DDP Newsletter – Vol. XXXVI, No. 2
The “silver bullet” of antibiotics seemed to herald the conquest of infectious diseases, and the Centers for Disease Control and Prevention (CDC) shifted its focus to noninfectious “epidemics” such as cancer and heart diseases. But with the rise of multiply resistant bacteria as well as the ever-present threat of viral diseases, we might soon be living in the post-antibiotic era. We need to review methods from the pre-antibiotic era, which rapidly lost favor after the discovery of penicillin.
In 1892, William Osler wrote that lobar pneumonia “is a self-limited disease and runs its course uninfluenced in any way by medicine. It can be neither aborted, nor cut short by any known means at our disposal.” By 1913, leaders at the Rockefeller Institute initiated equine serum therapy for the treatment of pneumonia. Two decades later, mortality from lobar pneumonia was 25%–40% in patients not receiving serum, but 10%–20% in those who received this therapy. While the treatment was a major advance, it was expensive, time-consuming, needed to be matched to the serotype of the bacteria, and limited by allergic reactions to horse or other serum. Serum therapy was soon eliminated after the introduction of sulfonamides in 1939.
X-irradiation began to emerge as an alternative to the therapeutic monopoly of serum treatments in the 1930s. Edward Calabrese and Gaurav Dhawan (Yale J Biol Med 2013;86:555-570, tinyurl.com/s7ua856) trace its history, beginning with the first report in 1905. Radiotherapy (RT) was broadly accepted early in the 20th century, with notable successes in the treatment of many inflammatory and infectious diseases such as gas gangrene, carbuncles, sinusitis, arthritis, and inner ear infections.
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