Antibiotic Cycling: Is It Ready for Prime Time?

John, Joseph F.

doi:10.1086/501689

Cited by 32 publications

(10 citation statements)

References 23 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It is not straightforward to find consistency in the available clinical data (McGowan 1986; Brown and Nathwani 2005; John 2000) and, in summary, there is data both for (Sandiumenge et al 2006; Takesue et al 2010) and against mixing (Takesue et al 2006) but the same can be said of cycling. The support for cycling (Raymond et al 2001; Martinez et al 2006; John 2000) is tempered by others who advocate against it, or who at least indicate their indifference to it (van Loon et al 2005; Warren et al 2004; Toltzis et al 2002).…”

Section: Discussionmentioning

confidence: 99%

“…The support for cycling (Raymond et al 2001; Martinez et al 2006; John 2000) is tempered by others who advocate against it, or who at least indicate their indifference to it (van Loon et al 2005; Warren et al 2004; Toltzis et al 2002). To give one more example, the cycling of linezolid and vancomycin in an ICU was called a “ promising method to reduce infections with MRSA ” (Smith et al 2008) but cycling was also implicated as the cause of an outbreak of multi-drug resistant Pseudomonas aeruginosa (Hedrick et al 2008).…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Antibiotic Cycling and Antibiotic Mixing: which one best mitigates antibiotic resistance?

et al. 2017

View full text Add to dashboard Cite

Can we exploit our burgeoning understanding of molecular evolution to slow the progress of drug resistance? One role of an infection clinician is exactly that: to foresee trajectories to resistance during antibiotic treatment and to hinder that evolutionary course. But can this be done at a hospital-wide scale? Clinicians and theoreticians tried to when they proposed two conflicting behavioral strategies that are expected to curb resistance evolution in the clinic, these are known as “antibiotic cycling” and “antibiotic mixing.” However, the accumulated data from clinical trials, now approaching 4 million patient days of treatment, is too variable for cycling or mixing to be deemed successful. The former implements the restriction and prioritization of different antibiotics at different times in hospitals in a manner said to “cycle” between them. In antibiotic mixing, appropriate antibiotics are allocated to patients but randomly. Mixing results in no correlation, in time or across patients, in the drugs used for treatment which is why theorists saw this as an optimal behavioral strategy. So while cycling and mixing were proposed as ways of controlling evolution, we show there is good reason why clinical datasets cannot choose between them: by re-examining the theoretical literature we show prior support for the theoretical optimality of mixing was misplaced. Our analysis is consistent with a pattern emerging in data: neither cycling or mixing is a priori better than the other at mitigating selection for antibiotic resistance in the clinic. Key words: antibiotic cycling, antibiotic mixing, optimal control, stochastic models.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Antibiotic Cycling and Antibiotic Mixing: which one best mitigates antibiotic resistance?

et al. 2017

View full text Add to dashboard Cite

show abstract

“…The idea is to reduce selective pressure to any one antimicrobial class by providing heterogeneity in drug use -in the case of cycling, temporal heterogeneity (by time period) rather than spatial (by patient) heterogeneity. The subject has been thoroughly reviewed elsewhere (49,74,79,83,102,128) -in fact, the number of reviews of antibiotic cycling exceeds the number of well-designed studies on the subject (20).…”

Section: Antibiotic Cycling Strategiesmentioning

confidence: 99%

Antimicrobial Stewardship Programs in Health Care Systems

2005

View full text Add to dashboard Cite

SUMMARY Antimicrobial stewardship programs in hospitals seek to optimize antimicrobial prescribing in order to improve individual patient care as well as reduce hospital costs and slow the spread of antimicrobial resistance. With antimicrobial resistance on the rise worldwide and few new agents in development, antimicrobial stewardship programs are more important than ever in ensuring the continued efficacy of available antimicrobials. The design of antimicrobial management programs should be based on the best current understanding of the relationship between antimicrobial use and resistance. Such programs should be administered by multidisciplinary teams composed of infectious diseases physicians, clinical pharmacists, clinical microbiologists, and infection control practitioners and should be actively supported by hospital administrators. Strategies for changing antimicrobial prescribing behavior include education of prescribers regarding proper antimicrobial usage, creation of an antimicrobial formulary with restricted prescribing of targeted agents, and review of antimicrobial prescribing with feedback to prescribers. Clinical computer systems can aid in the implementation of each of these strategies, especially as expert systems able to provide patient-specific data and suggestions at the point of care. Antibiotic rotation strategies control the prescribing process by scheduled changes of antimicrobial classes used for empirical therapy. When instituting an antimicrobial stewardship program, a hospital should tailor its choice of strategies to its needs and available resources.

show abstract

“…Thus, the impact of cycling itself could not be adequately assessed. The cycling of antibiotics may sometimes be effective, but may also result in the emergence of resistance to unrelated classes of drugs caused by genetic linkage of resistance mechanisms (Wiener et al, 1999;John, 2000;Weinstein, 2001). The apparent success of cycling programmes has also been reported elsewhere (Kollef et al, 1997;Raymond et al, 2001;Moss et al, 2002).…”

Section: Rotation Policiesmentioning

confidence: 82%

How to fight antimicrobial resistance

Foucault

Brouqui

2007

FEMS Immunology &Amp; Medical Microbiology

View full text Add to dashboard Cite

Antimicrobial misuse results in the development of resistance and superbugs. Over recent decades, resistance has been increasing despite continuing efforts to control it, resulting in increased mortality and cost. Many authorities have proposed local, regional and national guidelines to fight against this phenomenon, and the usefulness of these programmes has been evaluated. Multifaceted intervention seems to be the most efficient method to control antimicrobial resistance. Monitoring of bacterial resistance and antibiotic use is essential, and the methodology has now been homogenized. The implementation of guidelines and infection control measures does not control antimicrobial resistance and needs to be reinforced by associated measures. Educational programmes and rotation policies have not been evaluated sufficiently in the literature. Combination antimicrobial therapy is inefficient in controlling antimicrobial resistance.

show abstract

Antibiotic Cycling: Is It Ready for Prime Time?

Cited by 32 publications

References 23 publications

Antibiotic Cycling and Antibiotic Mixing: which one best mitigates antibiotic resistance?

Antibiotic Cycling and Antibiotic Mixing: which one best mitigates antibiotic resistance?

Antimicrobial Stewardship Programs in Health Care Systems

How to fight antimicrobial resistance

Contact Info

Product

Resources

About