Antibiotic Resistance Understanding and Responding to an Emerging Crisis

Once hailed as "magic bullets," antibiotics are now used so widely that their success is threatening their effectiveness. The natural mutability of microbes is enabling pathogens to develop bulletproof shields that make antibiotic treatments useless. Meanwhile, it has become increasingly difficult to replace failing treatments with newer, more powerful antibiotics. If we fail to address resistance, we may lose control of infectious diseases, reverting back to the dangerous era before penicillin. Fortunately, new ideas and principles have emerged for slowing the development of antibiotic resistance, both in individual patients and in the human population as a whole.Antibiotic Resistanceintroduces these crucial ideas to everyone who makes decisions about antibiotic use: doctors, medical providers, and healthcare administrators; public health professionals and government regulators; farmers and agricultural providers; and especially,individual patients. Antibiotic Resistancebrings together current and authoritative answers to key questions such as: What is resistance, and how does it emerge? How do resistance genes move between pathogens, and how are they transmitted? How do common human activities promote antibiotic resistance? How can we lengthen the effective life span of antibiotic treatments? How do we balance risks to individual patients against risks to the human species? What do physicians and pharmaceutical companies need to know about setting antibiotic dosages? What simple steps can hospitals and other institutions take to prevent the emergence and spread of dangerous pathogens, such as MRSA? How can surveillance be used more effectively as the first line of defense against resistance? How can we rationalize and accelerate the discovery of new antibiotics? What unique resistance challenges are associated with viral influenza, seasonal flu, avian flu, and human flu pandemics? Simple examples and clear experimental descriptions make this book easily understandable to anyone familiar with biologyand a complete glossary and introductory appendixes make it accessible even to those who arenrs"t.

Karl Drlica, Ph.D. is a Principal Investigator at the Public Health Research Institute and Professor of Microbiology & Molecular Genetics at the UMDNJ–New Jersey Medical School in Newark. His laboratory focuses on fluoroquinolone action and resistance with Mycobacteriun tuberculosis and other bacteria, including approaches for slowing the enrichment and amplification of resistant bacterial subpopulations.

 

David S. Perlin, Ph.D. is Executive Director of the Public Health Research Institute and UMDNJ Regional Biocontainment Laboratory, as well as Professor of Microbiology & Molecular Genetics at the New Jersey Medical School in Newark. He is also a Fellow of the New York Academy of Sciences. Dr. Perlin’s laboratory explores mechanisms of antifungal drug-resistance, rapid detection of drug resistant bloodstream pathogens in high-risk patients, and the application of small-animal models for the study of respiratory pathogens.

Preface     xv

Chapter 1 Introduction to the Resistance Problem     1

Chapter 2 Working with Pathogens     17

Chapter 3 A Survey of Antibiotics     31

Chapter 4 Dosing to Cure     55

Chapter 5 Emergence of Resistance     73

Chapter 6 Movement of Resistance Genes Among Pathogens     91

Chapter 7 Transmission of Resistant Disease     105

Chapter 8 Surveillance     125

Chapter 9 Making New Antibiotics     139

Chapter 10 Restricting Antibiotic Use and Optimizing Dosing     149

Chapter 11 Influenza and Antibiotic Resistance     167

Chapter 12 Avoiding Resistant Pathogens     177

Afterword A Course of Action     203

Appendix A Molecules of Life     207

Appendix B Microbial Life Forms     221

Glossary     227

Literature Cited     233

Index     251