The Antibiotic Paradox [Hardcover]

Stuart B. Levy (Author)

Book Description

Publication Date: August 21, 1992

The discovery of antibiotics heralded medicine’s triumph over previously fatal diseases that once destroyed entire civilizations—thus earning their reputation as miracle drugs. But today, the terrifying reality of antibiotic-resistant bacteria resulting from our widespread misuse of antibiotics forewarns us that the miracle may be coming to an end. The seemingly innocent consumer who demands antibiotics to treat nonbacterial diseases such as the common cold or plays doctor by saving old prescriptions for later use is paving the way for a future of antibiotic failure. ”What harm can it do?” is a popular refrain of people worldwide as they pop another antibiotic pill.Dr. Stuart Levy--the leading international expert on hazards of antibiotics can have deadly consequences. He explains that we are presently witnessing a massive evolutionary change in bacteria. This build-up of new antibiotic-resistant bacteria in individuals and the environment worldwide is an insidious and silent process. Thus, unwittingly consumers encounter resistant bacteria in their meat, poultry, fish, and vegetables. Unregulated dispensing of antibiotics in poorer countries breeds countless more resistant strains. Since bacteria recognize no geographical boundaries, resistant forms can travel the globe. If this trend continues to grow unchecked, we may someday find that all of our antibiotics are obsolete.Today doctors can no longer expect that their first choice of antibiotic for women’s urinary tract infections or children’s ear infections will work. Similarly, cancer therapy is rendered useless if patients are unable to fight infections that are sometimes resistant to eight to ten different drugs. In developing countries, people are now dying of previously treatable diseases that are no longer responsive to traditional antibiotics. These problems are just a harbinger of what will come if we do not act now.Dr. Levy, recognized by The New Yorker for his superb contributions to this field, is sending out an urgent message that the world cannot afford to ignore any longer. The goal of this unprecedented investigation into the dangers of antibiotic misuse is to protect the world community from resistant infections and ensure the success of antibiotics for generations to come.

Editorial Reviews

From The New England Journal of Medicine

The antibiotic era, barely 60 years old, is increasingly challenged by the continued emergence of drug-resistant organisms. The variables that currently predict the level of resistance in a community (or a hospital) are the misuse of antibiotics and the resultant selection of mutants, the spread of resistant strains as a result of poor infection control, and intrusion from the outside of strains already resistant to the drug. Without the pressure of antibiotics, however, the selection of strains in the community harboring the genes that code for resistance would not be so effective. No one has been more outspoken on this point than Stuart Levy, author of this encyclopedic account of the misuse of antibiotics. Ten years after the book's initial publication, the new edition is an accessible, fact-filled warning of the risks posed by the unwise use of the prize drugs -- antibiotics. Nowhere else are the history of antibiotic discovery and the mechanisms of microbial resistance so clearly presented for general readers. For those in medicine and related disciplines who are interested in the topic, this book is easy to read, a comfortable and logical presentation of the problem with sufficient notes and references for the serious student to pursue the topic by reading original publications beyond the book. Levy's writing is lucid, and his analogies are helpful in explaining complex biologic systems. For example, in describing the exciting discovery of transferable resistance, the genes coding for antibiotic resistance that are located on plasmids, Levy writes about a strain of Escherichia coli that was suddenly found to be resistant to four antibiotics: "Even if each mutation occurred once in 10 million, mutations to four drugs would have needed 10 million x 10 million x 10 million x 10 million or 10(sup 28) doublings! This realization led the astute Japanese workers to look for a different genetic basis for multiple drug resistance. They guessed that the resistance traits might be associated with genes not on the chromosome." Later, in explaining the genetic determinants of multidrug resistance on the plasmid, Levy writes: "It's like a snowball rolling downhill, picking up snow and any debris during its transit, becoming bigger in the process, and not losing what it had acquired before. So do plasmids as they `roll' through the environment." In discussing antibiotic use in animals and in agriculture, Levy has no peer. Some of the facts he offers are both fascinating and entertaining: there are five times as many domestic food animals as people in the United States, and "daily animal fecal excretion can be 5-400 times greater than that of humans. For example, the amount of feces excreted by a cow per day is 100 times that by a human. . . . Hence . . . animals are contributing a large amount of resistant bacteria to the natural environment." He also refers to studies showing that flies caught on flypaper carried antibiotic-resistant organisms with specific genetic markers of identical strains from nearby animals. Furthermore, with the local ground environment continually burdened with antibiotic-resistant bacteria, streams nearby could become contaminated. Later in the book, Levy also cites the volume of antibiotics continually used to treat fruit trees, hives of honeybees, and commercial catfish and salmon farms. Thus, he provides an unusually graphic portrait of a vibrant ecosystem contributing constantly to the spread of antibiotic-resistant strains of bacteria. The title of Levy's book is appropriate, because the reality is that our society still believes in the infallibility of antibiotics, their ability to cure whatever ailments we have, and the absence of important side effects. The paradox, of course, is that the more we use, the less we have. If we take this paradox to its logical conclusion, we may eventually be faced with what Levy calls the "impending disaster." At the time of printing there had been no identified cases of Staphylococcus aureus strains that were fully resistant to vancomycin. Thus, Levy could not address this latest threat. However, the fact that, in the summer of 2002, the United States witnessed the first case of vancomycin-resistant S. aureus with the vanA gene for resistance on a plasmid acquired from an enterococcus supports his thesis. Richard P. Wenzel, M.D.
Copyright © 2002 Massachusetts Medical Society. All rights reserved. The New England Journal of Medicine is a registered trademark of the MMS. --This text refers to the Paperback edition.

