Obesity

Dosing antibiotics in obesity – Dosing of antimicrobials for obese patients

We provide an overall critical review of the available data regarding PK and dosing issues including dosing recommendations in both critically ill and noncritically ill patients with significant obesity.

Additional studies are needed sntibiotics better understand and resolve discrepant published results regarding the PK of antibiotics to establish optimal dosing strategies in obese adults. Hanrahan View author publications. Whilst vancomycin concentrations are easily measured, concentrations of other antibiotics used in obese patients are measured far less frequently. Subsequently, obese patients may develop reduced drug clearance compared with age-matched comparators, especially those critically ill with augmented renal clearance. Higher comorbidity burden predicts worsening neurocognitive trajectories in people with HIV.

  • Cite this article Hanrahan, T. In healthy obese patients renal flow is augmented compared with non-obese [ 7 ].

  • Morbid obesity is associated with several pathophysiological changes that can profoundly affect drug distribution and clearance. 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.

  • Higher colistin or polymyxin B doses that may be seen in obese patients may unfortunately put the patient at unacceptably high risks of nephrotoxicity. Clin Pharmacokinet.

  • We searched PubMed, Scopus, and the Cochrane Library using Medical Subject Headings including anti-infectives, specific antimicrobial names, obese, pharmacokinetics, and others.

  • Our dosing recommendations for piperacillin-tazobactam, cefazolinmeropenem, levofloxacinand vancomycin incorporate dosing considerations in those with increased CrCl i. Keywords: antibiotic; antimicrobial; critically ill; dosing; obesity; pharmacokinetics.

Abbreviations

First, I found the differences that exist within antibiotic classes to be striking. I reached out to Dr. Critical Care. Neely et al.

Although 11 of these do not appear to require dose adjustment, obesity-specific dosing guidance is provided for the remaining 23 antimicrobials. In this narrative review, we critically review literature on dosing, PK, and possible dosing strategies in obese adults. We developed dosing recommendations for 34 antimicrobials based on articles of the identified by the search strategy. We provide an overall critical review of the available data regarding PK and dosing issues including dosing recommendations in both critically ill and noncritically ill patients with significant obesity. Understanding of the pharmacokinetic alterations and maximum doses of antibiotics safely used is paramount to appropriate treatment in the obese population.

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We provide an overall critical review of the available data regarding PK and dosing issues including dosing recommendations in both critically ill and noncritically ill patients with dsoing obesity. Keywords: Antibiotics; obesity; pharmacokinetics. Abstract Physiologic alterations seen in obesity commonly impact dosing antibiotics in obesity pharmacokinetics PK and pharmacodynamics PD of antibiotics and may result in suboptimal dosing in this expanding but understudied population. We reviewed articles, cross-referenced select cited references, and when applicable, referenced drug databases and package inserts to develop dosing recommendations. 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. Understanding of the pharmacokinetic alterations and maximum doses of antibiotics safely used is paramount to appropriate treatment in the obese population.

Keywords: Antibiotics; obesity; pharmacokinetics. Substances Anti-Bacterial Agents. We provide an overall critical review of the available data regarding PK and dosing issues including dosing recommendations in both critically ill and noncritically ill patients with significant obesity. Substances Anti-Bacterial Agents.

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Citing articles via Web of Science Critical Care. Sign In or Create an Account. Firstly, the daily weight-based vancomycin dose was significantly lower for obese compared with non-obese patients when administered by continuous infusion whilst achieving target concentrations [ 11 ].

Based on your research are there any scenarios that come to mind in which obesity would try to obesith using a particular antibiotic due to a patient being obese? Your comment will be reviewed and published at the journal's discretion. Hanrahan View author publications. Oxford University Press is a department of the University of Oxford. Int J Antimicrob Agents. Volume New issue alert.

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Additional studies are needed obesity better understand and resolve discrepant published results regarding the PK of antibiotics to establish optimal dosing strategies in obese adults. Alternative dosing strategies, such as extended infusions, should be considered for time-dependent antibiotics e. Although the prevalence of obesity is increasing over the last decades, pharmacokinetic evaluations are still conducted in individuals with a body weight of approximately 70 kg. Publication types Review. Publication types Review.

Understanding of the pharmacokinetic alterations and maximum doses of antibiotics safely used is paramount to appropriate treatment in the obese population. We provide an overall critical review of the available data regarding PK and dosing issues including dosing recommendations in both critically ill and noncritically ill patients with significant obesity. Publication types Review. Abstract 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.

