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In this case study, students will have the opportunity to model the spread of tuberculosis and development of antibiotic resistance in a hypothetical prison environment. After reading a brief handout and viewing a short video, students play a simulation game by first identifying a group of prison inmates represented by index cards. The placement of the cards will influence how drug resistance spreads from one inmate to another. Using a dice roll to mimic random probability of infection and antibiotic misuse, students then track the development of resistance to four specific antibiotics, determined by selection of playing card suit. Opportunity for release or transfer on inmates from one facility to another introduces a further level of complexity, allowing students to study resistance spread. This activity was originally designed for a section of an upper-division biology course about antibiotic resistance, but it would also be appropriate for lower-division undergraduate and high school biology courses discussing antibiotic use.

This case study presents the story of Phil, an undergraduate majoring in biology, whose Russian cousin Dimitri has contracted tuberculosis (TB) from inmates at the prison where he works.  Phil learns that his cousin's failure to complete his antibiotic regimen likely contributed to the evolution of antibiotic-resistant TB in his body.  Phil consults with his friend Stacy, and together they try to understand Dimitri's condition by applying what they are learning in their genetics lab experiment about the role of random mutation in bacterial evolution (including the development of antibiotic resistance) through Luria- Delbrück fluctuation analysis. The same analysis includes calculation of the mutation rate, which Phil realizes is sufficient to cause MRSA and other antibiotic-resistant infections. This case study was originally developed for concurrent use in freshman/sophomore-level genetics, elementary statistics, and precalculus. However, it is also very appropriate for courses in introductory biology, evolutionary biology, and biostatistics. The teaching notes discuss various ways to run the case depending on the mathematics and biology background of students.

When scientists first made contact with an isolated village of Yanomami hunter-gatherers in the remote mountains of the Amazon jungle of Venezuela in 2009, they marveled at the chance to study the health of people who had never been exposed to Western medicine or diets. But much to their surprise, these Yanomami's gut bacteria have already evolved a diverse array of antibiotic-resistance genes, according to a new study, even though these mountain people had never ingested antibiotics or animals raised with drugs. The find suggests that microbes have long evolved the capability to fight toxins, including antibiotics, and that preventing drug resistance may be harder than scientists thought.

An exciting new test might help us save antibiotics. Needing only a drop of blood, researchers at Duke have developed a rapid assay that can tell viral infections-which generally can't be treated-from bacterial ones that may benefit from antibiotics. While I don't usually write about drugs or products in development, this test piqued my interest and left me excited about its potential to help contain antibiotic overuse.

Almost 80% of all antibiotics in the United States aren't taken by people. They're given to cows, pigs, and chickens to make them grow more quickly or as a cheap alternative to keeping them healthy. These drugs could give rise to superbugs-bacteria that can't be treated with modern medicine-and things are only getting worse. In 2013, more than 131,000 tons of antibiotics were used in food animals worldwide; by 2030, it will be more than 200,000 tons. In a paper published today in Science, epidemiologist Thomas Van Boeckel of the Swiss Federal Institute of Technology in Zurich and colleagues outline the growing threat-and what can be done about it. Boeckel spoke to us about his team's work. This interview has been edited for clarity and length.

In order to be useful in treating human infections, antibiotics must selectively target bacteria for eradication and not the cells of its human host. Indeed, modern antibiotics act either on processes that are unique to bacteria--such as the synthesis of cell walls or folic acid--or on bacterium-specific targets within processes that are common to both bacterium and human cells, including protein or DNA replication. Following are some examples.

For more than 100 years, the standard treatment for appendicitis has been surgery. Now a large Finnish study provides the best evidence to date that most patients can be treated with antibiotics alone. The study, published Tuesday in JAMA, involved 530 patients aged 18 to 60 who agreed to have their treatment - antibiotics or surgery - decided at random.

7:23 video Are we entering the post-antibiotic era? Antibiotic-resistant bacteria are on the rise, with millions of infections reported every year and thousands of deaths. How does antibiotic resistance work? How did we get here? And what can we do in the future to make sure that papercuts don't spell a death sentence?

