Does penicillin kill bacteria?

The thesis is presented that the bactericidal action of penicillin and of other inhibitors of cell wall peptidoglycan synthesis, such as vancomycin and cycloserine, is secondary or tertiary to their ability inhibit specific reactions in the assembly of an osmotically protective cell wall. Examples are given of the inhibition of these reactions, which results in inhibition of cell growth (bacteriostatic action) in the absence of either cellular lysis or rapid loss of viability. Thus, in some instances, inhibitory concentrations of these drugs are, in effect, sublethal; this is true, for example, for Streptococcus mutans, a species of bacteria that is part of the normal flora of the oropharynx and that can cause subacute bacterial endocarditis. On the other hand, the damaging effects of the subminimal inhibitory concentrations of penicillin G on Streptococcus faecalis, a species with an active autolytic enzyme system, can be uncovered and converted to a lytic (and lethal) response by partial inhibition of fatty acid synthesis with low concentrations of cerulenin. Some theoretical and practical implications of the occurrence and inhibition of these secondary lethal consequences are discussed.