In this narrative review, we critically review literature on dosing, PK, and possible dosing strategies in obese adults. For a review of antifungal dosing in obesity, interested readers should refer to a review referenced at the end of this article.We searched PubMed, Scopus, and the Cochrane Library to identify articles in the English‐language literature from 1966 through May 2017, using subject headings containing We screened 2336 articles including 121 articles, drug databases, and package inserts to develop dosing recommendations for 35 antimicrobials (Tables Consider an initial maximum daily dose of 4.5 g (including load)Among the penicillins, the PK of piperacillin/tazobactam has been the most extensively studied in obese patients with critical illness.
Distribution into tissues is influenced by a drug's physiochemical characteristics and determined by drug delivery from blood to tissues, ability to cross tissue membranes (e.g., permeability, drug molecular size, degree of ionization, lipid solubility), binding within blood and tissues (e.g., protein binding), and partitioning into fat.In obese patients, increases in Vd are generally observed as a result of increased adipose and lean muscle mass.Factors other than lipophilicity and Vd affect dosing in obesity (Figure Renal drug dosing is commonly based on the Cockcroft‐Gault equation (using IBW), a surrogate of glomerular filtration rate (GFR).In this narrative review, current data are reviewed, and their implications for antibacterial use in obese individuals including those with critical illness is discussed. ® community-education program, and is funded by the Health Ministries of the provinces of Alberta and British Columbia. On average, kidney function changed by 30 mL/min over the course of an AKI episode. The Modified Jelliffe equation is significantly better at estimating kidney function than the Cockcroft-Gault equation in the setting of AKI. The discordance rate for antimicrobial dosing ranged from a minimum of 8.6% to a maximum of 16.4%. Prolonged infusions of meropenem or doripenem may be considered for less susceptible pathogens, to target higher PD parameters, or in critically ill patients prone to fluctuating renal function and variable serum levels.
Because Vd/kgThe PKs of levofloxacin appear unaltered by obesity, although Cl and AUC results varied widely in a small study of 15 ambulatory and hospitalized obese patients.Doses exceeding 1000 mg/day have been rarely reported in the clinical setting.
Jul 20 2020 Sanford_Antibiotic_Guide 1/5 PDF Drive - Search and download PDF files for free. In the event of discordance, the dose administered was supra-therapeutic 100% of the time using the Modified Jelliffe equation. The objective of this study is to assess the degree of antimicrobial dosing discordance using different glomerular filtration rate (GFR) estimating equations. Adipose tissue penetration of cefoxitin in obese patients undergoing abdominal and pelvic surgery was only 22% that of nonobese patients, despite doubling the dose in the obese group, and did not correspond to a proportional increase in plasma exposure, described as area under the curve (AUC), These data are consistent with national guideline recommendations to use increased doses of cephalosporins based on body weight for surgical prophylaxis and also have potential implications for their therapeutic use. © 2020 American College of Clinical Pharmacy In the last 10 years, additional antimicrobial PK/PD and clinical data encompassing prolonged infusion strategies and examination of critically ill populations have emerged to inform antimicrobial dosing in obesity. Academic Medical Center; National/Policy Context. Pooled analyses of phase III studies showed a numerical, but nonsignificant, decrease in clinical response rates with increasing BMIs.Oxazolidinones do not appear to require dose adjustments in obesity. You can message your clinic, view lab results, schedule an appointment, and pay your bill.Acute kidney injury (AKI) can potentially lead to the accumulation of antimicrobial drugs with significant renal clearance.
and you may need to create a new Wiley Online Library account.Enter your email address below and we will send you your usernameIf the address matches an existing account you will receive an email with instructions to retrieve your username We searched PubMed, Scopus, and the Cochrane Library using Medical Subject Headings including The obesity epidemic has innumerable health consequences for individuals including an increased risk of several types of infection.Obesity is most often classified using body mass index (BMI) (Table The volume of distribution (Vd) relates the total amount of drug in the body to plasma concentration and is the principal determinant of a loading dose.
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