Review

"A timely book...an invaluable resource for those in the health professions and for policy makers." -- Choice, September, 2002

"Clear, concise language...[Dr. Levy] brings us up to date." -- (The BloomsburyReview January / February 2003)

"Easily accessible to lay readers, peppered with personal anecdotes and clear explanations...[a] thought-provoking treatise." -- Lancet Journal of Infectious Diseases November, 2002

"Provides the information we need...in language that is accessible to those without scientific backgrounds...a 'must-read.'" -- Infections in Medicine March 2004

"There is no one who knows this subject better or who has written about it with more lucidity than Stuart Levy." -- Orville Schell, author, Modern Meat: Antibiotics, Hormones, and the Pharmaceutical Farm

"[Levy is] one of the world's leading experts on the misuse of antibiotics." -- Washington Post, 8/29/02 --This text refers to the Paperback edition.

See all Editorial Reviews

Product Details

• Hardcover: 296 pages
• Publisher: Da Capo Press; 1 edition (August 21, 1992)
• Language: English
• ISBN-10: 0306443317
• ISBN-13: 978-0306443312
• Product Dimensions: 8.5 x 5.7 x 1.1 inches
• Shipping Weight: 1.2 pounds
• Average Customer Review: 4.5 out of 5 stars  See all reviews (2 customer reviews)
• Amazon Best Sellers Rank: #642,219 in Books (See Top 100 in Books)

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Customer Reviews

Most Helpful Customer Reviews

9 of 10 people found the following review helpful:

4.0 out of 5 stars The book was well explained and educational, May 16, 1999

By A Customer

This review is from: The Antibiotic Paradox (Hardcover)

Could the chemicals that help us survive today become useless in the near future, leaving us defenseless against dangerous bacteria. This is a very real possibility. In The Antibiotic Paradox by Plenum Press, Stuart Levy confronts this problem. Antibiotic resistance is not a new problem it has been known about since antibiotics were discovered. Still, we are learning more about how it works. The book also talks about how it can be controlled. The first antibiotic was penicillin, which was extracted from a mold. Penicillin was used in small quantities in WW2. Alexander Fleming, the discoverer of penicillin, warned that if many small doses of penicillin were given then the microbes would be educated to resist the medicine. As more kinds of antibiotics were discovered the problem of resistance seemed unimportant. This is despite studies during the 40's and on that more and more resistant bacteria are being found. How are these bacteria becoming resistant? There are a couple ways that bacteria can become resistant. These ways are all started by an initial mutation. In a colony of bacteria one or two might have a certain mutation that makes them resistant to an antibiotic. When an antibiotic is used to kill that colony, the only bacteria left are the resistant ones. Now those bacteria have no competition for resources and they start to multiply more quickly. So there now is a colony of antibiotic resistant bacteria. Often the bacteria is harmless so we are not going to get sick but sometimes it is a disease causing bacteria. There are two ways that bacteria can resist an antibiotic. One is that the outer membrane is not very permeable to the antibiotic. The other is the bacteria can secrete an enzyme that destroys the antibiotic. The second is more dangerous because the harmless bacteria could be secreting this enzyme and destroying the antibiotic which will enable the harmful bacteria to survive. The other problem is sometimes harmless bacteria gives their plasmid, which contains a resistance gene, to harmful bacteria who will then become resistant. How can we keep the bacteria from becoming resistant to all our drugs? This is where the paradox comes in, how can we use antibiotics effectively without allowing bacteria to become resistant to them? First, we have to limit the use of antibiotics. They should be used only when nothing else will work and only when it is necessary. This is often hard because patients might demand to have the drug when it is not needed, but the doctors must make the final decision. There also are places where no restriction on use is followed. For example on resistant strain of bacteria was traced to brothels in Vietnam where penicillin was given to prevent disease in the women. Scientists have also found bacteria that are resistant to multiple antibiotics. This is why we need to control the use of them so all of them don't become useless. We need to be aware of the problem that exists and try to stop it from getting worse. I think the book is a little repetitive because it repeats the same message too often. The message is that if we don't use antibiotics responsibly than they will become ineffective. This is a good point but it is easy to understand so it doesn't have to be repeated. Other than that it does a good job of making me aware of a problem that I hardly knew existed. I even try to think of other ways we can limit the misuse of antibiotics, like only allowing them to be injected so the patient will not try to get them unless he or she really needs them. It is important for a book to make you think.

4 of 6 people found the following review helpful:

5.0 out of 5 stars Resistance can lead to disease outbreaks, April 11, 2002

By 

Midwest Book Review (Oregon, WI USA) - See all my reviews

This review is from: The Antibiotic Paradox: How the Misuse of Antibiotics Destroys Their Curative Powers (Paperback)

The Antibiotic Paradox appears in a newly revised second edition to update information on the misuse of antibiotics in general and Cipro in particular, linking new mutations of bacterial resistance to the overuse of Cipro and other important antibiotics. Resistance can lead to disease outbreaks: The Antibiotic Paradox examines the build-up of new antibiotic-resistant bacteria and examines medical and social trends in treatment options.