During our literature review of antibiotic dosing we realized that a surprisingly large body of data obesty been published in the last 10 years since the article by Pai et al. Much of the published clinical and PK evidence to date consists of small patient populations and are retrospective with, not infrequently, heterogeneous results that in some cases are contradictory. Drug disposition in obesity: toward evidence-based dosing.

Submit Cancel. Focusing on antibiotic dosing in obesity, this is an important issue in the United Obesity today. Firstly, the daily weight-based vancomycin dose was significantly lower for obese compared with non-obese patients when administered by continuous infusion whilst achieving target concentrations [ 11 ]. Download citation. Although 11 of these do not appear to require dose adjustment, obesity-specific dosing guidance is provided for the remaining 23 antimicrobials. Clearly there is still a lot to learn about antibiotic dosing in obese patients, but where do you see the greatest need for more research on this topic? Publication types Review.

  • We developed dosing recommendations for 34 antimicrobials based on articles of the identified by the search strategy. I agree to the terms and conditions.

  • We reviewed articles, cross-referenced select cited references, and when applicable, referenced drug databases and package inserts to develop dosing recommendations.

  • Article Navigation.

  • In this narrative review, we critically review literature on dosing, PK, and possible dosing strategies in obese adults. Additional studies are needed to better understand and resolve discrepant published results regarding the PK of antibiotics to establish optimal dosing strategies in obese adults.

Abstract Physiologic alterations seen in antibiiotics commonly impact the pharmacokinetics PK and pharmacodynamics PD of antibiotics and may result in suboptimal dosing in this expanding but understudied population. Keywords: antibiotic; antimicrobial; critically ill; dosing; obesity; pharmacokinetics. Global obesity has nearly doubled and is now a common occurrence in high-income and developing countries. 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.

An additional article readers may find helpful is from Dr. Reprints obesiyy Permissions. Interview By: Timothy P. As the project developed we eventually decided to pursue the comprehensive guidance paper we published in Pharmacotherapy. Final dosage adjustments for antimicrobials with a narrow toxic-therapeutic window should be based on serum concentrations. Recently, Dr. Focusing on antibiotic dosing in obesity, this is an important issue in the United States today.

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From a practice standpoint we had been getting more dosing antibiotics in obesity dosing questions about obese patients, especially with newer agents such as linezoliddaptomycinand ceftolozane-tazobactam. For example, a recent review [ 14 ] concluded that very few hospitals worldwide perform beta-lactam TDM on a routine basis despite its availability likely being much higher [ 15 ]. Not only in the number and types of studies, but also the frequently conflicting PK changes reported for evaluations of the same antibiotic. As such, caution when relying on this alone is prudent. Pai MP.

Related articles in PubMed Effects of aerobic exercise on obese children with metabolic syndrome: a systematic obesiry and meta-analysis. Citing articles via Web of Science These data are similar to recent findings in non-obese critically ill populations [ 12 ], although there are ultimately many ill-defined variables that preclude direct extrapolation of non-obese data. Add comment Close comment form modal. Antibiotic dosing in obese patients can be a major challenge.

There are currently no specific dosing recommendations for antibiotics in obese patients, making doding suggestions primarily dosing antibiotics in obesity on pharmacokinetic characteristics of the medications and dosing recommendations in other disease states. Abstract Global obesity has nearly doubled and is now a common occurrence in high-income and developing countries. Keywords: antibiotic; antimicrobial; critically ill; dosing; obesity; pharmacokinetics. Although the prevalence of obesity is increasing over the last decades, pharmacokinetic evaluations are still conducted in individuals with a body weight of approximately 70 kg. We developed dosing recommendations for 34 antimicrobials based on articles of the identified by the search strategy. Substances Anti-Bacterial Agents.

The World Health Organization estimates that more than 1. We developed dosing recommendations for 34 antimicrobials based on articles of the identified by the search strategy. Global obesity has nearly doubled and is now a common occurrence in high-income and developing countries.

Publication types Review. Abstract 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. The World Health Organization estimates that more than 1. There are currently no specific dosing recommendations for antibiotics in obese patients, making dosing suggestions primarily based on pharmacokinetic characteristics of the medications and dosing recommendations in other disease states.

  • Clin Infect Dis. Firstly, there are changes to the volume of distribution Vd.

  • Additional studies are needed to better understand and resolve discrepant published results regarding the PK of antibiotics to establish optimal dosing strategies in obese adults.

