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In the United States, obesity is a prominent concern. It is linked to heightened mortality rates due to increased occurrences of conditions such as hypertension, atherosclerosis, coronary artery disease, and diabetes compared to nonobese individuals. A patient is classified as obese if their actual body weight surpasses the ideal or desirable body weight by 20%, based on Metropolitan Life Insurance Company data. Ideal body weights consider average weights and heights for males and females...
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Elderly individuals encompass a diverse population with varying degrees of age-related physiological changes. Defining the elderly presents challenges, as the geriatric population is often arbitrarily categorized as individuals older than 65. However, many individuals in this group lead active and healthy lives, with an increasing number surpassing 85 years and falling into the older elderly category. Physiological changes associated with aging impact performance capacity and homeostatic...
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Fractal Geometry-Based Decrease in Trimethoprim-Sulfamethoxazole Concentrations in Overweight and Obese People.

R G Hall1, J G Pasipanodya2, C Meek1

  • 1Department of Pharmacy Practice, Texas Tech University Health Sciences Center, School of Pharmacy, Austin, Texas, USA.

CPT: Pharmacometrics & Systems Pharmacology
|November 22, 2016
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Summary
This summary is machine-generated.

Obesity significantly impacts trimethoprim-sulfamethoxazole (TMP-SMX) drug levels, affecting clearance and distribution. New nonlinear dosing strategies are proposed for overweight and obese patients to ensure effective treatment.

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Area of Science:

  • Pharmacology
  • Clinical Pharmacy
  • Obesity Medicine

Background:

  • Trimethoprim-sulfamethoxazole (TMP-SMX) is a globally essential antibiotic recommended by the WHO.
  • Current dosing regimens often assume linear relationships with weight, which may be inaccurate in obese individuals.
  • Obesity is a growing global health concern, necessitating re-evaluation of drug pharmacokinetics.

Purpose of the Study:

  • To investigate the effect of obesity on the pharmacokinetics of trimethoprim-sulfamethoxazole.
  • To develop novel, nonlinear dosing algorithms for TMP-SMX in overweight and obese patient populations.

Main Methods:

  • A prospective clinical study utilizing optimized design strategies.
  • Application of artificial intelligence algorithms to analyze drug concentrations.
  • Evaluation of weight and body mass index (BMI) in relation to drug clearance and volume of distribution.
  • Confirmation of findings using standard regression statistics on peak and area under the concentration-time curves.

Main Results:

  • Weight and BMI demonstrated a significant, nonlinear effect on TMP-SMX clearance and volume of distribution.
  • Fractal geometry-based relationships were identified for these pharmacokinetic parameters.
  • Overweight patients exhibited decreased TMP-SMX peak and area under the concentration-time curves compared to standard expectations.
  • The study identified specific nonlinear relationships applicable to TMP-SMX dosing.

Conclusions:

  • Standard linear dosing of TMP-SMX may be suboptimal in overweight and obese individuals.
  • Nonlinear, fractal geometry-based relationships provide a framework for optimizing TMP-SMX dosing in obesity.
  • The findings enable the development of tailored dosing strategies for over 60 pathogens treated with TMP-SMX in diverse weight categories.