Cost-effectiveness analysis of low versus high dose colistin in the treatment of multi-drug resistant pneumonia: a comment

  • Effat Davoudi-Monfared
  • Maryam Taghizadeh-GhehiEmail author
Letter to the Editor

To the editor

We read with great interest the article by Cara et al. [1] in a recently published issue of the International Journal of Clinical Pharmacy. This study was conducted to evaluate cost-effectiveness of high dose versus low dose colistin (HDC vs. LDC) in treatment of nosocomial pneumonia (NP) due to multidrug resistant gram-negative bacteria (MDR-GNB). The authors concluded that LDC is as effective as and less nephrotoxic than HDC and could be considered as a cost-effective treatment for MDR-GNB NP. The study topic is important; however we faced issues in the study methodology and interpretation of results that need to be highlighted.

A major concern arises from considering LDC as a previously proven approach in treatment of MDR-GNB NP. In this study, doses less than 2.5 mg/kg were considered as LDC and doses above 2.5 mg/kg were defined as HDC. Three studies were cited in the paper as the basis for proven efficacy of LDC. The first citation belongs the study by Kalin et al. [


Conflicts of interest

The authors have nothing to declare.


  1. 1.
    Cara AKS, Zaidi STR, Suleman F. Cost-effectiveness analysis of low versus high dose colistin in the treatment of multi-drug resistant pneumonia in Saudi Arabia. Int J Clin Pharm. 2018;40(5):1051–8.CrossRefGoogle Scholar
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    Kalin G, Alp E, Coskun R, Demiraslan H, Gündogan K, Doganay M. Use of high-dose IV and aerosolized colistin for the treatment of multidrug-resistant Acinetobacter baumannii ventilator-associated pneumonia: do we really need this treatment? J Infect Chemother. 2012;18(6):872–7.CrossRefGoogle Scholar
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    Zaidi STR, Al Omran S, Al Aithan ASM, Al Sultan M. Efficacy and safety of low-dose colistin in the treatment for infections caused by multidrug-resistant gram-negative bacteria. J Clin Pharm Ther. 2014;39(3):272–6.CrossRefGoogle Scholar
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Copyright information

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Authors and Affiliations

  1. 1.Department of Clinical Pharmacy, Faculty of PharmacyTehran University of Medical SciencesTehranIran
  2. 2.Research Center for Rational Use of DrugsTehran University of Medical SciencesTehranIran

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