  • Advance article alerts.

View author publications. Advanced Search. Most use guidelines as dosing rules rather than a guide. Int J Antimicrob Agents. Comment title. Although 11 of these do not appear to require dose adjustment, obesity-specific dosing guidance is provided for the remaining 23 antimicrobials.

We attempted to address concomitant factors in our dosing guidance whenever possible. Download citation. From a practice standpoint we had been getting more antibiotic dosing questions about obese patients, especially with newer agents such as linezoliddaptomycinand ceftolozane-tazobactam. J Pharm Invest.

See related research by Lin et al. Estimating the glomerular filtration rate in obese adult patients for drug dosing. Critical Care volume 20Article number: Cite this article. Article Navigation. The guide would review alternative dosing strategies e.

Pharmacokinetic issues for antibiotics in the critically ill patient. J Pharm Invest. Most use guidelines as dosing antibioticd rather than a guide. Comments 0. Efficacy of Antimicrobial Therapy for Mycoplasma genitalium Infections. Ceftarolineceftolozane-tazobactam, and ceftazidime-avibactam do not appear to require dose modifications in obesity, while cefepime and ceftazidime may.

Hanrahan View author publications. Int J Obes Lond. Despite this, given the relative antibotics of prospective data surrounding antibiotic pharmacokinetics in the combined obese and critically ill cohort, it is clear that TDM makes sense to ensure target concentrations are achieved to increase the likelihood of clinical efficacy. Significantly higher loading doses are likely to be necessary to accommodate the increased Vd, whilst comparatively lower maintenance doses may be required to avoid drug toxicities in those with reduced clearance.

Skip Nav Destination Article Navigation. As patients age and obesity-related nephropathies develop, however, renal function can be reduced [ 9 ]. Higher comorbidity burden predicts worsening neurocognitive trajectories in people with HIV. Recently, Dr.

We searched PubMed, Scopus, and obese lady dead cat photos Cochrane Library using Medical Subject Headings including anti-infectives, specific antimicrobial names, obese, pharmacokinetics, and others. Keywords: Antibiotics; obesity; pharmacokinetics. Dosign 11 of these do not appear to require dose adjustment, obesity-specific dosing guidance is provided for the remaining 23 antimicrobials. We reviewed articles, cross-referenced select cited references, and when applicable, referenced drug databases and package inserts to develop dosing recommendations. The World Health Organization estimates that more than 1.

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  • Much of the published clinical and PK evidence to date consists of small patient populations and are retrospective with, not infrequently, heterogeneous results that in some cases are contradictory. Alternative dosing strategies, such as extended infusions, should be considered for time-dependent antibiotics e.

  • Meng for an interview and she graciously accepted the invitation. Keywords: antibiotic; antimicrobial; critically ill; dosing; obesity; pharmacokinetics.

  • Global obesity has nearly doubled and is now a common occurrence in high-income and developing countries.

One should assess relative changes in Vd and clearance CLsince each can be altered to different extents in obesity. These data are similar to recent findings in non-obese critically ill populations [ 12 ], although there are ultimately many ill-defined variables that preclude direct extrapolation of non-obese data. Add comment Close comment form modal. Add comment Cancel.

We reviewed articles, cross-referenced select cited references, and when applicable, referenced drug databases and package inserts to develop dosing recommendations. Abstract Global obesity has nearly doubled and is dosing antibiotics a common occurrence in high-income and developing countries. Alternative dosing strategies, such as extended infusions, should be considered for time-dependent antibiotics e. Keywords: Antibiotics; obesity; pharmacokinetics. We developed dosing recommendations for 34 antimicrobials based on articles of the identified by the search strategy. There are currently no specific dosing recommendations for antibiotics in obese patients, making dosing suggestions primarily based on pharmacokinetic characteristics of the medications and dosing recommendations in other disease states.

Critical Care. Your comment will be reviewed and published at the journal's discretion. We attempted to address concomitant factors in our dosing guidance whenever possible. View Metrics. Although there are many potential pharmacokinetic consequences of obesity, the actual effect on the pharmacokinetics and clinical efficacy of most antimicrobials is unknown.

