It was briefly thought that alternating the most commonly used antibiotics might stop the spread of antibiotic resistance. But a new model shows that the practice of cycling, alternating between two or more classes of antibiotics as often as every few months, probably will not work.
The latest theory is that mixing cocktails of antibiotics may help. And, in fact, this is closer to the way natural substances avoid the resistance problem.
Both these class of drugs fail because of basic processes of evolution ie adaptation to environment, natural selection of resistanat organisms under drug pressure and existence of Xenobiotic metabolism pathways in the organisms which is further amplified under the effects of the drugs . In addition there are host factors of variation in drug metabolism , food drug interaction , variable bioavailability, immune system of the host and sanctuary sites for the organisms , blood tissue barriers, infection where blood flow is compromised etc.
Mixing cocktails is far out the best, taking care of opportunistic pathogens as well. However, in the end resistance is inevitable. A new approach is the addition of an antimicrobial peptide which may perforate the membrane or affect the metabolism that supports efflux pumps.
Mixing two or more antibiotics is a reasonable option and they should be at a suboptimal doses for each one being mixed. In my early days of clinical practice as houseman our Professor as early as 1956 used to discuss on this and he strictly followed this practice. In my own in vitro studies earlier this could easily be demonstrated. Now, as I understand more of the antibiotic metabolic activities this mode of treatment of proven infections will greatly help in significant reduction of drug resistant bacteria.
Dr. H. N. Madhavan. MD., PhD. FAMS., FAC Path
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