'What is antibiotic resistance, and why should I care?'
Two decades after the first edition ofRevenge of the Microbes: How Bacterial Resistance Is Undermining the Antibiotic Miraclewarned of the looming threat of antibiotic resistance, it is now upon us. Not only has the spread of antibiotic resistance continued unabated, but the emergence of multidrug-resistant 'superbugs' is poised to set medical progress back centuries. Several distinct biological, social, economic, and technological factors have resulted in us only barely keeping pace with these new threats.
In this edition ofRevenge of the Microbes,the authors detail the intricacies of the antibiotic-microbe arms race. Beginning with a historical perspective on antibiotics and their profound impact on both modern medicine and present-day society, they review our current arsenal against infectious diseases and the various ways pathogens evade or overcome them. The authors examine the practices and policies driving the discovery and development of new antibiotics, what happens to antibiotics once they are released into the environment, how antibiotic-resistant bacteria evolve and spread, and the urgency for finding alternative approaches to combating infections. This discussion of the controversies surrounding antibiotics will empower readers-citizen scientists, policy makers, pharmaceutical researchers, and medical professionals alike-to generate informed opinions on antibiotic usage and stewardship as we contend with fewer effective antibiotics.
Reader-friendl and comprehensible, this new edition ofRevenge of the Microbesengages a diverse audience of scientists, clinicians, educators, students, lawyers, environmentalists, and public health advocates as it explores the ever-changing landscape of the antibiotic resistance crisis.
For anyone interested in antimicrobial resistance (AMR), this is a completely approachable 360-degree view of a very complex topic. The authors don't dilute the science but manage to deliver it in language and examples that everyone can digest. Don't miss the 'Points to Ponder' at the end of each chapter. These thought-provoking nuggets will inspire creative thinking even in the most experienced AMR authorities.
-JEAN B. PATEL, PhD, D(ABMM),Principle Scientist, Scientific Affairs, Microbiology, Beckman Coulter; former Science Team Lead, Antibiotic Resistance Coordination and Strategy Unit, CDC
Nowadays, nearly everyone has heard of antibiotics. In fact, most people even have had firsthand experience using them at some point in their life. Whether they were prescribed antibiotics to treat strep throat as a child, or they used an antibiotic cream to manage their teenage acne, or they simply applied an antibiotic ointment to a skin abrasion—the use of antibiotics to treat and prevent infection has become a ubiquitous part of our everyday lives.
However, despite their widespread use, there remains significant confusion regarding several aspects of how antibiotics work and when they should be used. Many patients still ask their doctors: “Why can’t I have antibiotics to cure my cold?” or “Why don’t antibiotics work against infections like flu or COVID?” And while more informed individuals will know that antibiotics are drugs that specifically target bacteria by inhibiting their growth or outright killing them, these people are then puzzled when doctors sometimes prescribe antibiotics for patients hospitalized with viral infections. What they may not realize is that those doctors are doing so not to directly treat the virus but to prevent secondary infections of bacterial pathogens in individuals with viral‐weakened immune systems. Unfortunately, many patients in this situation do not understand why they are taking antibiotics, thinking either that the doctor is just humoring them or, worse, that the antibiotics will actually kill the virus. When these individuals subsequently go on social media and spread their incomplete understanding, they sadly end up just eroding the general trust in the medical community.
Further confusion arises when discussing antibiotic resistance. After all, what exactly is antibiotic resistance? Most people correctly recognize that antibiotic resistance means that antibiotics are becoming less effective. However, to many, it is not obvious that antibiotic resistance refers to the bacteria becoming resistant to the drugs rather than individual people becoming resistant to treatment. After all, there are some people who have developed allergies against certain families of antibiotics (e.g., penicillins or macrolides). So in a sense, the misunderstanding is not completely unfounded, as some people’s bodies do reject or “resist” these antibiotics. Ultimately, the real challenge is that the two different understandings of the issue have very different implications for what policies, if any, limiting antibiotic usage need to be implemented. If the bacteria are developing resistance, then it makes sense to have antibiotic stewardship policies that limit antibiotic use. However, if resistance occurs only in certain individuals, limiting the use of an antibiotic in one patient will not change the efficacy of that antibiotic when treating someone else.
Perhaps the most problematic source of confusion stems from the dissonance between what people hear from media and what they tangibly experience. Starting in the mid‐1990s, stories about antibiotic‐resistant bacteria suddenly started appearing everywhere. True to sensationalist form, or perhaps because of a lack of understanding of the problem, the press portrayed what was really a slowly developing, insidious trend to be a galloping crisis. Alarming headlines cautioned against the “Looming antibiotic crisis” and feared the “Return to the pre‐antibiotic era on the horizon” and “Superbugs on the march.” Writers of such stories conveyed the impression that doom was imminent. Yet 30 years later, antibiotics are still a routine part of our lives. Outside of medical and research circles, one could even be fooled into not knowing there was a problem. A big part of this perception stems from the fact that although many health organizations around the world have declared antimicrobial resistance and the emergence of pan‐resistant bacteria (“superbugs”) to be an urgentglobal public health threat, thus far antibiotic resistance has disproportionately impacted low‐ and middle‐income countries. However, citizens of the de