Morbid obesity is associated with several pathophysiological changes that can profoundly affect drug distribution and clearance. We provide an overall critical review of the available obesity regarding PK and dosing issues including dosing recommendations in both critically ill and noncritically ill patients with significant obesity. We reviewed articles, cross-referenced select cited references, and when applicable, referenced drug databases and package inserts to develop dosing recommendations. Keywords: Antibiotics; obesity; pharmacokinetics. We searched PubMed, Scopus, and the Cochrane Library using Medical Subject Headings including anti-infectives, specific antimicrobial names, obese, pharmacokinetics, and others.

Publication types Review. In this narrative review, we critically review literature on dosing, PK, and possible dosing strategies in obese adults. Morbid obesity is associated with several pathophysiological changes that can profoundly affect drug distribution and clearance. The World Health Organization estimates that more than 1. Substances Anti-Bacterial Agents.

About this article. In anyibiotics obese, there obesity be a significant change in the Vd of both hydrophilic and lipophilic antimicrobials consequential to increases in both adipose and lean muscle mass. For example, in urinary tract infections, the dosing of antibiotics that achieve high urinary levels are probably similar in obese and non-obese patients. Issue Section:. Article PubMed Google Scholar 8. Accessed 31 July Therapeutic drug monitoring is increasingly important in this population.

References

Keywords: Antibiotics; obesity; pharmacokinetics. Publication types Review. Global obesity has nearly doubled and is now a common occurrence in high-income and developing countries.

About this article. Clin Microbiol Dosing antibiotics in obesity. In such instances, alternative agents should be considered. Advance article alerts. Efficacy of Antimicrobial Therapy for Mycoplasma genitalium Infections. In the obese, there can be a significant change in the Vd of both hydrophilic and lipophilic antimicrobials consequential to increases in both adipose and lean muscle mass.

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There are currently no specific dosing recommendations for antibiotics in obese patients, making dosing antibiotics in obesity suggestions primarily based on pharmacokinetic characteristics of the medications and dosing recommendations in other disease states. Substances Anti-Bacterial Agents. We developed dosing recommendations for 34 antimicrobials based on articles of the identified by the search strategy. Although 11 of these do not appear to require dose adjustment, obesity-specific dosing guidance is provided for the remaining 23 antimicrobials. Much of the published clinical and PK evidence to date consists of small patient populations and are retrospective with, not infrequently, heterogeneous results that in some cases are contradictory. In this narrative review, we critically review literature on dosing, PK, and possible dosing strategies in obese adults.

Morbid obesity is antibiogics with several pathophysiological changes that can profoundly affect drug distribution and clearance. 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. Publication types Review. Abstract 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.

Additional information See related research by Lin et al. Related articles in Web of Science Google Scholar. Significantly higher loading doses are likely to be necessary to accommodate the increased Vd, whilst comparatively lower maintenance doses may be required to avoid drug toxicities in those with reduced clearance. Your comment will be reviewed and published at the journal's discretion. Gauthier, Pharm. Contact us Submission enquiries: Access here and click Contact Us General enquiries: info biomedcentral.

Publication types Review. Physiologic alterations seen in obesity commonly impact the pharmacokinetics PK and pharmacodynamics Obesity of antibiotics and may result in suboptimal dosing in this expanding but understudied population. Morbid obesity is associated with several pathophysiological changes that can profoundly affect drug distribution and clearance. Keywords: Antibiotics; obesity; pharmacokinetics. The World Health Organization estimates that more than 1.

Hanrahan, T. Recently, Dr. As such, caution when relying on this alone is prudent. Vancomycin therapeutic guidelines: a summary of consensus recommendations from the infectious diseases Society of America, the American Society of Health-System Pharmacists, and the Society of Infectious Diseases Pharmacists. Hanrahan View author publications. Comments 0.

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Although the prevalence of obesity is increasing over the last decades, pharmacokinetic evaluations are still conducted in individuals with a body weight of approximately 70 kg. Keywords: Antibiotics; obesity; pharmacokinetics. 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. We reviewed articles, cross-referenced select cited references, and when applicable, referenced drug databases and package inserts to develop dosing recommendations. In this narrative review, we critically review literature on dosing, PK, and possible dosing strategies in obese adults. Additional studies are needed to better understand and resolve discrepant published results regarding the PK of antibiotics to establish optimal dosing strategies in obese adults. Therapeutic drug monitoring across the spectrum of antimicrobials is of increasing importance in this and other populations to ensure optimized dosing.

Int J Obes Lond. Annu Rev Pharmacol Toxicol. Alternative dosing strategies, such as extended infusions, should be considered for time-dependent antibiotics e. Mechanisms of Action of Antimicrobials: Focus on Fluoroquinolones.

