ALTHOUGH penicillin has been used successfully in clinical medicine for some 20 years its precise mode of action has until recently been ill understood. Now, progress can be reported.Previous reviews on its mode of action have been published by Rinderknecht (1 946), Pratt and Dufrenoy (1 947) and Eagle and Saz (1 955), and Stenlake (1959) has recently summarised the actions of various antibiotics. Because one of the main effects of penicillin appears to be concerned with an inhibition of bacterial cell wall synthesis, the greater part of this review will deal with cell wall structure and the effect thereon of the antibiotic.After this review was completed, a review on the mucopeptide components of bacterial cell walls was published by Work (1961) who described briefly the effect of penicillin on cell wall synthesis.
Morphological Changes Induced by PenicillinGardner (1940) reported that, in dilute solutions, penicillin induced a distinct lengthening in all the rod-shaped bacteria which were sensitive to the antibiotic. In a later report, Gardner (1945) extended his work to a microscopical examination of the effect of penicillin on the spores and vegetative cells of bacilli, and found that even the weakest inhibitory dose of penicillin attacked the organism in the early stages of germination. It was also shown that lytic changes in vegetative cells of Bacillus anthracis were less pronounced in a strong than in a weak penicillin solution. Thomas and Levine (1945) demonstrated that penicillin in inhibitory but not completely bacteriostatic concentrations induced bizarre involution forms in Gram-negative intestinal bacteria growing in liquid or solid media. Fisher (1946) showed that the in vitro activity of penicillin on staphylococci caused enlargement of the bacterial cells followed by lysis. Similar effects were observed to a lesser degree on cultures of /3-haemolytic streptococci and pneumococci. Fisher also made the interesting observation that the group A streptococcus was not killed in the same manner, since there was no evidence of debris to suggest that many of the bacteria had been lysed, although cultures were almost sterile after 10 hr. and completely so after 24 hr. Duguid (1946) showed that low concentrations of penicillin induced giant forms in Escherichia coli and Hughes, Kramer and Fleming (1946) described the morphological changes induced by penicillin in Proteus vulgaris; these included (a) elongation up to 200 p in length, and (b) production of single or multiple swellings on the rods. Often, completely spherical, actively motile forms of 6 p or less could be observed on microscopical examination.