[Therapeutic antibiotics for postoperative infection: antibiotic heterogeneity]

Antibiotic heterogeneity is a strategy to reduce antibiotic pressure, thus preventing or minimizing the emergence of antibiotic-resistant strains. Periodic changing of (classes of) antibiotics for empiric therapy, so-called antibiotic rotation or cycling, has been proposed as one measure to achieve this strategy. Promising results of cycling have been reported, mainly from intensive care units and largely involves cycling regimens targeted at the treatment of suspected infection with gram-negative bacteria. Antibiotic mixing, in which at any given time equal fractions of the population receive different antibiotics, is another modality to exert heterogenic use of antibiotics. Mixing is usually accomplished by administering different classes of antibiotics in consecutive patients. Although promising results have been reported, further studies are needed before these interventions of cycling and mixing can be widely implemented.