We provide an overall critical review of the available abtibiotics regarding Dosing antibiotics in obesity and dosing issues including dosing recommendations in both critically ill and noncritically ill patients with significant obesity. Substances Anti-Bacterial Agents. Although 11 of these do not appear to require dose adjustment, obesity-specific dosing guidance is provided for the remaining 23 antimicrobials.

  • We developed dosing recommendations for 34 antimicrobials based on articles of the identified by the search strategy.

  • Alternative dosing strategies, such as extended infusions, should be considered for time-dependent antibiotics e. Keywords: Antibiotics; obesity; pharmacokinetics.

  • Substances Anti-Bacterial Agents. These data are similar to recent findings in non-obese critically ill populations [ 12 ], although there are ultimately many ill-defined variables that preclude direct extrapolation of non-obese data.

  • Global obesity has nearly doubled and is now a common occurrence in high-income and developing countries.

  • In the obese, there can be a significant change in the Vd of both hydrophilic and lipophilic antimicrobials consequential to increases in both adipose and lean muscle mass. Additionally, the precise effect obesity has on antimicrobial clearance is unclear, with literature scarce.

We searched PubMed, Scopus, and the Cochrane Library using Medical Subject Headings including anti-infectives, specific antimicrobial names, obese, pharmacokinetics, and others. In this narrative review, we critically review literature on dosing, PK, and possible dosing strategies in obese adults. Substances Anti-Bacterial Agents. Publication types Review.

Additional studies are needed to better understand and resolve discrepant published results regarding the PK antibiotids antibiotics to establish optimal dosing strategies in obese adults. Morbid obesity is associated with several pathophysiological changes that can profoundly affect drug distribution and clearance. Abstract 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. Alternative dosing strategies, such as extended infusions, should be considered for time-dependent antibiotics e.

  • Lina Meng and colleagues published a comprehensive paper on this topic:. Furthermore, no significant difference in non-weight normalized vancomycin clearance between obese and non-obese patients with preserved renal function was found with minimal correlation to total body weight [ 11 ].

  • Much of the published clinical and PK evidence to date consists of small patient populations and are retrospective with, not infrequently, heterogeneous results that in some cases are contradictory.

  • Receive exclusive offers and updates from Oxford Academic. Firstly, the daily weight-based vancomycin dose was significantly lower for obese compared with non-obese patients when administered by continuous infusion whilst achieving target concentrations [ 11 ].

  • Ultimately, the paucity of data in obese, critically ill populations may force us to accept that therapeutic drug monitoring TDM is still the way forward.

Publication types Review. Not only in the obesity and types of studies, but also the frequently conflicting PK changes reported for evaluations of the same antibiotic. Vancomycin dosing in critically ill patients: robust methods for improved continuous-infusion regimens. Receive exclusive offers and updates from Oxford Academic. J Antimicrob Chemother. Estimating the glomerular filtration rate in obese adult patients for drug dosing.

Abstract Physiologic alterations seen in obesity commonly impact obesiity pharmacokinetics PK and pharmacodynamics PD of antibiotics and may result in suboptimal dosing in this expanding but understudied population. Global obesity has nearly doubled and is now a common occurrence in high-income and developing countries. Although 11 of these do not appear to require dose adjustment, obesity-specific dosing guidance is provided for the remaining 23 antimicrobials. Substances Anti-Bacterial Agents. Keywords: Antibiotics; obesity; pharmacokinetics. We reviewed articles, cross-referenced select cited references, and when applicable, referenced drug databases and package inserts to develop dosing recommendations. Although the prevalence of obesity is increasing over the last decades, pharmacokinetic evaluations are still conducted in individuals with a body weight of approximately 70 kg.

A lacto-ovo-vegetarian dietary pattern is protective against sarcopenic obesity: A cross-sectional study of elderly Chinese people. When approaching antibiotic dosing in special patient populations e. Subsequently, obese patients may develop reduced drug clearance compared with age-matched comparators, especially those critically ill with augmented renal clearance.

In this narrative review, we critically review doeing on dosing, PK, and possible dosing strategies in obese adults. Publication types Review. Abstract Global obesity has nearly doubled and is now a common occurrence in high-income and developing countries. Morbid obesity is associated with several pathophysiological changes that can profoundly affect drug distribution and clearance. Additional studies are needed to better understand and resolve discrepant published results regarding the PK of antibiotics to establish optimal dosing strategies in obese adults. Although 11 of these do not appear to require dose adjustment, obesity-specific dosing guidance is provided for the remaining 23 antimicrobials.

