A STIRRING EXAMINATION OF A LOOMING CRISIS Virtually everyone has taken antibiotics. They can be lifesavers - or they can be useless. But what are they? How are they used? And what happens as the effectiveness of antibiotics begins to decline? Antibiotics: What Everyone Needs to Know (R) examines the personal and societal implications of our planet's most important - and arguably most overused - medications. In a question-and-answer format, it unpacks the most complicated aspects of this issue, including:* How antibiotics are used (and overused) in humans, plants, and livestock* The consequences to date, and the potential crisis ahead, as overuse of existing antibiotics breeds new resistance in bacteria* How the globalized world enables antibiotic resistance more quickly* Collateral damage, individually and societally, of antibiotic use* The difficult decisions ahead related to medical care and the food systemGrounded in the latest scientific research and translated for general readers, Antibiotics: What Everyone Needs to Know (R) offers a clear-eyed overview of where we are, and what the future holds, as antibiotics lose their might.
Table of Contents
Why should you read this book? xv
Why did I write this book? xviii
1 Origin And Function 1 (42)
What is an antibiotic? 1 (1)
What is the difference between an antibiotic 1 (6)
and an antimicrobial?
How do antibiotics work? 7 (1)
What is the difference between broad- and 8 (2)
Why do we have so many different antibiotics? 10 (3)
Do antibiotics work against viruses? 13 (1)
Why do people confuse bacteria and viruses? 14 (1)
How were antibiotics discovered? 15 (11)
Where do antibiotics come from? 26 (4)
How are antibiotics made? 30 (2)
Are new antibiotics created in the laboratory 32 (1)
or discovered in nature?
What happens after a compound with 32 (5)
antibacterial activity is discovered? How
does it come to be used to treat infections?
Are the same antibiotics used all over the 37 (2)
How common are substandard and falsified 39 (2)
What is the WHO model list of essential 41 (2)
2 Use In Humans 43 (58)
How are antibiotics administered? What are 43 (3)
the routes of administration besides by mouth
and by injection? What determines how they
should be given?
Are pills as effective as injections? 46 (3)
Where does the antibiotic go in the body? 49 (2)
Does it reach all organs and tissues? What is
its fate? Does any part of the antibiotic
leave the body in urine or feces?
What happens with antibiotics after they 51 (1)
leave the body?
Why are antibiotics that are not absorbed 52 (1)
How does one decide which antibiotic to use? 53 (4)
What information about each antibiotic is 57 (3)
available to the pharmacist, the health
provider, and the patient?
How long does it take for an antibiotic to 60 (1)
work? Why are some antibiotics given as a
single dose and others prescribed for weeks
What determines the right dose of an 61 (2)
Can one overdose on an antibiotic? 63 (1)
Does an antibiotic have any effect other than 63 (2)
against the bacteria being treated?
How long does the effect of an antibiotic 65 (1)
Why are some infections, such as 66 (2)
tuberculosis, always treated with multiple
different antibiotics taken simultaneously?
Does one always have to take the entire 68 (2)
course of prescribed antibiotics?
Can one take leftover antibiotics for a new 70 (1)
infection? Or give it to a family member or
What should one do with leftover antibiotics? 71 (1)
Is it dangerous to take expired antibiotics? 72 (3)
When are antibiotics used to prevent 75 (1)
infections (in contrast to treating an
How are antibiotics used to prevent 76 (2)
infections in surgery?
In what other settings are antibiotics used 78 (4)
to prevent infections (antibiotic
When are antibiotics used to treat entire 82 (5)
populations in mass treatment campaigns?
What are the consequences of mass treatment 87 (3)
How are antibiotics used in the human 90 (1)
population? Who receives them?
What are the main reasons that antibiotics 91 (1)
Why is antibiotic use so common for 92 (2)
Does antibiotic use vary by region or by 94 (2)
Is antibiotic use increasing or decreasing? 96 (2)
How much is spent on antibiotics? 98 (3)
3 Consequences Of Use: Adverse Events 101 (48)
Associated With Use Of Antibiotics In Humans
What is the difference between an allergic 101 (6)
reaction and an adverse reaction? What are
the signs and symptoms of an allergic
How common are adverse reactions? 107 (2)
How much antibiotic does it take to cause an 109 (1)
Do genetic factors influence drug reactions? 109 (2)
What are drug-drug interactions? 111 (1)
Does exposure to the sun make one more likely 111 (1)
to have a reaction to an antibiotic?
