International Journal of Clinical Pharmacy

, Volume 41, Issue 1, pp 1–2 | Cite as

Cost-effective analysis of low- versus high-dose colistin in the treatment of multi-drug resistant pneumonia in Saudi Arabia

  • Lama H. NazerEmail author
  • Jennifer Le
Letter to the Editor

Dear Editor,

We have recently read with great interest the article by Cara et al. in which they reported that low-dose colistin (< 5 mg/kg/day colistin base activity [CBA]) was not inferior to high-dose colistin (> 5 mg/kg/day CBA) in terms of clinical cure and was associated with a lower incidence of nephrotoxicity resulting in significant cost avoidance [1]. Although the authors shed light on an area with very limited information, we believe that the authors’ conclusions were perhaps misleading due to limitations in the study methodology.

The major limitation was in the underlying assumption that both high- and low-dose of colistin are acceptable for the treatment of multi-drug resistant pneumonia. While we concur with the authors that there are currently no definite dosing recommendations for colistin, several recently published studies have provided us with a better understanding of its pharmacokinetics and dosing strategies.

The doses evaluated in the study by Cara et al., high...


Conflicts of interest





  1. 1.
    Cara AKS, Zaidi STR, Suleman F. Cost-effectiveness analysis of low versus high dose colistin in the treatment of milt-drug resistant pneumonia is Saudi Arabia. Int J Clin Pharm. 2018;40(5):1051–8.CrossRefGoogle Scholar
  2. 2.
    JHP Pharmaceuticals, LLC. Coly-Mycin M Parenteral (colistimethate for injection, USP) (January 2013). Accessed 27 Nov 2018.
  3. 3.
    Nation RL, Garonzik SM, Li J, Thamlikitkul V, Giamarellos-Bourboulis EJ, Paterson DL, et al. Updated US and European dose recommendations for intravenous colistin: how do they perform? CID. 2016;62:552–8.CrossRefGoogle Scholar
  4. 4.
    Nazer LH, Anabtawi N. Optimizing colistin dosing: is a loading dose necessary? AJHP. 2017;74:e9–16.Google Scholar
  5. 5.
    Nation RL, Garonzik SM, Thamlikitkul V, Giamarellos-Bourboulis EJ, Forrest AL, Paterson DL, et al. Dosing guidance for intravenous colistin in critically ill patients. CID. 2017;64(5):565–71.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.Department of PharmacyKing Hussein Cancer CenterAmmanJordan
  2. 2.Skaggs School of Pharmacy and Pharmaceutical ScienceUniversity of California San DiegoSan DiegoUSA

Personalised recommendations