Two decades after the first edition of Revenge of the Microbes: How Bacterial Resistance Is Undermining the Antibiotic Miracle warned 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 of Revenge 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-friendly and comprehensible, this new edition of Revenge of the Microbes engages 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



TABLE OF CONTENTS
Foreword by Stanley Maloy ix

Preface xiii

About the Authors xv

Chapter 1 Antibiotics: What Are They? 1

Chapter 2 The Miracle in Miracle Drugs 11

Chapter 3 Bacterial Resistance Threatens the Mighty Reign of Antibiotics 27

Chapter 4 A Brief Look at the History of Antibiotics 41

Chapter 5 Bacterial Targets of Antibiotics: How Antibiotics Work 49

Chapter 6 Bacteria Reveal Their Adaptability and Gain Resistance 71

Chapter 7 The Spread of Antibiotic Resistance 85

Chapter 8 The Escalating Crisis in Antibiotic Availability Amidst Renewed Efforts 107

Chapter 9 The Battle Continues To Combat Antibiotic Resistance: Alternative Approaches 127

Chapter 10 Building a Viable Framework for Tackling the Escalating Antibiotic Resistance Crisis 139

Index 153