Antibiotic Cycling: Is It Ready for Prime Time?

Abstract

EXCERPT The growing, gene†trading, burping, breathing bacteria are suspected to be living control mechanisms in a system of global elemental cycling and gas exchange. Dorion Sagan, Lynn Margulis Garden of Microbial Delights1 Cycle (from the Greek kyklos, meaning a ring or circle) implies in English a recurrent sequence of events. Medical imagery abounds with cycles: anovulatory, cardiac, citric acid, endometrial, Krebs, mammary, menstrual, etc. The term cycling, to describe the purposeful alternation of antimicrobials, appeared in the mid†1980s, just about the time of the first substitution trials involving aminoglycosides.2 Despite the success of those early aminoglycoside cycling programs, very few experiences with cycling were reported in the 1990s. With the global problem of antimicrobial resistance, particularly in hospitals,3,4 antibiotic cycling has reemerged as one of several potential strategies to control antimicrobial selection of resistance. 5,6 This issue of the Journal is accompanied by a supplement entitled Antibiotic Cycling. My editorial is intended to put the concept of antibiotic cycling and the content of the Supplement into perspective.