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Review
. 2014 Apr;27(2):165-73.
doi: 10.1097/QCO.0000000000000045.

Antibiotic therapy of pneumonia in the obese patient: dosing and delivery

Hasan M Al-Dorzi  1 , Shmylan A Al Harbi, Yaseen M Arabi
Affiliations
Free PMC article
Review

Antibiotic therapy of pneumonia in the obese patient: dosing and delivery

Hasan M Al-Dorzi et al. Curr Opin Infect Dis. 2014 Apr.
Free PMC article

Abstract

Purpose of review: Obesity has been shown to be associated with antibiotic underdosing and treatment failure. This article reviews the recent literature on antibiotic dosing in obese patients with pneumonia.

Recent findings: Obesity is associated with several alterations in antibiotic pharmacokinetics and pharmacodynamics, including increases in the antibiotic volume of distribution and clearance. These alterations necessitate changes in the dosing of certain antibiotics. However, data on antibiotic dosing for pneumonia in obese patients are limited and come mainly from observational studies. Additionally, dosing recommendations are often extrapolated from healthy obese volunteers and from the studies of antibiotics given for other indications.

Summary: Recognizing obesity-related pharmacokinetic and pharmacodynamic alterations is important in treating obese patients with pneumonia. Studies that evaluate such alterations and assess the impact of antibiotic dosing and delivery on the clinical outcomes of this patient population are needed.

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Figures

Box 1
Box 1
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FIGURE 1
FIGURE 1
Mechanisms by which obesity alters antibiotic pharmacokinetics and pharmacodynamics.
FIGURE 2
FIGURE 2
Pharmacokinetic and pharmacodynamic parameters. AUC, area under the curve; AUC/MIC, ratio of AUC to MIC (time and concentration-dependent antibiotics); Cmax, peak antibiotic concentration; Cmax/MIC, ratio of peak concentration to MIC (concentration-dependent antibiotics); MIC, minimum inhibitory concentration for a pathogen; T > MIC, percentage of time that the antibiotic concentration remains above MIC (time-dependent antibiotics).
FIGURE 3
FIGURE 3
Effects of obesity on the pharmacokinetics and pharmacodynamics of hydrophilic and lipophilic antibiotics used in pneumonia treatment and general dosing recommendations. aRefer to Table 2 for specific antibiotic recommendation.
See this image and copyright information in PMC

References

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    2. This is a review article on dosing antibiotics in critically ill obese patients.

    1. Udy AA, Roberts JA, Lipman J. Clinical implications of antibiotic pharmacokinetic principles in the critically ill. Intensive Care Med 2013; 39:2070–2082 - PubMed

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