David Greenwood. Oxford University Press, 2008, 429p, $ 125.00

In Antimicrobial Drugs-Chronicle of a Twentieth Century Medical Triumph, author David Greenwood describes the contributors and contributions to the revolution in infectious disease therapy which took place 1900 to 1980. During those years, the convergence of organic chemistry, industrial fermentation technology, clinical medicine, and disease microbiology produced hundreds of life-saving antimicrobials.

David Greenwood is Emeritus Professor of Antimicrobial Science, University of Nottingham Medical Society and Archivist of the British Society for Antimicrobial Chemotherapy. He is coauthor of Antimicrobial Chemotherapy, Oxford University Press, now in its 5th edition. In both the subject and the composition of this new book, Professor Greenwood is well versed.

Antimicrobial Drugs is neither a microbiology nor a history text, but is a fluent, personal account of the drug researchers and the competitive, sometimes serendipitous, routes to the products they sought. Nine chapters contain stories of conquests of specific diseases (syphilis, TB/leprosy, scarlet fever, malaria); descriptions of both antimicrobial pioneers (Ehrlich, Waksman, Fleming, Domagk, Shope) and pursuers (Bernheim, Conover, Umezawa); breakthrough discoveries that lead to sulphonamides, beta-lactamases, streptomycin, and the diverse antibiotic lineages that followed. Historical context is given also to chemotherapies against protozoa, helminths, fungi, and viruses.

What makes this book especially palatable are the interwoven "mini-stories" surrounding antimicrobial research. An early antiviral compound inducing interferon was isolated from a penicillium mold growing on the isinglass cover of a photograph of Richard Shope's wife Helen. It was named Helenine by virologist Shope "out of recognition of the good taste shown by the mold producing the substance in locating on the picture of my wife."

Equally interesting are Greenwood's descriptions of the legal and personal squabbles of Waksman and his prote´ge´ Schatz over recognition and profits from the discovery of streptomycin, and of the imbalanced, if not unfair, level of public accolade awarded to Alexander Fleming for discovering penicillin but not to the research contributions of Florey, Chain, and American pharmaceutical companies. Science is a human endeavor.

One weakness is the chapter dealing with antibiotic resistance. Against the standard of its predecessors, this final chapter is too brief a coverage of an important subject whose history is yet unfolding. Undescribed topics include research to find alternatives to antibiotics (probiotics, phage-related therapies) and the growing list of collateral effects of subtherapeutic antibiotics (signaling microbes; stimulating gene exchange).

Greenwood's proposition that, despite antibiotic resistance . . . the treatment of infectious disease will never get as bad as it was in the "pre-antibiotic era" is likely true. From another perspective, we have entered the "antibiotic resistance era," and the therapeutic challenges of antibiotic resistance are better compared against the "pre-antibiotic resistance era." The large concerns for scientists, health professionals, and society are the slowing stream of new antibiotics and the current attitudes and practices that sustain and prolong the antibiotic resistance era. In response to antimicrobial resistance, it is not useful to become Cassandras-but neither should we become Pollyannas.

This book is recommended reading for human and veterinary health practitioners, clinically oriented microbiologists, medical students, organic chemists, pharmaceutical professionals, and the interested public. Pharmacology professors will find a wellspring of interesting material to liven dull lectures on antibiotics.

Thad Stanton
Research Leader, PHFSED Unit
NADC USDA-ARS
Ames, Iowa