Implementing an antibiotic cycle program to reduce antimicrobial resistance while optimizing antibiotic usage: a sobering experience from a tertiary care facility in northern Mumbai
DOI:
https://doi.org/10.18203/2394-6040.ijcmph20230622Keywords:
Antibiotic cycling, Antimicrobial stewardship, Antimicrobial resistance, Cefoperazone, PiperacillinAbstract
Background: The increase of antimicrobial resistance and the scarcity of new broad-spectrum antibiotics is a major challenge. Antibiotic cycling is one tactic that increases antibiotic homogeneity to the greatest extent possible and can aid in controlling resistance pattern, but this approach has not undergone a thorough evaluation. The study’s objective was to examine the effects of an antibiotic cycling strategy on the antimicrobial susceptibility profile by avoiding and alternately using beta lactam/beta lactamase inhibitors over a period of many years.
Methods: During the four-year trial period, from January 2018 to December 2021, an antibiotic cycling protocol was applied for indoor patients. Piperacillin/tazobactam and cefoperazone/sulbactam were alternately rotated and withheld for the full year. Using the hospital’s antibiogram as a guide, antibiotics were chosen for cycling. Data obtained from positive clinical cultures were used for preparing antibiogram.
Results: The general susceptibility profile of the most prevalent species remained stable or showed a minor increase in sensitivity. While piperacillin/tazobactam susceptibility failed to approach statistical significance, the antibiogram for cefoperazone/sulbactam indicated a 4% increase in susceptibility with a shift to the left of the minimum inhibitory concentration (MIC).
Conclusions: Antibiotic cycling is a controversial idea, yet it can be a successful technique to achieve either stability or a continuous decrease in resistance to a chosen antibiotic. Additionally, for meaningful outcomes, the antibiotic selected and the length of cycling must be in accordance with the hospital’s antibiogram.
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