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J Res Pharm Pract. 2019 Dec 27;8(4):196-201. doi: 10.4103/jrpp.JRPP_19_68. eCollection 2019 Oct-Dec.

A Randomized Clinical Trial Evaluating the Efficacy of Colistin Loading Dose in Critically Ill Children.

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Department of Clinical Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
Department of Pediatric Infectious Diseases, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran.
Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Department of Clinical Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
Non-communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran.
Department of Pathology, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.



Pharmacokinetic and clinical studies recommend applying loading dose of colistin for the treatment of severe infections in the critically ill adults. Pharmacokinetic studies of colistin in children also highlight the need for a loading dose. However, there are no clinical studies evaluating the effectiveness of colistin loading dose in children.


In a randomized trial, children with ventilator-associated pneumonia or central line-associated bloodstream infection (CLABSI) for whom colistin was initiated, were enrolled. Patients were randomized into two groups; loading dose and conventional dose treatment arms. In the conventional treatment arm, colistimethate sodium was initiated with maintenance dose. In the loading dose group, colistimethate sodium was commenced with a loading dose of 150,000 international unit/kg, then on the maintenance dose. Both treatment arms also received meropenem as combination therapy. Primary outcomes were overall efficacy, clinical improvement and microbiological cure. Secondary outcomes were colistin-induced nephrotoxicity and development of resistance.


Thirty children completed this study. There was a significantly higher overall efficacy in the group received loading dose (42.9 vs. 6.3%, P = 0.031). There weren't any significant differences in the clinical and microbiological endpoints. In the subgroup of children with CLABSI, results illustrated a trend toward (though statistically nonsignificant) better clinical cure for patients receiving loading dose.


This preliminary study suggests that colistin loading dose might have some benefits in critically ill children, specifically in children with CLABSI. Further trials are required to elucidate colistin best dosing strategy in critically ill children with severe infections.


Children; Colistin; clinical efficacy; loading dose; safety

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