Sunday February 12, 2006
Cycling of Antibiotics in ICU
Concept of antibiotics cycling to reduce antibiotics resistance remains debatable in medical literature. 2 recent papers earlier showed it may not work.1,2 But a new study of 346 patients from spain (comparing mixing in one ICU vs cycling in another ICU) published this month in Critical Care Medicine points that this may actually have some potential.
Patients, who according to the physician's judgment required an anti-Pseudomonas drug, were assigned to receive 1) cefepime/ceftazidime 2) ciprofloxacin 3) a carbapenem or 4) piperacillin-tazobactam in this order. Cycling was accomplished by prescribing one of these antibiotics during 1 month each. 2 cycles were given of 4 months each. Mixing was accomplished by using the same order of antibiotic administration on consecutive patients. The main outcome variable was the proportion of patients acquiring enteric or nonfermentative Gram-negative bacilli resistant to the antibiotics under intervention.
During mixing, a significantly higher proportion of patients acquired a strain of Pseudomonas aeruginosa resistant to cefepime (9% vs. 3%, p = .01), and there was a trend toward a more frequent acquisition of resistance to ceftazidime (p = .06), imipenem (p = .06), and meropenem (p = .07).
Read precise review on different point of views in this regard here posted in pulmonaryreviews.com, september 2002 issue. Till we get more data to accept antibiotic cycling as a standard practice, lets concentrate on two basic themes - avoid unnecessary antibiotic use and prevent cross-transmission of pathogens.
References: Click to get article/abstract (second popup overwrites first popup)
1. Ecological theory suggests that antimicrobial cycling will not reduce antimicrobial resistance in hospitals - Proceedings of the National Academy of Sciences of the United States of America - PNAS September 7, 2004 vol. 101 no. 36 13285-13290
2. Antibiotic Rotation and Development of Gram-Negative Antibiotic Resistance - American Journal of Respiratory and Critical Care Medicine Vol 171. pp. 480-487, (2005)
3. Comparison of antimicrobial cycling and mixing strategies in two medical intensive care units. -Critical Care Medicine. 34(2):329-336, February 2006.
4. Antibiotic cycling in intensive care units: The value of organized chaos? - Bonten, Marc J. M. MD; Weinstein, Robert A. MD- Critical Care Medicine: Volume 34(2) February 2006 pp 549-551