Understanding of the pharmacokinetic alterations and maximum doses of antibiotics safely used is paramount to appropriate treatment in dosing antibiotics in obesity obese population. Global obesity has nearly doubled obesiry is now a common occurrence in high-income and developing countries. We developed dosing recommendations for 34 antimicrobials based on articles of the identified by the search strategy. Abstract 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. Keywords: antibiotic; antimicrobial; critically ill; dosing; obesity; pharmacokinetics. In this narrative review, we critically review literature on dosing, PK, and possible dosing strategies in obese adults. The World Health Organization estimates that more than 1.

Article PubMed Google Scholar Int J Antimicrob Agents. This disparity may be because, traditionally, beta-lactam antibiotics had a wide therapeutic window and risk of toxicity was low compared with other antibiotics routinely measured. Vancomycin therapeutic guidelines: a summary of consensus recommendations from the infectious diseases Society of America, the American Society of Health-System Pharmacists, and the Society of Infectious Diseases Pharmacists.

In an effort to promote discussion and share new updates from obesity literature, the following insights on antibiotic dosing in obesity are provided. Adv Chronic Kidney Dis. Article PubMed Google Scholar From a practice standpoint we had been getting more antibiotic dosing questions about obese patients, especially with newer agents such as linezoliddaptomycinand ceftolozane-tazobactam. Critical Care volume 20Article number: Cite this article. In healthy obese patients renal flow is augmented compared with non-obese [ 7 ].

Although 11 of these do not appear to require dose adjustment, obesity-specific dosing guidance is provided for the remaining 23 antimicrobials. There are currently no specific dosing dead cat for antibiotics in obese patients, making dosing suggestions primarily based on pharmacokinetic characteristics of the medications and dosing recommendations in other disease states. We developed dosing recommendations for 34 antimicrobials based on articles of the identified by the search strategy. Publication types Review. Substances Anti-Bacterial Agents. Abstract 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.

We searched PubMed, Scopus, and the Cochrane Library using Medical Subject Headings including anti-infectives, specific antimicrobial names, obese, pharmacokinetics, and others. The World Health Organization estimates that more than 1. Abstract 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. Global obesity has nearly doubled and is now a common occurrence in high-income and developing countries.

Morbid obesity is associated antibiiotics several pathophysiological changes that obesity profoundly affect drug distribution and clearance. There are currently no specific dosing recommendations for antibiotics in obese patients, making dosing suggestions primarily based on pharmacokinetic characteristics of the medications and dosing recommendations in other disease states. The World Health Organization estimates that more than 1. Keywords: Antibiotics; obesity; pharmacokinetics.

Alternative dosing strategies, such as extended infusions, should be considered for time-dependent antibiotics e. Abstract Physiologic alterations seen in obesity commonly impact the pharmacokinetics PK and pharmacodynamics PD of antibiotics and may result in suboptimal xosing in this expanding but understudied population. Although the prevalence of obesity is increasing over the last decades, pharmacokinetic evaluations are still conducted in individuals with a body weight of approximately 70 kg. Additional studies are needed to better understand and resolve discrepant published results regarding the PK of antibiotics to establish optimal dosing strategies in obese adults. The World Health Organization estimates that more than 1. In this narrative review, we critically review literature on dosing, PK, and possible dosing strategies in obese adults.

Google Scholar. Firstly, there are changes to the volume of distribution Vd. Critical Care volume 20Article number: Cite this article. Roberts Authors Timothy P. Cite this article Hanrahan, T. Most use guidelines as dosing rules rather than a guide.

Morbid obesity is associated with several pathophysiological changes that can profoundly affect drug distribution and clearance. We reviewed articles, cross-referenced select cited references, and when applicable, referenced drug databases and package inserts to develop dosing recommendations. We developed dosing recommendations for 34 antimicrobials based on articles of the identified by the search strategy. Understanding of the pharmacokinetic alterations and maximum doses of antibiotics safely used is paramount to appropriate treatment in the obese population.

  • In healthy obese patients renal flow is augmented compared with non-obese [ 7 ]. Vancomycin therapeutic guidelines: a summary of consensus recommendations from the infectious diseases Society of America, the American Society of Health-System Pharmacists, and the Society of Infectious Diseases Pharmacists.

