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Dosing of antibiotics in obesity

Janson, Bretta; Thursky, Karinb,c

Current Opinion in Infectious Diseases: December 2012 - Volume 25 - Issue 6 - p 634–649
doi: 10.1097/QCO.0b013e328359a4c1
ANTIMICROBIAL AGENTS: Edited by Monica A. Slavin, Simon L. Croft and Deenan Pillay

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.

aPharmacy Department

bDepartment of Infectious Diseases, Peter MacCallum Cancer Centre, East Melbourne, Victoria

cVictorian Infectious Diseases Service, Royal Melbourne Hospital, Parkville, Melbourne, Australia

Correspondence to Brett Janson, Pharmacy Department, Peter MacCallum Cancer Centre, Locked Bag 1, A’Beckett Street, East Melbourne, VIC 8006, Australia. E-mail:

© 2012 Lippincott Williams & Wilkins, Inc.