Antibiotics : What Everyone Needs to Know
by Wilson, Mary Elizabeth







Prefacexv
Why should you read this book?
xv
Why did I write this book?
xviii
Acknowledgmentsxxi
1 Origin And Function1(42)
What is an antibiotic?
1(1)
What is the difference between an antibiotic and an antimicrobial?
1(6)
How do antibiotics work?
7(1)
What is the difference between broad- and narrow-spectrum antibiotics?
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 or discovered in nature?
32(1)
What happens after a compound with antibacterial activity is discovered? How does it come to be used to treat infections?
32(5)
Are the same antibiotics used all over the world?
37(2)
How common are substandard and falsified antibiotics?
39(2)
What is the WHO model list of essential medicines?
41(2)
2 Use In Humans43(58)
How are antibiotics administered? What are the routes of administration besides by mouth and by injection? What determines how they should be given?
43(3)
Are pills as effective as injections?
46(3)
Where does the antibiotic go in the body? Does it reach all organs and tissues? What is its fate? Does any part of the antibiotic leave the body in urine or feces?
49(2)
What happens with antibiotics after they leave the body?
51(1)
Why are antibiotics that are not absorbed used?
52(1)
How does one decide which antibiotic to use?
53(4)
What information about each antibiotic is available to the pharmacist, the health provider, and the patient?
57(3)
How long does it take for an antibiotic to work? Why are some antibiotics given as a single dose and others prescribed for weeks or longer?
60(1)
What determines the right dose of an antibiotic?
61(2)
Can one overdose on an antibiotic?
63(1)
Does an antibiotic have any effect other than against the bacteria being treated?
63(2)
How long does the effect of an antibiotic last?
65(1)
Why are some infections, such as tuberculosis, always treated with multiple different antibiotics taken simultaneously?
66(2)
Does one always have to take the entire course of prescribed antibiotics?
68(2)
Can one take leftover antibiotics for a new infection? Or give it to a family member or friend?
70(1)
What should one do with leftover antibiotics?
71(1)
Is it dangerous to take expired antibiotics?
72(3)
When are antibiotics used to prevent infections (in contrast to treating an established infection)?
75(1)
How are antibiotics used to prevent infections in surgery?
76(2)
In what other settings are antibiotics used to prevent infections (antibiotic prophylaxis)?
78(4)
When are antibiotics used to treat entire populations in mass treatment campaigns?
82(5)
What are the consequences of mass treatment with antibiotics?
87(3)
How are antibiotics used in the human population? Who receives them?
90(1)
What are the main reasons that antibiotics are prescribed?
91(1)
Why is antibiotic use so common for respiratory infections?
92(2)
Does antibiotic use vary by region or by country?
94(2)
Is antibiotic use increasing or decreasing?
96(2)
How much is spent on antibiotics?
98(3)
3 Consequences Of Use: Adverse Events Associated With Use Of Antibiotics In Humans101(48)
What is the difference between an allergic reaction and an adverse reaction? What are the signs and symptoms of an allergic reaction?
101(6)
How common are adverse reactions?
107(2)
How much antibiotic does it take to cause an adverse reaction?
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 to have a reaction to an antibiotic?
111(1)
Why have side effects from ciprofloxacin (and other fluoroquino/ones) gotten so much attention?
112(3)
What is Clostridioides difficile colitis and where did it come from?
115(3)
What is driving the increase in cases?
118(1)
What predisposes someone to Clostridioides difficile infection and how does it spread?
119(3)
How is it treated?
122(1)
What is a fecal microbiota transplant?
122(4)
Can fecal microbiota transplantation be used to treat other conditions?
126(2)
Why do yeast infections occur during and after treatment with antibiotics?
128(1)
What is the microbiome and why is it so important?
129(5)
What is the Human Microbiome Project?
134(2)
What are the functions of the human microbiome?
136(4)
How do antibiotics affect the human microbiome?
140(3)
Does human use of antibiotics and other agents affect animal microbiota?
143(2)
Do other drugs besides antibiotics affect the microbiome?
145(1)
Can the gut microbiota be protected from the effect of antibiotics?
146(3)
4 Other Uses Of Antibiotics (Nonhuman Use)149(32)
What are the uses of antibiotics other than to treat infections in humans?
149(1)
What proportion of antibiotics produced in recent years had a nonhuman use?
149(1)
Why are antibiotics given to healthy animals?
150(5)
Which animals receive antibiotics?
155(1)
Which antibiotics are used? Are the same antibiotics used in people also used in animals?
156(2)
Are antibiotics used in food animals in other countries?
158(1)
How are antibiotics used in aquaculture?
159(2)
Is it OK for humans to take antibiotics that were made for fish or other animals?
161(1)
What are the consequences of using antibiotics in animals?
162(2)
Is any antibiotic still present in the meat, fish, eggs, or milk when they are sold for human consumption?
164(2)
Why are antibiotics used in bees?
166(1)
Do plants develop infections? Why and how often are antibiotics used in plants?
167(1)
Can humans pick up infections from plants?
168(1)
How can plant infections affect human health?
169(3)
Is food from plants contaminated with antibiotics?
172(4)
Does feeding animals antibiotics in large production facilities (such as industrial production of food animals like chickens, pigs, and cattle) have an impact on the local environment?
176(2)
What are other sources of antibiotics in the environment?
178(3)
5 Antibiotic Resistance181(66)
What is antibiotic resistance?
181(4)
Where did antibiotic resistance come from?
185(4)
What are the mechanisms bacteria use to evade antibiotics?
189(1)
How do bacteria destroy or disable the antibiotic?
190(3)
How can bacteria change an antibiotic to resist it?
