In 1940, Ernst Chain and Edward Abraham reported the first indication of antibiotic resistance to penicillin, an E. coli strain that produced the penicillinase enzyme, which was capable of breaking down penicillin and negating its antibacterial effect. Chain and Abraham worked out the chemical nature of penicillinase which they reported in Nature as:
In his Nobel lecture, Fleming warned of the possibility of penicillin resistance in clinical conditions:
At the time, only poisons required a doctor's prescription, and self-treatment was a real possibility. Legislation was passed in the UK in 1947 to require a prescription for antibiotics. The United States followed in 1951. Elsewhere in the world, the export of Western pharmaceuticals diffused faster than Western medical knowledge and practices, and penicillin was often dispensed by practitioners of traditional medicine. As late as 1999, a study in the UK found that 39 per cent of respondents erroneously believed that antibiotics could cure colds and flu, and 12 per cent believed that they were the best treatment for them. The misplaced faith in antibiotics had serious consequences. It reduced the status of doctors to providers of pills. Many more people sought medical attention for ailments they would have ignored before, and they often demanded antibiotics. For their part, overworked doctors were increasingly willing to provide them even if not asked to do so.
By 1942, some strains of Staphylococcus aureus had developed a strong resistance to penicillin and many strains were resistant by the 1960s. In 1946, bacteriologist Mary Barber began a study of penicillin resistance through natural selection at Hammersmith Hospital in London. She found that in 1946, seven out of eight bacterial infections were susceptible to penicillin, but two years later only three out of eight were. Nurses were exposed to both bacteria and penicillin and harboured and transmitted bacterial infections. Miller found that three out of ten student midwives were colonized by bacteria when they arrived; after three months, seven out of ten were. The problem was sloppy hygiene practices by health care workers, poor medical practices like prophylactic use of antibiotics, and slipshod administrative practices, such as taking babies from their mothers to large hospital nurseries where they could infect each other.
Antibiotic-resistant infections were reported in Australia in 1952. During the 1957–1958 influenza pandemic there were 16,000 deaths in the UK and 80,000 in US from bacterial complications; 28 per cent of those who contracted pneumonia died. Most cases of pneumonia were contracted in hospitals, and many of these were antibiotic-resistant strains that had been nurtured there. In 1965, the first case of penicillin resistance in Streptococcus pneumoniae was reported from Boston. Since then other strains and species of bacteria have developed resistance.