Why have side effects from ciprofloxacin (and 112 (3)
other fluoroquinolones) gotten so much
What is Clostridioides difficile colitis and 115 (3)
where did it come from?
What is driving the increase in cases? 118 (1)
What predisposes someone to Clostridioides 119 (3)
difficile infection and how does it spread?
How is it treated? 122 (1)
What is a fecal microbiota transplant? 122 (4)
Can fecal microbiota transplantation be used 126 (2)
to treat other conditions?
Why do yeast infections occur during and 128 (1)
after treatment with antibiotics?
What is the microbiome and why is it so 129 (5)
What is the Human Microbiome Project? 134 (2)
What are the functions of the human 136 (4)
How do antibiotics affect the human 140 (3)
Does human use of antibiotics and other 143 (2)
agents affect animal microbiota?
Do other drugs besides antibiotics affect the 145 (1)
Can the gut microbiota be protected from the 146 (3)
effect of antibiotics?
4 Other Uses Of Antibiotics (Nonhuman Use) 149 (32)
What are the uses of antibiotics other than 149 (1)
to treat infections in humans?
What proportion of antibiotics produced in 149 (1)
recent years had a nonhuman use?
Why are antibiotics given to healthy animals? 150 (5)
Which animals receive antibiotics? 155 (1)
Which antibiotics are used? Are the same 156 (2)
antibiotics used in people also used in
Are antibiotics used in food animals in other 158 (1)
How are antibiotics used in aquaculture? 159 (2)
Is it OK for humans to take antibiotics that 161 (1)
were made for fish or other animals?
What are the consequences of using 162 (2)
antibiotics in animals?
Is any antibiotic still present in the meat, 164 (2)
fish, eggs, or milk when they are sold for
Why are antibiotics used in bees? 166 (1)
Do plants develop infections? Why and how 167 (1)
often are antibiotics used in plants?
Can humans pick up infections from plants? 168 (1)
How can plant infections affect human health? 169 (3)
Is food from plants contaminated with 172 (4)
Does feeding animals antibiotics in large 176 (2)
production facilities (such as industrial
production of food animals like chickens,
pigs, and cattle) have an impact on the local
What are other sources of antibiotics in the 178 (3)
5 Antibiotic Resistance 181 (66)
What is antibiotic resistance? 181 (4)
Where did antibiotic resistance come from? 185 (4)
What are the mechanisms bacteria use to evade 189 (1)
How do bacteria destroy or disable the 190 (3)
How can bacteria change an antibiotic to 193 (1)
How can bacteria prevent antibiotics from 194 (1)
getting through the cell wall of the bacteria?
How do bacteria manage to pump antibiotics 194 (1)
out of the bacterial cell?
How can bacteria alter the target of 195 (1)
antibiotic action in the bacteria?
How can bacteria bypass key functions to 196 (1)
survive despite the presence of antibiotics?
What else can bacteria do to avoid being 197 (2)
How does one test bacteria for resistance to 199 (3)
How does antibiotic resistance spread among 202 (3)
Where does this transfer of resistance genes 205 (1)
among bacteria take place?
How do resistant bacteria and resistance 206 (4)
genes spread globally? What is the role of
travel in the movement of resistant bacteria
and resistance genes globally?
How do travelers pick up multiply resistant 210 (5)
bacteria? Where are the resistant bacteria
How often do travelers pick up resistant 215 (3)
bacteria? Do they spread them to others?
What is medical tourism? Are travelers who 218 (2)
receive medical care abroad at risk for
infections with resistant bacteria?
Are mass gatherings an important source of 220 (1)
infections and spread of infections or
What is wastewater epidemiology? 221 (2)
How does resistance spread in health care 223 (2)
Are there ways resistant bacteria spread that 225 (2)
do not involve movement of humans?
Do pets carry antibiotic-resistant bacteria? 227 (1)
What are other routes of spread of bacteria 228 (1)
from animals to humans?
