Abstract
Significant physiological changes in obese patients limit the generalisability of dosing information of antimicrobials to this increasingly prevalent group of patients. Individualised approaches to drug dosing in obese patients are warranted to address the significant changes in the pharmacokinetics of antimicrobials in this patient group. Nevertheless, differences in the chemical, physiological and clinical characteristics of antimicrobials limit the application of established pharmacokinetics in obese patients. Important considerations when designing an antimicrobial regimen include an understanding of the focus of infection, relative susceptibilities of the micro-organism involved, the best match of the body size descriptor for the antimicrobial in question and the renal function of the patients under treatment.
This is a preview of subscription content, log in via an institution.
Buying options
Tax calculation will be finalised at checkout
Purchases are for personal use only
Learn about institutional subscriptionsReferences
WHO Expert Consultation. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies. Lancet. 2004;363(9403):157–63.
World Health Organisation. Obesity and overweight. Fact sheet no. 311 (updated January 2015, 30 January 2015). Available from: http://www.who.int/.
Vogtle LK. Measuring body composition: the limitations of body mass index. Dev Med Child Neurol. 2015;57(11):991–2.
Organisation WH. Prevelance world map and statistics of Obesity, age 18+ 2014 data 2015 (cited 2015 27/10/2015). Available from: http://gamapserver.who.int/gho/interactive_charts/ncd/risk_factors/obesity/atlas.html.
Falagas ME, Karageorgopoulos DE. Adjustment of dosing of antimicrobial agents for bodyweight in adults. Lancet. 2010;375(9710):248–51.
Pai MP. Drug dosing based on weight and body surface area: mathematical assumptions and limitations in obese adults. Pharmacotherapy. 2012;32(9):856–68.
Huttunen R, Syrjanen J. Obesity and the risk and outcome of infection. Int J Obes. 2013;37(3):333–40.
Muscedere JG, Shorr AF, Jiang X, Day A, Heyland DK, Canadian Critical Care Trials G. The adequacy of timely empiric antibiotic therapy for ventilator-associated pneumonia: an important determinant of outcome. J Crit Care. 2012;27(3):322 e7–14.
Pai MP, Bearden DT. Antimicrobial dosing considerations in obese adult patients. Pharmacotherapy. 2007;27(8):1081–91.
Allard S, Kinzig M, Boivin G, Sorgel F, LeBel M. Intravenous ciprofloxacin disposition in obesity. Clin Pharmacol Ther. 1993;54(4):368–73.
Bauer LA, Black DJ, Lill JS. Vancomycin dosing in morbidly obese patients. Eur J Clin Pharmacol. 1998;54(8):621–5.
Muzevich KM, Lee KB. Subtherapeutic linezolid concentrations in a patient with morbid obesity and methicillin-resistant Staphylococcus aureus pneumonia: case report and review of the literature. Ann Pharmacother. 2013;47(6):e25.
Corcoran GB, Salazar DE, Schentag JJ. Excessive aminoglycoside nephrotoxicity in obese patients. Am J Med. 1988;85(2):279.
Gauthier TP, Wolowich WR, Reddy A, Cano E, Abbo L, Smith LB. Incidence and predictors of nephrotoxicity associated with intravenous colistin in overweight and obese patients. Antimicrob Agents Chemother. 2012;56(5):2392–6.
Davies SW, Efird JT, Guidry CA, Dietch ZC, Willis RN, Shah PM, et al. Vancomycin-Associated Nephrotoxicity: The Obesity Factor. Surg Infect (Larchmt). 2015.
Ortiz VE, Kwo J. Obesity: physiologic changes and implications for preoperative management. BMC Anesthesiol. 2015;15:97.
Waki M, Kral JG, Mazariegos M, Wang J, Pierson RN, Jr., Heymsfield SB. Relative expansion of extracellular fluid in obese vs. nonobese women. Am J Physiol. 1991;261(2 Pt 1):E199–203.
