A COVID-19 booster? Shingrix? Two Shingrix? Lovely! What a time to be alive!
It seemed that all it took to overcome a few years of post-COVID pharmaceutical reluctance was a swarm of Streptococcus pyogenes colonizing my legs.
Telling this story, I encounter two groups of people. The first are skeptical of my account. “I’ve never heard of getting strep in your legs,” they say, frowning, as though I made all this up for attention. Others, however, know of what I speak, and some offered horror stories worse than mine. A colleague told me that a friend’s college-age son had strep throat and didn’t get treated for it, and the bacteria moved into his legs and eventually he had to be hospitalized and have surgery. Another had written about a Utah mom who lost her legs and part of her arm from a strep infection after giving birth — “She was fighting a life-and-death battle against Streptococcus pyogenes — Strep A — a common one-cell organism that is mindless in its drive to survive,” Lois Collins wrote.
Even in the age of antibiotics, more than 1,000 Americans die every year from a strep infection that spreads, often because they didn’t get treatment quickly enough. There are many more horror stories in the scientific literature, and photographs you probably don’t want to see.
One case in particular haunts me: a woman identified only as “Ms. A,” whose illness was described in a medical journal. She had developed cellulitis after the spread of strep bacteria, but delayed getting treatment because of a winter storm. By the time she sought help, the bacteria had spread throughout both legs. “She was started on antibiotics but quickly progressed into acute respiratory distress and multi-organ failure. She expired three days after presenting to the emergency department,” the paper describing her case said.
The woman had other medical issues, and the authors of the paper make clear that such dire outcomes occur most often when patients have “underlying chinks in their defenses.” Those younger than 2 and older than 65 are most at risk, especially if they have other infections, diabetes, heart disease or other instances of immune suppression.
I, however, had none of those risk factors, which is why I now serve as a cautionary tale at my local urgent care, where a physician assistant was all too happy to take pictures of blotchy and swollen legs. “I’d like to use you as an example of what can happen if you don’t finish all the medication, if you don’t mind,” she said.
I did not mind at all.
If you can’t be a good example, be a cautionary tale.
It’s the least I can do — for science, and for Alexander Fleming, who on this week in history 98 years ago noticed that green mold was killing the Staphylococcus aureus on his petri dish and thought to wonder why.