  • Although 11 of these do not appear to require dose adjustment, obesity-specific dosing guidance is provided for the remaining 23 antimicrobials. We searched PubMed, Scopus, and the Cochrane Library using Medical Subject Headings including anti-infectives, specific antimicrobial names, obese, pharmacokinetics, and others.

  • Things such as drug absorption, drug concentration at the site of infection, and microbial resistance are just a few of the many variables to account for.

  • Meng for an interview and she graciously accepted the invitation.

  • Abstract 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. Although the prevalence of obesity is increasing over the last decades, pharmacokinetic evaluations are still conducted in individuals with a body weight of approximately 70 kg.

Publication types Review. Publication types Review. Understanding of the pharmacokinetic alterations and maximum doses of antibiotics safely used is paramount to appropriate treatment in the obese population. Substances Anti-Bacterial Agents.

Alternative dosing strategies, such as extended infusions, should be considered for obesity antibiotics e. Physiologic obrsity 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. Abstract Global obesity has nearly doubled and is now a common occurrence in high-income and developing countries. Additional studies are needed to better understand and resolve discrepant published results regarding the PK of antibiotics to establish optimal dosing strategies in obese adults. Morbid obesity is associated with several pathophysiological changes that can profoundly affect drug distribution and clearance. We reviewed articles, cross-referenced select cited references, and when applicable, referenced drug databases and package inserts to develop dosing recommendations.

Mechanisms of Action of Antimicrobials: Focus on Fluoroquinolones. Gail Itokazu. Your comment will be reviewed and published at the journal's discretion. Whilst vancomycin concentrations are easily measured, concentrations of other antibiotics used in obese patients are measured far less frequently. Adv Chronic Kidney Dis. Timothy P.

The World Health Organization estimates that more than 1. Substances Anti-Bacterial Dosing antibiotics in obesity. Much of the aantibiotics clinical and PK evidence to date consists of small patient populations and are retrospective with, not infrequently, heterogeneous results that in some cases are contradictory. We provide an overall critical review of the available data regarding PK and dosing issues including dosing recommendations in both critically ill and noncritically ill patients with significant obesity.

  • Although 11 of these do not appear to require dose adjustment, obesity-specific dosing guidance is provided for the remaining 23 antimicrobials.

  • Abstract Global obesity has nearly doubled and is now a common occurrence in high-income and developing countries. We reviewed articles, cross-referenced select cited references, and when applicable, referenced drug databases and package inserts to develop dosing recommendations.

  • I would like to express my sincerest appreciation to Dr. Advance article alerts.

  • Much of the published clinical and PK evidence to date consists of small patient populations and are retrospective with, not infrequently, heterogeneous results that in some cases are contradictory.

Within this guide we were considering to include a subsection on dosing antibiotics in obese patients with critical illness. Meng for an interview and she graciously accepted the invitation. Effect of obesity on the pharmacokinetics of antimicrobials in critically ill patients: a structured review. As pharmacists, physicians, and others continue to grapple with the challenges of antibiotic dosing in obese patients it can be helpful to acquire new resources and insights.

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Keywords: antibiotic; antimicrobial; critically ill; dosing; obesity; pharmacokinetics. Understanding of the pharmacokinetic alterations and maximum doses of antibiotics safely used is paramount to appropriate treatment in the obese population. Substances Anti-Bacterial Agents. Morbid obesity is associated with several pathophysiological changes that can profoundly affect drug distribution and clearance. Additional studies are needed to better understand and resolve discrepant published results regarding the PK of antibiotics to establish optimal dosing strategies in obese adults. Although the prevalence of obesity is increasing over the last decades, pharmacokinetic evaluations are still conducted in individuals with a body weight of approximately 70 kg. Substances Anti-Bacterial Agents.

In conclusion, antjbiotics clearance may be similar in obese and non-obese populations, with smaller weight-based dosages required to maintain steady state concentrations. Download all slides. Particularly in patients with sepsis, fluid shifts from the intravascular space to the interstitium lowers the intravascular concentrations of hydrophilic antimicrobials [ 4 ]. As patients age and obesity-related nephropathies develop, however, renal function can be reduced [ 9 ].

Morbid obesity is associated with several pathophysiological changes that can profoundly affect drug distribution and clearance. Keywords: Antibiotics; obesity; pharmacokinetics. Publication types Review.

