Abstract
Antibiotic dosing in obesity: a BIG challenge.
Highlights
When almost 60 % of the world’s population is predicted to be overweight by 2030 [1], dosing regimens that are developed and tested in non-obese patients will be inappropriate for the future use of drugs
Antibiotic pharmacokinetics are different in the critically ill compared with other patient groups [3]
In patients with sepsis, fluid shifts from the intravascular space to the interstitium lowers the intravascular concentrations of hydrophilic antimicrobials [4]
Summary
When almost 60 % of the world’s population is predicted to be overweight by 2030 [1], dosing regimens that are developed and tested in non-obese patients will be inappropriate for the future use of drugs. Antibiotic pharmacokinetics are different in the critically ill compared with other patient groups [3]. Given a decrease in plasma albumin concentration is seen in approximately 40 % of the critically ill, antimicrobials may further extravasate, increasing Vd. drug clearance may be altered in those with renal impairment (hydrophilic drugs) or hepatic impairment (largely lipophilic drugs).
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