Penicillin Was Not the First Antibiotic

“Ask most people what the first antibiotic was, and they’ll answer penicillin. But the real antibiotic revolution started years before penicillin was widely available.” Source. What was the first antibiotic? It was sulfanilimade or merely “sulfa.”

Prior to the discovery of sulfa there was no effective drug to fight bacterial infections. As a result, millions of people died every year from streptococcus, staphylococcus, pneumonia and other infections. Bacterial infections were especially deadly for wounded soldiers prior to the discovery of sulfa drugs. Records of Union deaths during the U.S. Civil War show that for every one soldier who died in battle another two died of infectious disease. Similarly, in World War I, more soldiers died of wound infection than died in battle.

Magic Bullets

A “magic bullet” drug is one that destroys the cause of disease but doesn’t kill the patient. Today, we are all accustomed to magic bullets, from antibiotics that cure bacterial infections to chemotherapy drugs that target cancer cells. But the idea that a drug could be a magic bullet wasn’t envisioned until the early 20th century by Nobel Prize-winning chemist Paul Ehrlich. Based on his limited success of using dyes as drugs, in 1927 the German drug giant Bayer hired a young doctor named Gerhard Domagk to run a lab to find a drug that would fight infection.

After years of testing all sorts of dyes paired various other chemicals Domagk found that a commonly used chemical – sulfa – was effective at killing many types of bacteria without harming the patient. With that discovery, sulfa burst into common use. It was cheap, incredibly effective against strep and staph infections, and had few side effects. It was the first magic bullet. Sulfa began being widely used in the late 1930s, particularly after the publicity the drug received when it was credited with saving the life of FDR’s son in 1936. Notably, sulfa also saved Winston Churchill from a bout of pneumonia in 1943. Due to its effectiveness and these well publicized successes, sulfa became ubiquitous in the treatment of infections in the 1940s. According to Thomas Hager in his book Ten Drugs,

Overenthusiastic doctors started using it for everything. The joke at one hospital was that when a patient came in they were immediately given sulfa, and if they weren’t better in a week they might get a physical exam. It was available without a prescription, so nurses made their rounds with a handful of pills in their pockets, passing it out like aspirin.

If you’ve ever seen a TV show or movie about World War II where a medic shakes white powder on a wound — that’s sulfa. Additionally, bandages used in World War II were usually coated with sulfa powder. And it worked. The widespread use of sulfa powder in World War II resulted in death by infection being a small fraction of what they were in World War I.

Dr. Domagk was awarded the Nobel Prize in Medicine for his discovery of sulfa drugs but Hilter didn’t allow him to accept the prize. Domagk actually spent some time in jail for sending a letter of thanks to the Nobel Committee.

The discovery of sulfa as an antibiotic showed that a large pharmaceutical company investing money and talent could solve could create a powerful drug. Thus, sulfa kicked off a frenzy of research and activity which helped lead to other magic bullets.

Sulfa’s popularity and widespread use was short-lived as penicillin replaced sulfa as the antibiotic of choice in the mid-1940s. Sulfa is still used some today to treat urinary tract infections, ear infections and other diseases. It has made a bit of a comeback in the last few decades as some bacteria has become resistant to other antibiotics. Because it has been sparsely used over the past 70 years, antibiotic resistance isn’t a big issue for sulfa drugs.

It’s hard to overstate the benefit that antibiotics have provided humanity. “During the two decades after World War II, the death rate from childhood diseases dropped by more than 90 percent, and the average life expectancy in the United States increased by more than ten years. Demographers call this drug-produced sea change ‘the great mortality transition.'” Source.