These data are similar onesity recent findings in non-obese critically ill populations [ 12 ], although there are ultimately many ill-defined variables that preclude direct extrapolation of non-obese data. Download PDF. Most use guidelines as dosing rules rather than a guide. Effect of obesity on the pharmacokinetics of drugs in humans. For example, in urinary tract infections, the dosing of antibiotics that achieve high urinary levels are probably similar in obese and non-obese patients. Our dosing recommendations for piperacillin-tazobactam, cefazolinmeropenem, levofloxacinand vancomycin incorporate dosing considerations in those with increased CrCl i. Looking for your next opportunity?

You must accept the terms and conditions. She provides clinical service to the Infectious Diseases ID Consult Services, and precepts pharmacy residents on the ID rotation dosing antibiotics in obesity ID fellows on the antimicrobial stewardship rotation. Therapeutic drug monitoring across the spectrum of antimicrobials is of increasing importance in this and other populations to ensure optimized dosing. Advanced Search. Vancomycin is a glycopeptide antibiotic whose clinical response is dependent on the h area-under-the-concentration-time curve AUC to minimum inhibitory concentration MIC ratio.

Substances Anti-Bacterial Obesity. There are currently no specific dosing recommendations for ddosing in obese patients, making dosing suggestions primarily based on pharmacokinetic characteristics of the medications and dosing recommendations in other disease states. Keywords: Antibiotics; obesity; pharmacokinetics. We provide an overall critical review of the available data regarding PK and dosing issues including dosing recommendations in both critically ill and noncritically ill patients with significant obesity.

Published : 10 August We provide an overall critical review of the obeaity data regarding PK and dosing issues including dosing recommendations in both critically ill and noncritically ill patients with significant obesity. Search Menu. This disparity may be because, traditionally, beta-lactam antibiotics had a wide therapeutic window and risk of toxicity was low compared with other antibiotics routinely measured. This is unsurprising given clearance is the primary determinant of maintaining steady state concentrations after initial loading is complete [ 12 ]. Ultimately, the paucity of data in obese, critically ill populations may force us to accept that therapeutic drug monitoring TDM is still the way forward.

Google Scholar. Int J Antimicrob Agents. It furthers the University's objective of excellence in research, scholarship, and education by publishing worldwide. Antibiotic pharmacokinetics are different in the critically ill compared with other patient groups [ 3 ]. Augmented renal clearance: implications for antibacterial dosing in the critically ill.

Additional studies are needed to better understand and resolve discrepant published results regarding the PK of antibiotics to establish optimal dosing strategies in obese adults. There dosing antibiotics in obesity currently no specific dosing recommendations for antibiotics in obese patients, making dosing suggestions primarily based on pharmacokinetic characteristics of the medications and dosing recommendations in other disease states. Substances Anti-Bacterial Agents. 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. Therapeutic drug monitoring across the spectrum of antimicrobials is of increasing importance in this and other populations to ensure optimized dosing. Understanding of the pharmacokinetic alterations and maximum doses of antibiotics safely used is paramount to appropriate treatment in the obese population.

Gail Itokazu. Antibiotic pharmacokinetics are different in the critically ill compared with other patient groups [ 3 ]. Sign In or Create an Account. Skip to main content. Email alerts Article activity alert.

As the project developed we eventually decided to pursue the comprehensive guidance paper we published in Pharmacotherapy. Dosing antibiotics in obesity data are similar to recent findings in non-obese critically ill populations [ 12 ], although there are ultimately many ill-defined variables that preclude direct extrapolation of non-obese data. For example, in urinary tract infections, the dosing of antibiotics that achieve high urinary levels are probably similar in obese and non-obese patients. Significantly higher loading doses are likely to be necessary to accommodate the increased Vd, whilst comparatively lower maintenance doses may be required to avoid drug toxicities in those with reduced clearance. Antibiotic dosing in obese patients can be a major challenge. One example is seen with the carbapenems, for which the volume of distribution Vd is generally increased in obese patients.

Substances Anti-Bacterial Agents. Abstract 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. There are currently no specific dosing recommendations for antibiotics in obese patients, making dosing suggestions primarily based on pharmacokinetic characteristics of the medications and dosing recommendations in other disease states. Keywords: Antibiotics; obesity; pharmacokinetics. Much of the published clinical and PK evidence to date consists of small patient populations and are retrospective with, not infrequently, heterogeneous results that in some cases are contradictory. In this narrative review, we critically review literature on dosing, PK, and possible dosing strategies in obese adults. Although 11 of these do not appear to require dose adjustment, obesity-specific dosing guidance is provided for the remaining 23 antimicrobials.

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