Comprehensive Guidance for Antibiotic Dosing in Obese Adults

Area of Science:

• Pharmacology
• Clinical Pharmacy
• Infectious Diseases

Background:

• Obesity significantly impacts antibiotic pharmacokinetics (PK) and pharmacodynamics (PD), often leading to suboptimal dosing in this growing patient population.
• Existing clinical and PK data are limited, often retrospective, and present heterogeneous or contradictory findings.
• Recent advancements include data on prolonged infusion strategies and critically ill obese patients, necessitating updated dosing guidelines.

Purpose of the Study:

• To critically review existing literature on antibiotic dosing, PK, and PD in obese adults.
• To develop evidence-based dosing recommendations for antimicrobials in obese individuals, considering both critically ill and non-critically ill patients.
• To identify knowledge gaps and suggest future research directions for optimizing antimicrobial therapy in obesity.

Main Methods:

• A comprehensive literature search was conducted using PubMed, Scopus, and Cochrane Library with relevant keywords (anti-infectives, obese, pharmacokinetics).
• Articles were reviewed, cross-referenced, and supplemented with drug databases and package inserts.
• Dosing recommendations were developed for 34 antimicrobials based on 121 selected articles from 2336 identified studies.

Main Results:

• Obesity-specific dosing guidance was established for 23 out of 34 reviewed antimicrobials; 11 required no dose adjustment.
• The review highlights discrepancies in published PK data, underscoring the need for further investigation.
• Alternative dosing strategies, like extended infusions for time-dependent antibiotics (e.g., beta-lactams), are recommended for obese patients.

Conclusions:

• Updated dosing recommendations for 23 antimicrobials are provided for obese adults, addressing critical and non-critical care scenarios.
• Further research is essential to resolve conflicting PK data and establish definitive optimal dosing strategies for antibiotics in obesity.
• Therapeutic drug monitoring is increasingly important for ensuring optimized antimicrobial dosing in obese and other patient populations.