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Comprehensive Guidance for Antibiotic Dosing in Obese Adults.
Pharmacotherapy. 2017 Sep 04;:
Authors: Meng L, Mui E, Holubar MK, Deresinski SC
Abstract
BACKGROUND: Physiologic alterations seen in obesity commonly impact the pharmacokinetics (PK) and pharmacodynamics (PD) of antibiotics and may result in suboptimal dosing in this expanding but understudied population. Much of the published clinical and PK evidence to date consists of small patient populations and are retrospective with, not infrequently, heterogenous results that, in some cases, are contradictory. In the last 10 years, additional antimicrobial PK/PD and clinical data encompassing prolonged infusion strategies and examination of critically ill populations has emerged to inform antimicrobial dosing in obesity. In this narrative review, we critically review literature on dosing, PK, and possible dosing strategies in obese adults.
METHODS: We searched PubMed, SCOPUS, and the Cochrane Library using MESH terms, including 'anti-infectives', specific antimicrobial names, 'obese', 'pharmacokinetics' and others. We reviewed articles, cross referenced select cited references, and when applicable, referenced drug databases and package inserts to develop dosing recommendations.
RESULTS: We provide an overall critical review of the available data regarding PK and dosing issues including dosing recommendations, in both critically ill and non-critically ill patients with significant obesity. We developed dosing recommendations for 34 antimicrobials based on 121 articles of the 2,336 identified by the search strategy. While 11 of these do not appear to require dose adjustment, obesity-specific dosing guidance is provided for the remaining 23 antimicrobials.
CONCLUSIONS: Additional studies are needed to better understand and resolve discrepant published results regarding the PK of antibiotics in order to establish optimal dosing strategies in obese adults. Alternative dosing strategies, such as extended infusions, should be considered for time-dependent antibiotics (e.g. β-lactams) in obese patients to reliably achieve pharmacodynamics targets. Therapeutic drug monitoring across the spectrum of antimicrobials is of increasing importance in this and other populations in order to assure optimized dosing. This article is protected by copyright. All rights reserved.
PMID: 28869666 [PubMed - as supplied by publisher]