Antimicrobial efficacy, which is central to many aspects of medicine, is being rapidly eroded by bacterial resistance. Since new resistance can be induced by antimicrobial action, highly lethal agents that rapidly reduce bacterial burden during infection should help restrict the emergence of resistance. To improve lethal activity, recent work has focused on toxic reactive oxygen species (ROS) as part of the bactericidal activity of diverse antimicrobials. We report that when Escherichia coli was subjected to antimicrobial stress and the stressor was subsequently removed, both ROS accumulation and cell death continued to occur. Blocking ROS accumulation by exogenous mitigating agents slowed or inhibited poststressor death. Similar results were obtained with a temperature-sensitive mutational inhibition of DNA replication. Thus, bacteria exposed to lethal stressors may not die during treatment, as has long been thought; instead, death can occur after plating on drug-free agar due to poststress ROS-mediated toxicity. Examples are described in which (i) primary stress-mediated damage was insufficient to kill bacteria due to repair; (ii) ROS overcame repair (i.e., protection from anti-ROS agents was reduced by repair deficiencies); and (iii) killing was reduced by anti-oxidative stress genes acting before stress exposure. Enzymatic suppression of poststress ROS-mediated lethality by exogenous catalase supports a causal rather than a coincidental role for ROS in stress-mediated lethality, thereby countering challenges to ROS involvement in antimicrobial killing. We conclude that for a variety of stressors, lethal action derives, at least in part, from stimulation of a self-amplifying accumulation of ROS that overwhelms the repair of primary damage.reactive oxygen species | poststress cellular response | antimicrobial | antioxidant | damage repair D iscovering ways to manage antimicrobial resistance is among the most important medical challenges of our time (1). Since many antimicrobials can stimulate the production of resistant mutants, often via the SOS response (2-8), one way to limit the emergence of new resistance is to more rapidly and extensively reduce pathogen populations during infection. Toward that end, we and others have been studying how antimicrobials and other lethal stressors kill bacteria. Recent work has drawn attention to the contribution of stress-stimulated accumulation of toxic reactive oxygen species (ROS) (9-21). Finding ways to stimulate ROS-mediated killing could in principle enhance the efficacy of a broad range of antimicrobials. However, an ROS contribution to antimicrobial killing became controversial when the original observation (9) was challenged (22-24). Subsequent work countered many of the challenges (13)(14)(15)25) and extended the phenomenon to thymineless death (26), phage infection (27), the type VI secretion system (27), and overexpression of a MalE-LacZ fusion (28). Moreover, nitric oxide and hydrogen sulfide interfere with antimicrobial killing by suppressing ROS generation/ac...