Chung EK, Cheatham SC, Fleming MR, Healy DP, Shea KM, Kays MB. Population pharmacokinetics and pharmacodynamics of piperacillin and tazobactam administered by prolonged infusion in obese and nonobese patients. J Clin Pharmacol. 2015;55(8):899–908.
Pai MP, Cojutti P, Pea F. Pharmacokinetics and pharmacodynamics of continuous infusion meropenem in overweight, obese, and morbidly obese patients with stable and unstable kidney function: a step toward dose optimization for the treatment of severe gram-negative bacterial infections. Clin Pharmacokinet. 2015;54(9):933–41.
Sketris I, Lesar T, Zaske DE, Cipolle RJ. Effect of obesity on gentamicin pharmacokinetics. J Clin Pharmacol. 1981;21(7):288–93.
Sturm AW, Allen N, Rafferty KD, Fish DN, Toschlog E, Newell M, et al. Pharmacokinetic analysis of piperacillin administered with tazobactam in critically ill, morbidly obese surgical patients. Pharmacotherapy. 2014;34(1):28–35.
Pai MP, Cojutti P, Pea F. Levofloxacin dosing regimen in severely morbidly obese patients (BMI >/= 40 kg/m(2)) should be guided by creatinine clearance estimates based on ideal body weight and optimized by therapeutic drug monitoring. Clin Pharmacokinet. 2014;53(8):753–62.
Levy BI, Schiffrin EL, Mourad JJ, Agostini D, Vicaut E, Safar ME, et al. Impaired tissue perfusion: a pathology common to hypertension, obesity, and diabetes mellitus. Circulation. 2008;118(9):968–76.
Brook RD, Bard RL, Bodary PF, Eitzman DT, Rajagopalan S, Sun Y, et al. Blood pressure and vascular effects of leptin in humans. Metab Syndr Relat Disord. 2007;5(3):270–4.
Hollenstein UM, Brunner M, Schmid R, Muller M. Soft tissue concentrations of ciprofloxacin in obese and lean subjects following weight-adjusted dosing. Int J Obes Relat Metab Disord. 2001;25(3):354–8.
Huttunen R, Syrjanen J. Obesity and the risk and outcome of infection. Int J Obes (Lond). 2013;37(3):333–40.
Wei JL, Leung JC, Loong TC, Wong GL, Yeung DK, Chan RS, et al. Prevalence and severity of nonalcoholic fatty liver disease in non-obese patients: a population study using proton-magnetic resonance spectroscopy. Am J Gastroenterol. 2015;110(9):1306–14.
Brill MJ, Diepstraten J, van Rongen A, van Kralingen S, van den Anker JN, Knibbe CA. Impact of obesity on drug metabolism and elimination in adults and children. Clin Pharmacokinet. 2012;51(5):277–304.
Merrell MD, Cherrington NJ. Drug metabolism alterations in nonalcoholic fatty liver disease. Drug Metab Rev. 2011;43(3):317–34.
Pai MP, Lodise TP. Steady-state plasma pharmacokinetics of oral voriconazole in obese adults. Antimicrob Agents Chemother. 2011;55(6):2601–5.
Hall JE, Guyton AC. Guyton and Hall textbook of medical physiology. 2011.
Pai MP. Estimating the glomerular filtration rate in obese adult patients for drug dosing. Adv Chronic Kidney Dis. 2010;17(5):e53–62.
Alicic RZ, Patakoti R, Tuttle KR. Direct and indirect effects of obesity on the kidney. Adv Chronic Kidney Dis. 2013;20(2):121–7.
Amann K, Benz K. Structural renal changes in obesity and diabetes. Semin Nephrol. 2013;33(1):23–33.
Dvorchik BH, Damphousse D. The pharmacokinetics of daptomycin in moderately obese, morbidly obese, and matched nonobese subjects. J Clin Pharmacol. 2005;45(1):48–56.
