Minimizing Antimicrobial Resistance in Hospital Bacteria: Can Switching or Cycling Drugs Help?

McGowan, John E.

doi:10.1017/s0195941700065401

Cited by 58 publications

(24 citation statements)

References 45 publications

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“…Many authors have suggested that antimicrobial cycling, in which the empiric use of two or more classes of antibiotics is alternated over a time scale of months to years, may slow the evolution and spread of resistant and multiply resistant bacterial strains (7,(9)(10)(11)(12)(13). The motivation is straightforward.…”

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confidence: 99%

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Ecological theory suggests that antimicrobial cycling will not reduce antimicrobial resistance in hospitals

Bergstrom

Lipsitch

2004

Proc. Natl. Acad. Sci. U.S.A.

332

333

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Hospital-acquired infections caused by antibiotic-resistant bacteria pose a grave and growing threat to public health. Antimicrobial cycling, in which two or more antibiotic classes are alternated on a time scale of months to years, seems to be a leading candidate in the search for treatment strategies that can slow the evolution and spread of antibiotic resistance in hospitals. We develop a mathematical model of antimicrobial cycling in a hospital setting and use this model to explore the efficacy of cycling programs. We find that cycling is unlikely to reduce either the evolution or the spread of antibiotic resistance. Alternative drug-use strategies such as mixing, in which each treated patient receives one of several drug classes used simultaneously in the hospital, are predicted to be more effective. A simple ecological explanation underlies these results. Heterogeneous antibiotic use slows the spread of resistance. However, at the scale relevant to bacterial populations, mixing imposes greater heterogeneity than does cycling. As a consequence, cycling is unlikely to be effective and may even hinder resistance control. These results may explain the limited success reported thus far from clinical trials of antimicrobial cycling.

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confidence: 99%

“…This simplification gives us the characteristic equation 2 Ϫ 2 r sinh t e ͑1Ϫ ͒rt Ϫ e 2͑1Ϫ ͒rt ϭ 0, [9] ϭ e f t .…”

mentioning

confidence: 99%

Ecological theory suggests that antimicrobial cycling will not reduce antimicrobial resistance in hospitals

Bergstrom

Lipsitch

2004

Proc. Natl. Acad. Sci. U.S.A.

332

333

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“…These include improvement of hospital hygiene (7), the use of vaccines (8), controls on or reductions of antibiotic use (9), and cycling of different antibiotics (4,10). The general goal of these interventions is to reduce the incidence of resistant infections, and thereby to prolong or restore the effectiveness of existing antibiotics.…”

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confidence: 99%

Evaluating treatment protocols to prevent antibiotic resistance

Bonhoeffer

Lipsitch

Levin

1997

Proc. Natl. Acad. Sci. U.S.A.

460

496

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The spread of bacteria resistant to antimicrobial agents calls for population-wide treatment strategies to delay or reverse the trend toward antibiotic resistance. Here we propose new criteria for the evaluation of the populationwide effects of treatment protocols for directly transmitted bacterial infections and discuss different usage patterns for single and multiple antibiotic therapy. A mathematical model suggests that the long-term benefit of single drug treatment from introduction of the antibiotic until a high frequency of resistance precludes its use is almost independent of the pattern of antibiotic use. When more than one antibiotic is employed, sequential use of different antibiotics in the population (''cycling'') is always inferior to treatment strategies where, at any given time, equal fractions of the population receive different antibiotics. However, treatment of all patients with a combination of antibiotics is in most cases the optimal treatment strategy.

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“…The term cycling, to describe the purposeful alternation of antimicrobials, appeared in the mid-1980s, just about the time of the first substitution trials involving aminoglycosides. 2 Despite the success of those early aminoglycoside cycling programs, very few experiences with cycling were reported in the 1990s. With the global problem of antimicrobial resistance, particularly in hospitals, 34 antibiotic cycling has reemerged as one of several potential strategies to control antimicrobial selection of resistance.…”

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confidence: 99%

Antibiotic Cycling: Is It Ready for Prime Time?

John¹

2000

Infect. Control Hosp. Epidemiol.

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Minimizing Antimicrobial Resistance in Hospital Bacteria: Can Switching or Cycling Drugs Help?

Cited by 58 publications

References 45 publications

Ecological theory suggests that antimicrobial cycling will not reduce antimicrobial resistance in hospitals

Ecological theory suggests that antimicrobial cycling will not reduce antimicrobial resistance in hospitals

Evaluating treatment protocols to prevent antibiotic resistance

Antibiotic Cycling: Is It Ready for Prime Time?

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