The fall of Antibiotics? Case: An immigrant from India with XDR-TB “Deadly Tuberculosis May be not so deadly” XDR-TB abbreviation stands for extensively drug resistant tuberculosis (TB) Antibiotic resistance is one of the most urgent threats to the public health. Why? Antibiotics are medicine that we use to prevent and treat infections. How do they work? Bacteria can cause illness invading healthy cell, now antibiotics can work two ways: killing it or make it difficult for bacteria to grow and multiply. Usually, we prescribe them as twice a day 7- 10 days therapy and patient will recover. But anytime they are used they can cause side effects or cause resistance. How does resistance develop? Resistance occurs when bacteria develop the ability to defeat the drug designed to kill them in this case antibiotics cannot fight them, and bacteria will multiply. After being exposed to antibiotics, sometimes one of the bacteria can survive, because it found a way to resist the antibiotic and if even one bacteria survives it can multiply and replace all that bacteria that were killed, they can also become resistant due to mutation of their own genetic material, change the outer structure that antibiotic has no way to attach to bacteria that is design to kill. They develop the ability to be resistant due to misuse and overuse of antibiotics. The key to prevent that is the smart use and controlled use of antibiotics. Which means that not every cold should be treated with antibiotics, they don’t work on viruses anyway. And when prescribed importance of teaching the patient that antibiotics therapy must be completed as prescribed, do not finish taking them as soon as you fill better, if it is 10-day therapy you must take them for full 10 days. In my case, my patient from India had develop Xdr-TB, which means he has resistance to isoniazid and rifampin, the two most potent TB drugs. That could happen if patient does not take his medications as prescribed and have stop taking them for a certain amount of time, had TB previously and developed it again. Living in India there is a huge potential to develop resistance due to misuse and uncontrolled use of antibiotics. And no antibiotic policy. The key to help this patient is early diagnosis and monitoring. Watch for symptoms such weakness, weight loss, fever, night sweats, cough, hemoptysis. Patient sputum will be analyzed, sputum results will confirm TB. Aggressive therapy must follow with TB anti-drug cocktail and I would add new generation fluroquinolone Levaquin but must be closely monitored since fluoroquinolones can cause serious or disabling side effects. Oxygen therapy and isolation is a must in TB, since bacteria is transferred by air. To recover from TB, it takes a long time usually up to 12 months, observation is very important, chest x rays and making sure patient is taking medications as prescribed. Keeping hydrated and high carb and fat diet is recommended. The aggressive early treatment and hopefully my patient will recover.