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