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Is there a role for antibiotic cycling in the intensive care unit?

Kollef, Marin H. MD

ANTIBIOTIC RESISTANCE IN THE ICU: Scientific Reviews

Antibiotic resistance of bacterial pathogens has emerged as one of the most important issues facing critical care practitioners. Resistance of many commonly encountered bacterial species is increasing and has been associated with greater administration of inadequate antimicrobial therapy to patients within intensive care units. This has resulted in greater patient morbidity, higher mortality rates, and increased healthcare costs. Methods to reduce antimicrobial resistance have focused on increasing adherence to infection control practices and improving antibiotic utilization. Antibiotic cycling is a strategy to reduce antimicrobial resistance by withdrawing an antibiotic or antibiotic class from use and subsequently reintroducing it at a later point in time. The main goal of cycling is to allow resistance rates for specific antibiotics to decrease, or at least remain stable, when their use is periodically eliminated from the intensive care unit.

From the Department of Internal Medicine, Pulmonary and Critical Care Division, Washington University School of Medicine, and the Medical Intensive Care Unit and Respiratory Care Services, Barnes-Jewish Hospital, St. Louis, MO.

Mathematical mod-els suggest that antibiotic cycling is inferior to having portions of the population receive different antibiotics at the same time.

© 2001 by the Society of Critical Care Medicine and Lippincott Williams & Wilkins