The Antibiotic Paradox: How the Misuse of Antibiotics Destroys Their Curative Powers
By Stuart B. Levy, MD
Perseus Publishing
353 pp $17.50

It's a mighty scary world out there. At least that's the sobering message of Dr. Stuart Levy's The Antibiotic Paradox: How the Misuse of Antibiotics Destroys Their Curative Powers, a book that ought to be read by every doctor, parent, and potential patient -- by anyone, in fact, who might ever prescribe or use antibiotics. That, of course, includes just about everyone.

Given how much modern medicine relies upon the dozens of antibiotics developed and introduced in the last 60 years, it's worrisome to reflect on what things were like before the advent of penicillin in 1945, when people routinely died from staph or strep infections or any number of other bacterial illnesses. And it's truly frightening to realize that the dramatic rise in bacterial resistance to antibiotic drugs may mean our most potent medications are in danger of losing the battle against wily pathogens.

"Today most infectious-disease causing bacteria that were previously universally susceptible to antibiotics are resistant to at least some antibiotics and, in many instances, to a large number of drugs," writes Levy, a professor of molecular biology and medicine at Tufts University School of Medicine in Boston. "We must face this unsettling question now, only 100 years since the recognition that bacteria cause disease and only 60 years since the discovery of antibiotics."

The dangers outlined by Levy, a well-known expert in antibiotic resistance, have become increasingly apparent in the past 10 or 20 years, at least to many doctors and health officials. As a means of combating the problem, for example, the U.S. Centers for Disease Control and Prevention in Atlanta, the country's leading public health agency, recently launched a major advertising campaign to inform parents about the dangers of antibiotic overuse.

The campaign, which was covered by the Wall Street Journal, the Associated Press, and numerous other media outlets, sought to persuade parents to refrain from demanding an antibiotic for childhood ailments such as ear infections until they and the doctor are sure the cause is a bacterial agent. Antibiotics have no effect on viruses, so prescribing them for common colds or other viral illnesses is useless -- and contributes greatly to the growing dilemma of antibiotic resistance.

Levy touches on every aspect of this problem in this lucid, no-nonsense book, from the discovery of penicillin to the various ways in which patterns of antibiotic use in humans, animals, and agriculture ultimately serve to undermine the drugs' effectiveness. Just as important, his discussion of the science of bacterial resistance to antibiotics is straightforward and easy to understand, clearly designed with the lay reader in mind.

Early proponents of antibiotics predicted the advent of drug resistance, Levy writes, but the pathogens' methods for developing -- and swapping among themselves -- protective mechanisms have proven to be far more complex, diverse, and ingenious than originally thought. While chromosomal mutation remains a common source of emerging resistance, bacteria also frequently exchange bits of independent, self-duplicating genetic material called "plasmids," or even smaller units of DNA called "transposons."

These methods allow them to transfer back and forth -- with remarkable agility -- genes designed to direct various resistance-conferring processes. And once resistance to a particular antibiotic gains a toehold in the bacterial world, it appears to spread with relative ease to different parts of the globe and multiple types of bacteria.

"These resistant bacteria have colonized ecological niches in countries worldwide, making all geographic areas vulnerable to the problem of ineffective therapy for bacterial diseases," he writes. "This situation raises the staggering possibility that a time will come when antibiotics as a mode of therapy will be only a fact of historic interest."

Part of the problem, argues Levy, is what he calls "the antibiotic myth" -- the popular notion that these drugs, which seemed nothing short of miraculous when first introduced, can vanquish all manner of infectious diseases and should therefore be taken at the first sign of a sniffle or fever. Compounding the problem is that most people are unaware of the "paradox" mentioned in the book's title -- that widespread use of antibiotics spawns the development of resistance and therefore profoundly diminishes their ability to fight disease.

The problem is not just in their overuse among humans, he explains. Food producers routinely add antibiotics to the diet of cattle, chickens, and other farm animals as a growth-promotion agent, even though studies have shown that the practice increases antibiotic resistance among bacterial agents found in humans. Spraying antibiotics on trees and other plants compounds the problem, as does their use in aquaculture. And the past decade's consumer craze for antibacterial soaps and other cleaning products has increased resistance among bacteria commonly found in the home, Levy notes.

The first edition of Levy's book appeared in 1992, with a revised version released 10 years later. In the current edition, Levy documents growing worldwide awareness of the problem and the dangers it presents, as well as ominous signs that resistance continues to spread at a rapid pace. In an epilogue written in November of 2001, he discusses the dilemma posed by the skyrocketing demand, in the wake of the anthrax attacks, for access to the antibiotic ciprofloxacin.

While this drug is currently an effective treatment for anthrax, Levy warns that such widespread public hoarding of a powerful antibiotic -- compounded with a total lack of control or oversight of its eventual use -- poses just the sort of risk that concerns him.

"The approach to all bacterial biowarfare agents should be rational use of antibiotics for prophylaxis and treatment," he writes. The alternative outcome -- consumers stockpiling and self-medicating with drugs like Cipro -- means, ironically, that the very disease they're trying to protect themselves from may become resistant to treatment. As Levy concludes, "All of us need to be aware of the dangers and consequences of antibiotic overuse -- namely, the emergence of bacteria no longer treatable with these life-saving therapeutics."

-- David Tuller is a former staff writer for the San Francisco Chronicle and currently writes for The New York Times, the Washington Post, and Salon.com. He is the author of Cracks in the Iron Closet: Travels in Gay and Lesbian Russia (Faber & Faber 1996).

First published November 5, 2003
Last updated December 5, 2007
Copyright © 2003 Consumer Health Interactive