A team of European researchers aimed to assess whether the cycling of antibiotics (the use of one of three antibiotic pre-defined groups) compared to a mixing strategy (changing antibiotic to an alternative class for each consecutive patient) would reduce the prevalence of antibiotic-resistant, Gram-negative bacteria in eight European intensive care units. In intensive care units where patients are vulnerable to antibiotic-resistant gram-negative bacterial infections, antibiotic usage is high, and transmission of drug-resistant bacteria frequently occurs. Main study findings summarize that neither antibiotic cycling nor mixing reduces the prevalence of carriage of antibiotic-resistant, Gram-negative bacteria in patients admitted to the ICU. However, reducing the total volume of antibiotics used in ICUs remains the best strategy for decreasing selection pressure and controlling the emergence of antibiotic-resistant bacteria. Authors also concluded that the best results can be achieved by improved diagnostics that can determine which patients need antibiotics and which do not, and by biomarker-guided reductions in antibiotic duration.
Link to the study publication, published on Lancet Infectious Diseases on January 24 2018: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(18)30056-2/fulltext