Pilot study of antibiotic cycling in a pediatric intensive care unit

William J. Moss, M. Claire Beers, Elizabeth Johnson, David G. Nichols, Trish M. Perl, James D. Dick, Michael A. Veltri, Rodney E. Willoughby

Research output: Contribution to journalArticlepeer-review

39 Scopus citations


Objective: This pilot study was performed to determine the safety and size of effect of antibiotic cycling to reduce colonization and infection with antibiotic-resistant bacteria. Design: Open, observational study. Setting: The study was performed in a 16-bed pediatric medical-surgical intensive care unit. Patients: Critically ill children requiring antibiotic therapy. Interventions: Three antibiotic classes were systematically cycled for 3-month intervals over 18 months. Antibiotic regimens were used for all empirical therapy and continued if the bacterial isolate was susceptible. Measurements: The primary outcome was colonization with antibiotic-resistant bacteria, determined by surveillance cultures obtained twice monthly from all patients in the unit. Rates of antibiotic-resistant, nosocomial blood stream infections, and risks of colonization over calendar time in the intensive care unit were also evaluated. Main results: The cycling of broad-spectrum, empirical antibiotics was safe and did not generate increased antibiotic resistance nor select for new organisms. Over the study period, the trend in prevalence of children colonized with antibiotic-resistant bacteria was from 29% to 24% (p = .41). The effect on prevalence of resistant blood stream infections was similar (p = .29). Changes in individual risks of colonization with resistant bacteria over calendar time were consistent with the ecologic effect in size and direction. Conclusions: Results of this pilot intervention suggest that cycling antibiotics may be a safe and viable strategy to minimize the emergence of antibiotic resistance in intensive care units. A definitive study will require a randomized and controlled trial of only four pediatric intensive care units over an 18-month period.

Original languageEnglish (US)
Pages (from-to)1877-1882
Number of pages6
JournalCritical care medicine
Issue number8
StatePublished - 2002


  • Antibiotics
  • Biological
  • Child
  • Drug resistance
  • Ecology
  • Infection
  • Microbial
  • Models

ASJC Scopus subject areas

  • Critical Care and Intensive Care Medicine


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