Access your health information from any device with MyHealth. 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. A multidisciplinary team at Stanford Health Care created a nurse telephone triage protocol to improve guideline-concordant prescription of appropriate antibiotics for uncomplicated cystitis to help prevent antimicrobial resistance. The package insert recommends use of IBW for dosing in obese patients.In a nested case‐control study of patients with BMI of 25 kg/mPolymyxin B is generally dosed using TBW, but caution should be used when applying this to obese patients given that PK data in obesity are limited to one case. Considering the Cockcroft-Gault estimate as the criterion standard, antimicrobials were appropriately adjusted at most 80.7% of the time. A case series of long‐term high‐dose daptomycin (mean dose 8 mg/kgObese patients when dosed by TBW experience higher daptomycin exposure compared with their nonobese counterparts.The package insert for telavancin recommends dosing 10 mg/kgA population PK analysis of dalbavancin that included patients up to 320 kg and BSA 4.0 mThe PK profile of oritavancin was studied in patients up to 178 kg and a BMI of 67.4 kg/mA maximum telavancin dose of 1000 mg may be considered in obese patients. Grand Round/A Case Study, Drug Discovery and Evaluation: Methods in Clinical Pharmacology, Population pharmacokinetics and dosing simulations of amoxicillin in obese adults receiving co-amoxiclav, Linezolid Concentrations in Plasma and Subcutaneous Tissue are Reduced in Obese Patients, Resulting in a Higher Risk of Underdosing in Critically Ill Patients: A Controlled Clinical Pharmacokinetic Study, Pharmacist-Driven Implementation of Outpatient Antibiotic Prescribing Algorithms Improves Guideline Adherence in the Emergency Department, Dosierung von Antiinfektiva bei intensivpflichtigen Patienten mit akutem Nierenversagen und NierenersatztherapieDosage of anti-infectives in intensive care patients with acute renal failure and renal replacement therapy, Towards precision medicine: Therapeutic drug monitoring–guided dosing of vancomycin and β-lactam antibiotics to maximize effectiveness and minimize toxicity, Influence of Body Weight Category on Outcomes in Candidemia Patients Treated With Anidulafungin, Antiinfektive Therapie bei Adipositas – „einfach das Doppelte?“Anti-infective treatment in obesity—“just double it?”, Vancomycin therapeutic drug monitoring in paediatrics, This is a retrospective evaluation of antimicrobial dosing using different estimating equations for kidney function in AKI and comparison to Cockcroft-Gault estimation as a reference.
Department of Pharmacy, Stanford Health Care, Stanford, CaliforniaStanford Antimicrobial Safety and Sustainability Program, Stanford Health Care, Stanford, CaliforniaDepartment of Pharmacy, Stanford Health Care, Stanford, CaliforniaStanford Antimicrobial Safety and Sustainability Program, Stanford Health Care, Stanford, CaliforniaStanford Antimicrobial Safety and Sustainability Program, Stanford Health Care, Stanford, CaliforniaDivision of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CaliforniaStanford Antimicrobial Safety and Sustainability Program, Stanford Health Care, Stanford, CaliforniaDivision of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CaliforniaDepartment of Pharmacy, Stanford Health Care, Stanford, CaliforniaStanford Antimicrobial Safety and Sustainability Program, Stanford Health Care, Stanford, CaliforniaDepartment of Pharmacy, Stanford Health Care, Stanford, CaliforniaStanford Antimicrobial Safety and Sustainability Program, Stanford Health Care, Stanford, CaliforniaStanford Antimicrobial Safety and Sustainability Program, Stanford Health Care, Stanford, CaliforniaDivision of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CaliforniaStanford Antimicrobial Safety and Sustainability Program, Stanford Health Care, Stanford, CaliforniaDivision of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, CaliforniaUse the link below to share a full-text version of this article with your friends and colleagues.