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Systematic review of the effects of antimicrobial cycling on bacterial resistance rates within hospital settings
  • Marianneta Chatzopoulou,
  • Lucy Reynolds
Marianneta Chatzopoulou
London School of Hygiene & Tropical Medicine

Corresponding Author:[email protected]

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Lucy Reynolds
London School of Hygiene & Tropical Medicine
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Aim Antimicrobial resistance is an evolving phenomenon with alarming public health consequences. Antibiotic cycling is a widely known antimicrobial stewardship initiative which encompasses periodical shifts in empirical treatment protocols with the aim to limit selective pressures on bacterial populations. Nonetheless, mathematical models have challenged its presumable efficacy by favouring a higher heterogeneity in antibiotic administration. We present a review of the evidence regarding the actual impact of antimicrobial cycling on bacterial resistance control within hospitals. Methods A systematic literature review was conducted using the PubMed/MedLine, Embase, CINAHL Plus and Global Health databases. Results A systematic search process retrieved a sole randomised study, and so we broadened inclusion criteria to encompass quasi-experimental designs. Fifteen studies formed our dataset including seven prospective trials and eight before-and-after studies. Nine studies evaluated cycling versus a control group and produced conflicting results whilst three studies compared cycling with antibiotic mixing, with none of the strategies appearing superior. The rest evaluated resistance dynamics of each of the on-cycle antibiotics with contradictory findings. Research protocols differed in parameters such as the cycle length, the choice of antibiotics, the opportunity to de-escalate to narrow-spectrum agents and the measurement of indicators of collateral damage. This limited our ability to evaluate the replicability of findings and the overall policy effects. Conclusions Dearth of robust designs and standardised protocols limits our ability to reach safe conclusions. Nonetheless, in view of the available data we find no reason to believe that cycling should be expected to improve antibiotic resistance rates within hospitals.
02 Apr 2021Submitted to British Journal of Clinical Pharmacology
03 Apr 2021Submission Checks Completed
03 Apr 2021Assigned to Editor
08 Apr 2021Reviewer(s) Assigned
17 May 2021Review(s) Completed, Editorial Evaluation Pending
22 May 2021Editorial Decision: Revise Major
15 Jun 20211st Revision Received
18 Jun 2021Submission Checks Completed
18 Jun 2021Assigned to Editor
18 Jun 2021Review(s) Completed, Editorial Evaluation Pending
02 Aug 2021Editorial Decision: Accept
Mar 2022Published in British Journal of Clinical Pharmacology volume 88 issue 3 on pages 897-910. 10.1111/bcp.15042