Does antibiotic resistance ever disappear? 229 (1)
Which bacteria have developed resistance? 229 (1)
Why does tuberculosis remain such a serious 230 (9)
Why is gonorrhea so hard to treat? 239 (5)
Are antibiotic-resistant bacteria found in 244 (1)
Are levels of resistance influenced by the 245 (1)
amount of antibiotic used in a region or
What can be done to slow or stop antibiotic 245 (2)
6 Consequences Of Antibiotic Resistance 247 (16)
What are the most important consequences of 247 (2)
having infections caused by
Are infections caused by antibiotic-resistant 249 (1)
bacteria less severe, more severe, or the
Are outcomes worse for antibiotic-resistant 250 (3)
What would be the consequences if antibiotics 253 (1)
stopped working? What do people mean by the
What medical procedures today rely on the 253 (2)
availability of highly effective preventive
Do we have antibiotics to use when bacteria 255 (1)
become resistant to first-line drugs?
Are these other antibiotics as safe and 256 (1)
effective as first-line drugs? Are they
available and affordable?
Can antibiotics still be used for prevention 257 (1)
when bacteria become resistant?
Are people dying today because of 257 (3)
Why are antibiotics considered community 260 (3)
drugs? How does my taking an antibiotic
affect my neighbors and the community?
7 Interventions To Reduce Need For Antibiotics 263 (44)
And Alternatives To Antibiotics
Are there ways to reduce the risks of 263 (1)
infections so that we do not need antibiotics?
How do clean water and improved sanitation 264 (3)
reduce use of antibiotics?
How can processing and handling of food 267 (3)
affect antibiotic use?
How can using vaccines reduce the need for 270 (2)
How can vaccines against viral infections 272 (6)
reduce the need for antibiotics? Why does
influenza, a virus, get so much attention?
Are vaccines used to prevent infections in 278 (1)
animals? Can they prevent infections that
could affect humans?
How can controlling vectors like mosquitoes 279 (1)
and ticks reduce antibiotic use?
Are health care-associated infections a 280 (6)
common reason for antibiotic treatment?
Do antiseptics and alcohol-based hand 286 (2)
sanitizers work against all microbes?
How can copper be used to reduce infections? 288 (5)
Are there approaches to treating infections 293 (1)
that do not involve antibiotics-treatment
approaches that do not drive the development
of resistance the way that use of antibiotics
What other approaches to treating infections 294 (3)
are being tried that do not involve
What is bacteriophage therapy? How does it 297 (5)
work? Is it being used today?
Looking to the future 302 (1)
How are phages and bacteriocins used today? 303 (4)
8 Preserving Antibiotics And Developing New 307 (40)
How common is inappropriate prescribing of 307 (4)
What approaches have been effective in 311 (5)
increasing the appropriate use of antibiotics
and decreasing inappropriate prescribing by
What can individuals do to reduce the 316 (2)
inappropriate use of antibiotics?
What are antibiotic stewardship programs? 318 (1)
Do antibiotic stewardship programs work? 319 (2)
Why do stewardship programs include focus on 321 (3)
reported allergies to antibiotics?
What is the role of better diagnostic testing 324 (1)
in reducing use of antibiotics?
What is procalcitonin and can it help guide 325 (3)
Are procalcitonin levels useful in diagnosing 328 (1)
infections in infants?
Why did use of rapid diagnostic tests lead to 329 (2)
increased use of antibiotics in some settings?
Are there other approaches that use urine, 331 (4)
saliva, breath, or other specimens to
What is the role of national and 335 (2)
international agencies in reducing
inappropriate use of antibiotics?
Why aren't pharmaceutical companies 337 (1)
developing more new antibiotics? Why
don't we have more antibiotics in the
Which bacteria are the highest priority for 338 (1)
development of new antibiotics?
What antibiotics or antibacterial products 339 (1)
are currently in the pipeline?
Whose responsibility is it to develop new 340 (2)
antibiotics? Who pays for their development?
What incentives or other approaches might
increase the development of new antibiotics?
What are priority areas in looking for other 342 (5)
ways to treat bacterial infections?
Glossary 347 (10)
Bibliography 357 (22)