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The Antibiotic Paradox: How the Misuse of Antibiotics Destroys Their Curative Powers Paperback – January 8, 2002

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Product Details

  • Paperback: 296 pages
  • Publisher: Da Capo Press; 1st edition (January 8, 2002)
  • Language: English
  • ISBN-10: 0738204404
  • ISBN-13: 978-0738204406
  • Product Dimensions: 5.5 x 0.9 x 8.5 inches
  • Shipping Weight: 14.4 ounces (View shipping rates and policies)
  • Average Customer Review: 4.8 out of 5 stars  See all reviews (5 customer reviews)
  • Amazon Best Sellers Rank: #1,424,857 in Books (See Top 100 in Books)

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.


"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

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9 of 10 people found the following review helpful By A Customer on May 16, 1999
Format: Paperback
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.Read more ›
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1 of 1 people found the following review helpful By Spudman TOP 100 REVIEWERVINE VOICE on December 5, 2012
Format: Paperback Verified Purchase
Antibiotics are wonderful lifesavers, yet they come with limitations and inherent dangers. Even Fleming warned that overuse of antibiotics would have consequences, and history has proven him correct.
Levy writes that 100,000 pounds of antibiotics are used annually to treat fruit trees. In the past half century tons of them have been used to treat crops, plants, farm animals, fish, bees, lobsters, and yes people. Why is this a problem? The bacterial targets of antibiotics are not static, but have the ability to evolve, adapt, and change, as well as the ability to borrow and exchange whatever it takes from each other to become ever more resistant to our shrinking arsenal of working antibiotics. The danger is that disease causing bacteria can eventually become impervious to any and all current antibiotics.

Levy details the dangers of misuse and overuse of antibiotics. He bemoans the current practice of adding antibiotic chemicals to too many everyday cleaning products, especially to hand soaps. Patients and prescribers must become more vigilant if humankind is to stay ahead of the war against diseases. Levy sugggest putting antibiotics in a separate category of pharmaceuticals to better control and monitor them.

The Antibiotic Paradox, though somewhat dated now, is a readable and still relevant book on a topic of great importance that affects us all.
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1 of 1 people found the following review helpful By Richard Reese (author of Sustainable or Bust) on September 2, 2012
Format: Paperback
Antibiotics are a family of drugs used to treat bacterial infections, including diseases like the bubonic plague, pneumonia, typhus, cholera, and tuberculosis. The first antibiotic to hit the market was penicillin, in 1941. It was soon seen to be a wonder drug, because it saved so many lives. Prior to antibiotics, there were no effective treatments for many life-threatening diseases -- they were incurable. The new drugs revolutionized the practice of medicine, giving doctors power that had previously been unimaginable.

Of course, every technological miracle has a dark shadow of harmful side effects, unintended consequences, and fatal flaws. Dr. Stuart Levy described this ominous shadow in his book, The Antibiotic Paradox. He did an excellent job of explaining a very complicated subject in a manner that ordinary folks could readily comprehend.

Our skin and digestive system are home to far more bacteria than the number of cells in our body. Sometimes bacteria get under our skin, and reproduce faster than our immune system can kill them. This is an infection, and infections can sometimes be fatal.

"An antibiotic is a natural substance made by one microorganism that inhibits growth of another microorganism." Most antibiotics originated as molds or soil bacteria. Both friendly and unfriendly microorganisms enjoy reproducing at a phenomenal rate, and they often mutate genetically. Some of these mutants are drug-resistant, because they can survive contact with one or more antibiotics. These resistant survivors then proceed to produce large numbers of bulletproof offspring.

Science has attempted to eliminate resistant strains by developing new forms of antibiotics.
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4 of 6 people found the following review helpful By Midwest Book Review on April 11, 2002
Format: 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.
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