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    Title Page
    Antibiotic Resistance: Understanding and Responding to an Emerging Crisis
    Copyright Page
    Dedication Page
    Contents
    About the Authors
    Preface
    Chapter 1. Introduction to the Resistance Problem
    Chapter 2. Working with Pathogens
    Chapter 3. A Survey of Antibiotics
    Chapter 4. Dosing to Cure
    Chapter 5. Emergence of Resistance
    Chapter 6. Movement of Resistance Genes Among Pathogens
    Chapter 7. Transmission of Resistant Disease
    Chapter 8. Surveillance
    Chapter 9. Making New Antibiotics
    Chapter 10. Restricting Antibiotic Use and Optimizing Dosing
    Antibiotic Conservation: Use Less Often When Unnecessary and Higher Amounts When Needed
    Human Consumption of Antibiotics Correlates with Resistance
    Limiting Human Consumption of Antibiotics
    Agricultural Use Contributes to Antibiotic Consumption
    Antibiotic Contamination of the Environment Is a Byproduct of Usage
    Clinical Resistance and Resistant Mutants Are Not the Same
    Dosing to Eradicate Susceptible Cells May Not Halt Emergence of Resistance
    Keeping Concentrations Above MPC Restricts Mutant Amplification
    Combining MPC with PK/PD Targets
    Combination Therapy Restricts Emergence of Resistance
    Consideration of Resistance During Drug Discovery
    Perspective
    Chapter 11. Influenza and Antibiotic Resistance
    Chapter 12. Avoiding Resistant Pathogens
    Afterword: A Course of Action
    Appendix A. Molecules of Life
    Appendix B. Microbial Life Forms
    Glossary
    Literature Cited
    Index
    Financial Times Press
    Chips, Clones, and Living Beyond 100: How Far Will the Biosciences Take Us?
    It Takes a Genome: How a Clash Between Our Genes and Modern Life Is Making Us Sick
    City of Dust: Illness, Arrogance, and 9/11
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    Chapter 10. Restricting Antibiotic Use a... > Antibiotic Contamination of the Envi...

    Antibiotic Contamination of the Environment Is a Byproduct of Usage

    Many antibiotics are not easily destroyed when they escape into the environment. Consequently, we could be creating a huge reservoir of antibiotic-resistant microbes and resistance genes in our soil, rivers, and lakes by dumping medical and agricultural waste198 (see Box 10-4). Although gene exchange among microbes occurs only rarely, even rare events can be significant when astronomically large numbers of microbes are involved.

    Box 10-4: Contamination of Drinking Water

    In March 2008, the Associated Press reported that a vast array of pharmaceuticals—antibiotics, anticonvulsants, mood stabilizers, and sex hormones—were found in drinking water supplies for more than 41 million Americans. In Philadelphia, officials identified 56 pharmaceuticals or byproducts in treated drinking water. These compounds included medicines for pain, infection, high cholesterol, asthma, epilepsy, mental illness, and heart problems; 63 pharmaceuticals or byproducts were found in the city’s watersheds.


      

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