Antimicrobial Cycling: The Future or a Fad?

OBJECTIVE:To assess the current evidence of the value of cycling of antimicrobials to control the emergence of resistance or to reverse existing resistance to antimicrobials.DATA SOURCES:Articles were obtained through a MEDLINE search of the English-language literature from 1966 to January 2000. Additionally, references from retrieved publications were reviewed to identify further articles.STUDY SELECTION AND DATA EXTRACTION:All investigations of switching between or cycling among antimicrobials were evaluated. Studies switching between or cycling among specific drugs or classes of drugs within institutional settings were included in this review.DATA SYNTHESIS:Studies involving cycling among different aminoglycosides suggest that, although temporary decreases in resistance can be documented, resistance usually rebounds rapidly on completion of the cycle and return to the original agent. Switching between classes of antimicrobials has produced inconsistent results and has been shown to replace resistance t...