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Updated: Jul 13, 2026

Fecal Microbiota Transplantation via Colonoscopy for Recurrent C. difficile Infection
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Vancomycin dosing in morbidly obese patients

L A Bauer1, D J Black, J S Lill

  • 1Department of Pharmacy, School of Pharmacy, University of Washington, Seattle 98195-7630, USA. labauer@u.washington.edu

European Journal of Clinical Pharmacology
|December 22, 1998
PubMed
Summary

Vancomycin dosing in morbidly obese patients requires similar total daily doses as normal weight individuals when using total body weight. However, shorter dosing intervals may be necessary to maintain therapeutic vancomycin trough concentrations.

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Area of Science:

  • Pharmacology
  • Clinical Pharmacy
  • Obesity Medicine

Background:

  • Morbid obesity significantly alters drug pharmacokinetics, impacting dosing strategies for critical antibiotics like vancomycin.
  • Establishing optimal vancomycin dosing is crucial for achieving therapeutic efficacy and minimizing resistance in diverse patient populations.

Purpose of the Study:

  • To determine vancomycin hydrochloride dosing requirements in morbidly obese patients with normal renal function.
  • To compare these requirements with those of a normal weight population to achieve target steady-state concentrations.

Main Methods:

  • Calculated vancomycin dosing for morbidly obese patients based on total body weight (TBW) and ideal body weight (IBW).
  • Compared dosing regimens and pharmacokinetic parameters (t1/2, V, CL) between morbidly obese and normal weight individuals.
  • Assessed the correlation between TBW and pharmacokinetic parameters.

Main Results:

  • Morbidly obese patients required 31.2 mg/kg/day TBW or 81.9 mg/kg/day IBW, while normal weight patients needed 27.8 mg/kg/day.
  • Obese patients exhibited shorter half-lives (3.3h vs 7.2h) and higher clearance (197ml/min vs 77ml/min).
  • 20 of 24 obese patients required q8h dosing, compared to q12h for normal weight patients.

Conclusions:

  • Vancomycin doses are similar in morbidly obese and normal weight patients when using TBW for dosing.
  • Shorter dosing intervals (q8h) may be needed for morbidly obese patients to maintain adequate trough concentrations.
  • Therapeutic drug monitoring of vancomycin serum concentrations is recommended for morbidly obese patients due to dose variability.