Dosing of antibiotics in obesity

Abstract

Purpose of review: Obesity is becoming a major burden on healthcare systems worldwide. The management of infections is problematic due to both an increased risk of morbidity and mortality, as well as a lack of information about dosing of antibiotics in the obese population. Recommendations in this patient group are severely lacking, so clinicians need to consider pharmacokinetic/pharmacodynamic parameters and the relative risks of overdosing and underdosing.

Recent findings: Since 2011, articles on a number of antibiotics have been published, including cefazolin/cephazolin, cefepime, cefoxitin, clindamycin, cotrimoxazole, daptomycin, ertapenem, levofloxacin, linezolid, meropenem, moxifloxacin, piperacillin/tazobactam and vancomycin.

Summary: Obesity causes a number of changes, including an increase in volume of distribution and changes in hepatic metabolism and renal excretion. Several antibiotics have sufficient data to be able to make recommendations, whereas other antibiotics may need to make use of doses at the upper end of the recommended range, or utilize other dose modifications based on pharmacokinetic/pharmacodynamic parameters, in an attempt to reach adequate levels and achieve similar efficacy.