and efforts have been sporadic at best. 36 Many factors can affect the outcome
of cycling programs, such as which antibiotics are cycled, the order in which
they are cycled, and the length of each cycle. 37 Healthcare institutions must
carefully adjust these factors and optimize antibiotic utilization strategies for
their particularized setting to succeed in reducing resistance.
2. Misuse Through Failure to Complete Course of Treatment
Many patients unknowingly contribute to antibiotic resistance by failing
to complete their entire course of treatment, thus failing to eradicate the
infection from their bodies. 38 Patients often stop taking their antibiotics when
their symptoms improve because they do not recognize that the drug has not
yet effectively eliminated the underlying bacteria. 39 This causes eradication
of bacteria with the weakest resistance, but high-resistance bacteria will
remain and reproduce. 40 Many patients remain unaware that such behavior
can help fuel antibiotic resistance problems. 41
To prevent misuse and curb antibiotic resistance, patients must take greater
responsibility toward their treatments. Moreover, physicians must find
innovative ways to sufficiently educate their patients and support
adherence. 42 Physicians must take time to emphasize the need to adhere to
dosage amounts and length of treatment in order to maximize the benefit to
the patient and minimize resistance problems. 43 Methods to increase
medication adherence must also be developed. These adherence methods
could range from high tech mobile applications and “smart” pill bottles to
simple and cheap methods, such as adding a milestone to a treatment ( i.e.
advising patients to complete ten white pills before completing five blue pills
of the same drug) to increase adherence. 44 These measures will help patients
tobramycin, and amikacin fall under the antibiotic category of aminoglycosides, used in the
treatment of gram-negative bacterial infections); Marie-Paule Mingeot-Leclercq et al.,
Aminoglycosides: Activity and Resistance, 43 ANTIMICROBIALAGENTS&CHEMOTHERAPY
727, 727 (1999).
36. See Erwin M. Brown & Dilip Nathwani, Antibiotic Cycling or Rotation: A Systematic
Review of the Evidence of Efficacy, 55 J. ANTIMICROBIAL CHEMOTHERERAPY 6, 6-9 (2005)
(discussing the methodological flaws and lack of standardization that render the results of
studies evaluating the efficacy of antibiotic cycling to be unreliable, as many issues relating to
cycling remain unaddressed).
37. Id. at 8–9.
38. See Fox, supra note 29, at 41.
39. Bacquero & Blázquez, supra note 12, at 485.
40. TENNENHOUSE, supra note 18.
42. See Saver, supra note 30, at 472.
43. See id. at 450 (explaining that physician management of antibiotics must extend to
beyond prescribing and include monitoring and counseling use).
44. E. Patchen Dellinger et al., Quality Standard for Antimicrobial Prophylaxis in