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

During the past decade, some pathogens in the hospital, and in the community as well, have developed resistance to the antimicrobial drugs in current use. 1 Use of antimicrobial agents is one of the factors leading to resistance in microorganisms. 2,3Existence of this cause and effect relationship forces us to examine the ways in which we use antibiotics.It has been postulated that switching to a new drug of the same family can reduce levels of resistance to older drugs, and that "cycling" antimicrobials (periodically substituting a new member of the same drug family for a ?drug currently in use) might minimize development of resistance to specific drugs in the same family. 4A number of recent studies 5 " 19 have attempted to discern the effectiveness of these strategies (Table ).The majority of these trials have substituted amikacin for gentamicin or tobramycin in hopes of reducing prevalence of resistance .todrugs of this group.This review addresses two major questions about these practices: Do they work?and Are they cost-effective?