Results
A systematic search process retrieved a sole randomised study, and so we
broadened inclusion criteria to encompass quasi-experimental designs.
Fifteen studies formed our dataset including seven prospective trials
and eight before-and-after studies. Nine studies evaluated cycling
versus a control group and produced conflicting results whilst three
studies compared cycling with antibiotic mixing, with none of the
strategies appearing superior. The rest evaluated resistance dynamics of
each of the on-cycle antibiotics with contradictory findings. Research
protocols differed in parameters such as the cycle length, the choice of
antibiotics, the opportunity to de-escalate to narrow-spectrum agents
and the measurement of indicators of collateral damage. This limited our
ability to evaluate the replicability of findings and the overall policy
effects.