193(1)
How can bacteria prevent antibiotics from getting through the cell wall of the bacteria?
194(1)
How do bacteria manage to pump antibiotics out of the bacterial cell?
194(1)
How can bacteria alter the target of antibiotic action in the bacteria?
195(1)
How can bacteria bypass key functions to survive despite the presence of antibiotics?
196(1)
What else can bacteria do to avoid being killed?
197(2)
How does one test bacteria for resistance to antibiotics?
199(3)
How does antibiotic resistance spread among bacteria?
202(3)
Where does this transfer of resistance genes among bacteria take place?
205(1)
How do resistant bacteria and resistance genes spread globally? What is the role of travel in the movement of resistant bacteria and resistance genes globally?
206(4)
How do travelers pick up multiply resistant bacteria? Where are the resistant bacteria found?
210(5)
How often do travelers pick up resistant bacteria? Do they spread them to others?
215(3)
What is medical tourism? Are travelers who receive medical care abroad at risk for infections with resistant bacteria?
218(2)
Are mass gatherings an important source of infections and spread of infections or resistance?
220(1)
What is wastewater epidemiology?
221(2)
How does resistance spread in health care facilities?
223(2)
Are there ways resistant bacteria spread that do not involve movement of humans?
225(2)
Do pets carry antibiotic-resistant bacteria?
227(1)
What are other routes of spread of bacteria from animals to humans?
228(1)
Does antibiotic resistance ever disappear?
229(1)
Which bacteria have developed resistance?
229(1)
Why does tuberculosis remain such a serious global problem?
230(9)
Why is gonorrhea so hard to treat?
239(5)
Are antibiotic-resistant bacteria found in all countries?
244(1)
Are levels of resistance influenced by the amount of antibiotic used in a region or country?
245(1)
What can be done to slow or stop antibiotic resistance?
245(2)
6 Consequences Of Antibiotic Resistance247(16)
What are the most important consequences of having infections caused by antibiotic-resistant bacteria?
247(2)
Are infections caused by antibiotic-resistant bacteria less severe, more severe, or the same?
249(1)
Are outcomes worse for antibiotic-resistant infections?
250(3)
What would be the consequences if antibiotics stopped working? What do people mean by the "postantibiotic era"?
253(1)
What medical procedures today rely on the availability of highly effective preventive antibiotics?
253(2)
Do we have antibiotics to use when bacteria become resistant to first-line drugs?
255(1)
Are these other antibiotics as safe and effective as first-line drugs? Are they available and affordable?
256(1)
Can antibiotics still be used for prevention when bacteria become resistant?
257(1)
Are people dying today because of antibiotic-resistant infections?
257(3)
Why are antibiotics considered community drugs? How does my taking an antibiotic affect my neighbors and the community?
260(3)
7 Interventions To Reduce Need For Antibiotics And Alternatives To Antibiotics263(44)
Are there ways to reduce the risks of infections so that we do not need antibiotics?
263(1)
How do clean water and improved sanitation reduce use of antibiotics?
264(3)
How can processing and handling of food affect antibiotic use?
267(3)
How can using vaccines reduce the need for antibiotics?
270(2)
How can vaccines against viral infections reduce the need for antibiotics? Why does influenza, a virus, get so much attention?
272(6)
Are vaccines used to prevent infections in animals? Can they prevent infections that could affect humans?
278(1)
How can controlling vectors like mosquitoes and ticks reduce antibiotic use?
279(1)
Are health care-associated infections a common reason for antibiotic treatment?
280(6)
Do antiseptics and alcohol-based hand sanitizers work against all microbes?
286(2)
How can copper be used to reduce infections?
288(5)
Are there approaches to treating infections that do not involve antibiotics-treatment approaches that do not drive the development of resistance the way that use of antibiotics does?
293(1)
What other approaches to treating infections are being tried that do not involve antibiotics?
294(3)
What is bacteriophage therapy? How does it work? Is it being used today?
297(5)
Looking to the future
302(1)
How are phages and bacteriocins used today?
303(4)
8 Preserving Antibiotics And Developing New Antibacterial Treatments307(40)
How common is inappropriate prescribing of antibiotics?
307(4)
What approaches have been effective in increasing the appropriate use of antibiotics and decreasing inappropriate prescribing by clinicians?
311(5)
What can individuals do to reduce the inappropriate use of antibiotics?
316(2)
What are antibiotic stewardship programs?
318(1)
Do antibiotic stewardship programs work?
319(2)
Why do stewardship programs include focus on reported allergies to antibiotics?
321(3)
What is the role of better diagnostic testing in reducing use of antibiotics?
324(1)
What is procalcitonin and can it help guide antibiotic treatment?
325(3)
Are procalcitonin levels useful in diagnosing infections in infants?
328(1)
Why did use of rapid diagnostic tests lead to increased use of antibiotics in some settings?
329(2)
Are there other approaches that use urine, saliva, breath, or other specimens to diagnose infection?
331(4)
What is the role of national and international agencies in reducing inappropriate use of antibiotics?
335(2)
Why aren't pharmaceutical companies developing more new antibiotics? Why don't we have more antibiotics in the pipeline?
337(1)
Which bacteria are the highest priority for development of new antibiotics?
338(1)
What antibiotics or antibacterial products are currently in the pipeline?
339(1)
Whose responsibility is it to develop new antibiotics? Who pays for their development? What incentives or other approaches might increase the development of new antibiotics?
340(2)
What are priority areas in looking for other ways to treat bacterial infections?
342(5)
Glossary347(10)
Bibliography357(22)
Index379


