Antibiotic cycling or rotation: a systematic review of the evidence of efficacy

Of the interventions designed to reduce antibiotic resistance rates in hospitals, one that is currently attracting considerable interest, particularly in the intensive care unit setting, is antibiotic cycling or rotation. Cycling is the scheduled rotation of one class of antibiotics with one or more different classes exhibiting comparable spectra of activity; in order to fulfil the definition, the cycle must be repeated. Following a search of the literature we identified 11 articles in which the authors claimed to have evaluated the efficacy of this intervention. Only four were suitable for review, but, owing to multiple methodological flaws and a lack of standardization, the results of these studies do not permit reliable conclusions regarding the efficacy of cycling. Further studies are therefore required in order to resolve this question. However, before such studies can be undertaken, there are a great many issues relating to cycling which must be addressed. For the time being, we advise against the routine implementation of this measure as a means of reducing antibiotic resistance rates.