Velissaris D, Karamouzos V, Marangos M, Pierrakos C, Karanikolas M. Pharmacokinetic changes and dosing modification of aminoglycosides in critically ill obese patients: a literature review. J Clin Med Res. 2014;6(4):227–33.
Giuliano C, Haase KK, Hall R. Use of vancomycin pharmacokinetic–pharmacodynamic properties in the treatment of MRSA infections. Expert Rev Anti-infective Ther. 2010;8(1):95–106.
Panidis D, Markantonis SL, Boutzouka E, Karatzas S, Baltopoulos G. Penetration of gentamicin into the alveolar lining fluid of critically ill patients with ventilator-associated pneumonia. Chest. 2005;128(2):545–52.
Chen SY, Liao CH, Wang JL, Chiang WC, Lai MS, Chie WC, et al. Method-specific performance of vancomycin MIC susceptibility tests in predicting mortality of patients with methicillin-resistant Staphylococcus aureus bacteraemia. J Antimicrob Chemother. 2014;69(1):211–8.
Zaidi STR, Al Omram 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.
Gillespie EL, Kuti JL, Nicolau DP. Pharmacodynamics of antimicrobials: treatment optimisation. Expert Opin Drug Metab Toxicol. 2005;1(3):351–61.
Zelenitsky SA, Ariano RE. Support for higher ciprofloxacin AUC 24/MIC targets in treating Enterobacteriaceae bloodstream infection. J Antimicrob Chemother. 2010;65(8):1725–32.
Wurtz R, Itokazu G, Rodvold K. Antimicrobial dosing in obese patients. Clin Infect Dis. 1997;25(1):112–8.
Payne KD, Hall RG 2nd. Dosing of antibacterial agents in obese adults: does one size fit all? Expert Rev Anti Infect Ther. 2014;12(7):829–54.
Janmahasatian S, Duffull SB, Ash S, Ward LC, Byrne NM, Green B. Quantification of lean bodyweight. Clin Pharmacokinet. 2005;44(10):1051–65.
Denetclaw TH, Yu MK, Moua M, Dowling TC, Steinke D. Performance of a divided-load intravenous vancomycin dosing strategy for obese patients. Ann Pharmacother. 2015;49(8):861–8.
Reynolds DC, Waite LH, Alexander DP, DeRyke CA. Performance of a vancomycin dosage regimen developed for obese patients. Am J Health Syst Pharm. 2012;69(11):944–50.
Cohen LG, DiBiasio A, Lisco SJ, Hurford WE. Fluconazole serum concentrations and pharmacokinetics in an obese patient. Pharmacotherapy. 1997;17(5):1023–6.
Levey AS, Greene T, Schluchter MD, Cleary PA, Teschan PE, Lorenz RA, et al. Glomerular filtration rate measurements in clinical trials. Modification of Diet in Renal Disease Study Group and the Diabetes Control and Complications Trial Research Group. J Am Soc Nephrol. 1993;4(5):1159–71.
Demirovic JA, Pai AB, Pai MP. Estimation of creatinine clearance in morbidly obese patients. Am J Health Syst Pharm. 2009;66(7):642–8.
Salazar DE, Corcoran GB. Predicting creatinine clearance and renal drug clearance in obese patients from estimated fat-free body mass. Am J Med. 1988;84(6):1053–60.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2016 Springer International Publishing Switzerland
About this chapter
Cite this chapter
Zaidi, S.T.R. (2016). Introduction. In: Zaidi, S., Roberts, J. (eds) Drug Dosing in Obesity. Springer, Cham. https://doi.org/10.1007/978-3-319-44034-7_1
Download citation
DOI: https://doi.org/10.1007/978-3-319-44034-7_1
Published:
Publisher Name: Springer, Cham
Print ISBN: 978-3-319-44032-3
Online ISBN: 978-3-319-44034-7
eBook Packages: MedicineMedicine (R0)