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<jats:sec> <jats:title>Introduction</jats:title> <jats:p>Understanding how bacteria harboring antibiotic resistance grow in the presence of antibiotics is critical for predicting the spread and evolution of drug resistance. Because drugs inhibit cell growth and a cell’s growth state globally influences its gene expression, the expression of drug resistance is subject to an innate, growth-mediated feedback, leading to complex behaviors that affect both the characterization and the prevention of antibiotic resistance. We characterized the consequences of this feedback for the growth of antibiotic-resistant bacteria.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p> We studied the growth of <jats:italic>Escherichia coli</jats:italic> strains expressing resistance to translation-inhibiting antibiotics, by using both bulk and single-cell techniques. The growth of each strain was quantified in a broad range of drug concentrations by using time-lapse microscopy (to track the responses of individual cells to antibiotics inside a microfluidic chemostat) and by the enrichment of batch cultures for nongrowing cells. We formulated a quantitative phenomenological model to predict the growth rates of drug-resistant strains in the presence of drugs, based on the well-characterized biochemistry of drug and drug-resistance interactions and on bacterial growth laws that dictate relations between cell growth and gene expression. We tested the model predictions for various drugs and resistance mechanisms by constructing strains that constitutively express varying degrees of drug resistance. </jats:p> </jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>In strains expressing a moderate degree of drug resistance, growth rates dropped abruptly above a critical drug concentration, the minimum inhibitory concentration (MIC), whose value increased linearly with the basal level of resistance expression (see figure below, panel A). Cells exhibited growth bistability over a broad range of drug concentrations below the MIC: Isogenic cells expressing drug resistance coexisted in growing and nongrowing states in a homogeneous environment (panel B). Our model accurately predicted the range of drug concentrations in which growth bistability occurred, as well as the growth rates of the growing subpopulation, without any ad hoc fitting parameters. These findings reveal a plateau-like fitness landscape (panel A), which can be used to study the evolution of drug resistance in environments with varying drug concentrations.</jats:p> </jats:sec> <jats:sec> <jats:title>Discussion</jats:title> <jats:p>The broad occurrence of growth bistability in drug-resistant bacteria challenges the common notions and measures of drug efficacy and resistance. And because growth bistability can arise without complex regulation when gene expression is coupled to the state of cell growth, similar physiological links may underlie the growth bistability implicated in causing bacterial persistence. The availability of quantitative, predictive models will facilitate the formulation of strategies to limit the efficacy and evolvability of drug resistance.</jats:p> </jats:sec>