Antibiotic Cycling: Can We Revisit History?

Antibiotic cycling can be an important component of antibiotic stewardship, which aims to optimize the rational use of antibiotics. This approach involves the planned removal of the antimicrobial with the goal of reintroducing that antimicrobial at a scheduled future date. The main purpose of cycling is to decrease the resistance to a particular antibiotic when that antibiotic is no longer used. In addition to restriction, it helps to alter the selective pressures and thus preventing emergence of resistance. This approach contrasts with mixing, which involves administering several antimicrobial medicines to equal segments of a target population at any one moment.

Even though antibiotic cycling has received a lot of criticism, it has been shown to either produce marginally improved susceptibility or sustained steady susceptibilities to the cycled antibiotics. However, it is crucial that the hospital local antibiogram be used to determine the cycled antibiotics and their duration.

It is impossible to undo the damage that has been done but experimenting with current antibiotics can help to strengthen control over developing antibiotic resistance. In addition to infection control procedures and policy compliance monitoring, significant variations are discernible. By implementing such approach at smaller setups, we can track patterns of antibiotic consumption and resistance, which will eventually aid in making bigger judgments.

The ship has already set sail, but we can use our all-encompassing plan to slow it down or change its course.

References

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2. Li XJ, Liu Y, Du L, Kang Y. The Effect of Antibiotic-Cycling Strategy on Antibiotic-Resistant Bacterial Infections or Colonization in Intensive Care Units: A Systematic Review and Meta-Analysis. Worldviews Evid Based Nurs. 2020;17(4):319-328.

3. Chatzopoulou M, Reynolds L. Systematic review of the effects of antimicrobial cycling on bacterial resistance rates within hospital settings. Br J Clin Pharmacol 2022; 88:897–910.

4. Beardmore RE, Peña-Miller R, Gori F, Iredell J. Antibiotic Cycling and Antibiotic Mixing: Which One Best Mitigates Antibiotic Resistance?. Mol Biol Evol. 2017;34(4):802-817.

5. Cobos-Trigueros N, Solé M, Castro P, et al. Evaluation of a Mixing versus a Cycling Strategy of Antibiotic Use in Critically-Ill Medical Patients: Impact on Acquisition of Resistant Microorganisms and Clinical Outcomes. PLoS One. 2016;11(3):e0150274.

6. Goulart CP, Mahmudi M, Crona KA, et al. Designing antibiotic cycling strategies by determining and understanding local adaptive landscapes. PLoS One. 2013;8(2):e56040.