Virtually everyone has taken antibiotics. They can be lifesavers - and they can be useless. What are they? How are they used? And what happens as the effectiveness of antibiotics continues to decline?

Antibiotics: What Everyone Needs to Know® examines the personal and societal implications of our planet's most important - and frequently misused - 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 causes and consequences of bacterial resistance to antibiotics; how the globalized world enables antibiotic resistance to spread quickly; and the difficult decisions ahead for both medical care and the food system.

Grounded in the latest scientific research and crafted for general readers, Antibiotics: What Everyone Needs to Know® offers a clear-eyed overview of where we are, and what the future holds, as antibiotics lose their power.






Mary E. Wilson, MD, is a renowned leader in global health and infectious diseases. She has diagnosed and treated patients with a wide range of infections, studied the global epidemiology of infectious diseases, and serves as a professor at the Harvard T.H. Chan School of Public Health and the University of California, San Francisco. She lectures frequently in US and abroad and has published widely on topics in infectious disease and global health.





This fact-packed, easy-to-understand introduction to the world of antibiotics is presented via answers to a series of questions, such as How do antibiotics work? and Is it dangerous to take expired antibiotics? Infectious-disease expert Wilson reviews the discovery and development of antibiotics, their mechanisms of action, and how they are used in humans, animals, plants, and aquaculture. Her discussion of antibiotics is also cautionary as she points out possible adverse effects, the influence on the microbiome (unintended destruction of beneficial resident bacteria), and escalation of bacterial resistance. The most commonly prescribed antibiotics in U.S. outpatient situations are azithromycin, amoxicillin, amoxicillin/clavulanate, ciprofloxacin, and cephalexin. Roughly half of antibiotic prescriptions are given for respiratory-tract infections. Global use of antibiotics is rising, but an estimated 30-40 percent are prescribed unnecessarily or inappropriately. Wilson's final two chapters are notable for suggesting methods to reduce the need for antibiotics and presenting newer approaches to diagnosing and treating bacterial infections. Wilson views antibiotics as a shared resource, a community property. When these drugs are employed improperly, their effectiveness and our health are seriously imperiled. Copyright 2019 Booklist Reviews.






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