Box 3Appraisal committee’s discussion on antibiotic sequencing regimens reproduced from the Final Appraisal Determination for NICE TA276

“The committee heard from the Assessment Group that information from their clinical experts suggested that less than 25% of people with cystic fibrosis and chronic P. aeruginosa lung infection would receive an alternating therapy regimen. The committee therefore concluded that some people with cystic fibrosis and chronic pseudomonas lung infection may receive alternating tobramycin and colistimethate sodium treatment in clinical practice. The committee noted the increased cost of such alternating antibiotic regimens and that it had not been presented with any evidence as to the clinical effectiveness of this approach by the Assessment Group or the manufacturers or during consultation. It concluded that because there was no evidence of the clinical effectiveness of using these antibiotics in an alternating regimen, it could not consider this issue further.”