by Jason P. Burnham
Whoopsie-doodle! Your protagonist has just been written into a world where the infrastructure for antibiotic production no longer exists. Perhaps you’re writing in the near future, and climate change has progressed to the point of the complete collapse of global commerce. Perhaps the aliens from the first Independence Day movie have blown up all the major centers of production around the world. Or maybe the antibiotic production infrastructure has yet to be invented because you’re writing in the past or a pre-technological fantasy world. Wherever you’re creating, no one is making antibiotics. Protagonists living a “life after antibiotics” (or before, as may be the case) is becoming an increasingly relevant theme/scenario for modern speculative fiction. What’s a protagonist (and author looking to write such a setting with believable medical accuracy) to do?
Before we dive into what your main character’s options are for making/acquiring antibiotics, first we must consider the spectrum of conditions for which you might need antibiotics. Some common bacterial infections are those of the urinary tract, lungs (pneumonia), ears, skin and soft tissue, bones, and meninges (meningitis). Add to that diarrheal illness and sexually transmitted infections. If there are no antibiotics, what can your protagonist do for the afflicted?
Note: We won’t cover antivirals or antifungals here. For unchecked fungus, see The Last of Us, the empty pool scene from the movie Annihilation, or various National Geographic documentaries. The immune system tends to take care of viral infections without antivirals, though some people would die without supportive care in a hospital. Unchecked HIV without an antiviral infrastructure should be its own Planetside article, but you could also just read up on what happened in the 1980s (see And the Band Played On by Randy Shilts).
Managing Infections Without Antibiotics
Control of a bacterial infection’s source is paramount, and for some infections, this can be done surgically in a way that doesn’t necessarily require any antibiotics (think of draining a boil). Unfortunately, if there aren’t any antibiotics at your protagonist’s disposal, there probably aren’t any anesthetics either (ouch!). So, if you’re the unlucky protagonist (or patient/family member/love interest of the protagonist) who has toe gangrene in this story, break out the mouth guard, the whiskey, and the sleeping incantation,, as the most readily available chopping/cutting instrument is sharpened in preparation for gangrenous appendage removal. Make sure the post-operative wound is cleaned and bandaged appropriately, keeping it free of water and dirt.
These methods (cutting instead of finding an antibiotic) could also be applied to conditions/procedures like the lancing of boils and draining of other purulent collections from festering wounds that are close enough to the skin’s surface to be reached easily with whatever tools of the trade are available in Protagonist World. Note: You’ll want to consider how people with amputated parts are going to be received by others (is this an inclusive world or an ableist dystopia?) and what assistive devices might be fashioned/DIY-ed to make sure they have a chance of outrunning the zombies or rogue AIs or plutocrats.
But what about infections where “chopping it off” isn’t an option or “draining pus” just won’t fly? After all, you can’t cut out the urinary system if it burns when you pee (though your protagonist may think that preferable given their symptoms), nor can you cut out the meninges (yes, I see you autocracy who empties skulls to implant the next-gen brain/spine implant for mind-controlled super soldiers—meninges explant is not allowed!). So, what can the protagonist do? For a urinary tract infection, the best strategy may be an ounce of prevention. Something as simple as having your protagonist drink extra water will reduce the risk of getting a urinary tract infection. “But clean water is limited.” Touché. Perhaps your protagonist has access to cranberry juice or the extracts of urine of pregnant mares to reduce UTIs. But eventually, a character (perhaps even a main one) is going to get an infection that cannot have been prevented and can’t be cut or drained away. What then?
Ancient Recipes
In the last decade, scientists have recreated a 10th-century Anglo-Saxon recipe for an anti-infective salve used for eye infections. Known as Bald’s Eyesalve, this remedy was rediscovered in Bald’s Leechbook (archived in the British Library) by a team of microbiologists and experts in Old English. The concoction involves onions, garlic, wine, and a cow’s bile salts combined in a brass vessel (talk about a witch’s brew). When applied in a lab to Staphylococcus aureus (a bacterium that causes more than a million deaths per year globally), the concoction showed excellent killing activity. The Dark Ages aren’t sounding so dark now, huh?
Bald’s Eyesalve is just one example—perhaps your protagonist has access to other forgotten or dismissed remedies. An ancient text, only recently discovered. An Indigenous remedy known only through oral tradition, in danger of being phased out of history by colonial violence. Lost scrolls from antiquity stumbled upon in a cave, desert, or island that are previously unread, but provide crucial insights into antibiotic properties and preparations from commonly available plants, fungi, insects, or other plot/world-convenient source. It is entirely plausible! One of the first-line drugs against malaria was discovered by a Chinese researcher in the 1970s, who went through thousands of ancient texts and folk manuals to identify potential anti-malarials! Consider also that wounded Confederate soldiers from the first American Civil War were treated with Native American remedies derived from plants ranging from white oak to devil’s walking stick to tulip trees. The sources of nature-derived antibiotics are myriad in real life and can be in your fiction too.
So, where does this leave our protagonist? If the infection can plausibly be cut out/off, this may be the route to go. If an infection can be prevented, this will save much grief. For those infections that can’t be cut or prevented, an herbal/plant concoction from a plausibly arcane tome/text/scroll may just save the day (and limb)! If you want your story to be a commentary on loss, maybe the concoctions have great promise and the ancient text swears they work, but despite your protagonist’s best efforts, the loved one still dies. But if you’re going for hope, these ancient remedies are going to do just the trick!
The Aftermath
One final note: In a world without antibiotics, disabilities will arise in survivors—limb loss, deafness (meningitis is a common culprit), blindness, gait problems, and debility, among others. Accommodations for and coping among the infirm and the recovered can be powerful points in your story (if you so choose). Happy apocalypse writing!
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Jason P. Burnham (he/him) loves to spend time with his wife and children. He dearly misses his dog. He is an infectious diseases physician and researcher.