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Antimicrobial cycling: the future or a fad?

B M Hodges1, R L White

  • 1Department of Clinical Pharmacy, School of Pharmacy, West Virginia University, Morgantown 26506-9520, USA. bhodges@hsc.wvu.edu

The Annals of Pharmacotherapy
|October 26, 2001
PubMed
Summary

Antimicrobial cycling shows limited success in reversing existing resistance and may only offer temporary decreases. Further research is needed to determine if cycling can prevent future antimicrobial resistance.

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Area of Science:

  • Infectious Diseases
  • Pharmacology
  • Microbiology

Background:

  • Antimicrobial resistance is a growing global health threat.
  • Strategies to combat resistance include antimicrobial stewardship programs.
  • Antimicrobial cycling is one such strategy being investigated.

Purpose of the Study:

  • To evaluate the existing evidence on the effectiveness of antimicrobial cycling.
  • To determine if cycling can control the emergence or reverse existing antimicrobial resistance.

Main Methods:

  • A comprehensive literature search of MEDLINE (1966-2000) and reference lists.
  • Inclusion of studies investigating switching or cycling of antimicrobials within institutional settings.
  • Evaluation of both in vitro and clinical data, including mathematical modeling.

Main Results:

  • Cycling aminoglycosides led to temporary resistance decreases, with rapid rebound upon return to the original agent.
  • Switching between antimicrobial classes yielded inconsistent results, often replacing resistance to one drug with resistance to another.
  • Mathematical models suggest cycling is unlikely to achieve long-term reductions in resistance due to residual resistance.

Conclusions:

  • Current literature does not support the use of antimicrobial cycling to reverse resistance trends.
  • The potential of cycling to prevent resistance emergence requires further investigation.
  • Well-designed prospective studies are essential to ascertain the clinical value of antimicrobial cycling.

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