To treat problems from sore throats to acne, doctors expose kids early and often - and scientists have been finding links between antibiotic use and rising chronic illnesses. A new study in mice published in the journal Nature Microbiology finds a link between Type 1 diabetes and antibiotic use.

"We risk being in a post-antibiotic world," said Thomas Frieden, director of the U.S. Centers for Disease Control and Prevention, referring to the urinary tract infection of a 49-year-old Pennsylvania woman who had not traveled within the prior five months. Frieden, speaking at a National Press Club luncheon in Washington, D.C., said the bacteria was resistant to colistin, an antibiotic that is reserved for use against "nightmare bacteria."

A year since launching the international partnership, the Combating Antibiotic Resistant Bacteria Biopharmaceutical Accelerator, CARB-X ,announced its second round of antibiotic research and development funding, awarding seven projects in six countries - two in the United States, and one each in France, India, Switzerland, Ireland and the United Kingdom.

The threat of antibiotic resistance has become so dire that the United Nations General Assembly is holding a meeting to discuss it this month in New York City. Although WHO has been sounding the alarm on antibiotic resistance for years, this month's high-level U.N. meeting represents only the fourth time in the international body's history that its General Assembly-a global deliberative body that primarily grapples with issues like war and economics-has held a meeting to tackle a health topic.

Using bacteriophages to deliver a specific CRISPR/Cas system into antibiotic-resistant bacteria can sensitize the microbes to the drugs, according to a study published this week (May 18) in PNAS.

Department of Defense researchers disclosed Thursday in a report placed online by the journal Antimicrobial Agents and Chemotherapy that a 49-year-old woman who sought medical care at a military-associated clinic in Pennsylvania last month, with what seemed to be a urinary tract infection, was carrying a strain of E. coli resistant to a wide range of drugs. That turned out to be because the organism carried 15 different genes conferring antibiotic resistance, clustered on two "mobile elements" that can move easily among bacteria. One element included the new, dreaded gene mcr-1.

4:34 video Right now, you are inhabited by trillions of microorganisms. Many of these bacteria are harmless (or even helpful!), but there are a few strains of 'super bacteria' that are pretty nasty -- and they're growing resistant to our antibiotics. Why is this happening? Kevin Wu details the evolution of this problem that presents a big challenge for the future of medicine.

Discover natural selection as a mechanism of evolution with the Amoeba Sisters. This video also uncovers the relationship of natural selection and antibiotic resistance in bacteria.

In a creative stroke inspired by Hollywood wizardry, scientists from Harvard Medical School and Technion-Israel Institute of Technology have designed a simple way to observe how bacteria move as they become impervious to drugs. The experiments, described in the Sept. 9 issue of Science, are thought to provide the first large-scale glimpse of the maneuvers of bacteria as they encounter increasingly higher doses of antibiotics and adapt to survive - and thrive - in them.

In this activity, students learn why evolution is at the heart of a world health threat. They will investigate the increasing problem of antibiotic resistance in such menacing diseases as tuberculosis and influenza. Students take on the role of staff at a public health agency who are trying to communicate the widespread problem of evolving disease-causing agents to the public.

This integrative case study is based on real events that the author experienced with her ten-year-old daughter. Although the names have been changed, all of the events (symptoms, diagnoses and treatments, types of healthcare professionals) are recorded exactly as they occurred. Both asthma and pneumonia are common in the United States (and globally). Many of the drugs described in the case study are frequently prescribed for a wide variety of ailments. The four "episodes" that constitute the case cover 1) a study of asthma triggers, incidence and treatment; 2) side effects and possible medication errors associated with steroids; 3) causes, diagnosis, treatment and prevention of community-acquired bacterial pneumonia; and 4) the mechanism of action of two different antibiotics. The "epilogue" explores a few larger themes related to healthcare and public health (e.g., continuity of care, drug resistance, asthma prevention programs). The case study could be used in an undergraduate, upper-level, infectious disease, microbiology, public health or physiology course or in a graduate-level health professions program.

In this laboratory you will use some basic tools of molecular biology to gain an understanding of some of the principles and techniques of genetic engineering. In the first part of the lab, you will use antibiotic-resistance plasmids to transform Escherichia coli. In the second part, you will use gel electrophoresis to separate fragments of DNA for further analysis.