Skip to main content
Erschienen in: Clinical Pharmacokinetics 5/2000

01.05.2000 | Review Article

Dosage Adjustments for Antibacterials in Obese Patients

Applying Clinical Pharmacokinetics

verfasst von: David T. Bearden, Dr Keith A. Rodvold

Erschienen in: Clinical Pharmacokinetics | Ausgabe 5/2000

Einloggen, um Zugang zu erhalten

Abstract

Obesity is associated with physiological changes that can alter the pharmacokinetic parameters of many drugs. Vancomycin and the aminoglycosides are the only antibacterials that have been extensively investigated in the obese population. The apparent volume of distribution (Vd) and total body clearance of vancomycin are increased in obese patients and have a better correlation with total bodyweight (TBW) than with ideal bodyweight (IBW). The Vd of aminoglycosides is increased in obesity and can be estimated from an adjusted body-weight that accounts for a fraction of the excess bodyweight (TBW — IBW). These observed changes in pharmacokinetic parameters of vancomycin and aminoglycosides in obese patients may necessitate a deviation from the commonly recommended dosages administered to non-obese individuals.
There are limited data regarding the pharmacokinetics of other antibacterial classes in obese patients. The available information for Cephalosporins suggests that dosages may need to be increased in obese patients in order to obtain similar serum and tissue concentrations as in non-obese patients. Additional pharmacokinetic studies of other antibacterial classes are required in this special patient population.
Literatur
1.
Zurück zum Zitat Blouin RA, Warren GW. Pharmacokinetic considerations in obesity. J Pharm Sci. 1999; 88: 1–7.PubMedCrossRef Blouin RA, Warren GW. Pharmacokinetic considerations in obesity. J Pharm Sci. 1999; 88: 1–7.PubMedCrossRef
2.
Zurück zum Zitat Kotlyar M, Carson SW. Effects of obesity on the cytochrome P450 enzyme system. Int J Clin Pharmacol Ther. 1999; 37: 8–19.PubMed Kotlyar M, Carson SW. Effects of obesity on the cytochrome P450 enzyme system. Int J Clin Pharmacol Ther. 1999; 37: 8–19.PubMed
3.
Zurück zum Zitat Wurtz R, Itokazu G, Rodvold K. Antimicrobial dosing in obese patients. Clin Infect Dis. 1997; 25: 112–8.PubMedCrossRef Wurtz R, Itokazu G, Rodvold K. Antimicrobial dosing in obese patients. Clin Infect Dis. 1997; 25: 112–8.PubMedCrossRef
4.
Zurück zum Zitat Devine BJ. Gentamicin therapy. Drug Intell Clin Pharm. 1974; 8: 650–5. Devine BJ. Gentamicin therapy. Drug Intell Clin Pharm. 1974; 8: 650–5.
5.
Zurück zum Zitat Clinical guidelines on the identification, Evaluation, and treatment of overweight and obesity in adults — the evidence report. National Institutes of Health. Obes Res 1998; 6 Suppl.: 51S–209S. Clinical guidelines on the identification, Evaluation, and treatment of overweight and obesity in adults — the evidence report. National Institutes of Health. Obes Res 1998; 6 Suppl.: 51S–209S.
6.
Zurück zum Zitat Craig WA. Pharmacokinetic/pharmacodynamic parameters: rationale for antimicrobial dosing of mice and men. Clin Infect Dis. 1998; 26: 1–12.PubMedCrossRef Craig WA. Pharmacokinetic/pharmacodynamic parameters: rationale for antimicrobial dosing of mice and men. Clin Infect Dis. 1998; 26: 1–12.PubMedCrossRef
7.
Zurück zum Zitat Forrest A, Nix DE, Ballow CH, et al. Pharmacodynamics of intravenous Ciprofloxacin in seriously ill patients. Antimicrob Agents Chemother. 1993; 37: 1073–81.PubMedCrossRef Forrest A, Nix DE, Ballow CH, et al. Pharmacodynamics of intravenous Ciprofloxacin in seriously ill patients. Antimicrob Agents Chemother. 1993; 37: 1073–81.PubMedCrossRef
8.
Zurück zum Zitat Preston SL, Drusano GL, Berman AL, et al. Pharmacokinetics of levofloxacin: a new paradigm for early clinical trials. JAMA. 1998; 279: 125–9.PubMedCrossRef Preston SL, Drusano GL, Berman AL, et al. Pharmacokinetics of levofloxacin: a new paradigm for early clinical trials. JAMA. 1998; 279: 125–9.PubMedCrossRef
9.
Zurück zum Zitat Wada DR, Drover DR, Lemmens HJ. Determination of the distribution volume that can be used to calculate the intravenous loading dose. Clin Pharmacokinet. 1998; 35: 1–7.PubMedCrossRef Wada DR, Drover DR, Lemmens HJ. Determination of the distribution volume that can be used to calculate the intravenous loading dose. Clin Pharmacokinet. 1998; 35: 1–7.PubMedCrossRef
10.
Zurück zum Zitat Ritschel WA, Kaul S. Prediction of apparent volume of distribution in obesity. Methods Find Exp Clin Pharmacol. 1986; 8: 239–47.PubMed Ritschel WA, Kaul S. Prediction of apparent volume of distribution in obesity. Methods Find Exp Clin Pharmacol. 1986; 8: 239–47.PubMed
11.
12.
Zurück zum Zitat Morgan DJ, Bray KM. Lean body mass as a predictor of drug dosage. Implications for drug therapy. Clin Pharmacokinet. 1994; 26: 292–307. Morgan DJ, Bray KM. Lean body mass as a predictor of drug dosage. Implications for drug therapy. Clin Pharmacokinet. 1994; 26: 292–307.
13.
Zurück zum Zitat Hallynck TH, Soep HH, Thomis JA, et al. Should clearance be normalised to body surface or to lean body mass. Br J Clin Pharmacol. 1981; 11: 523–6.PubMedCrossRef Hallynck TH, Soep HH, Thomis JA, et al. Should clearance be normalised to body surface or to lean body mass. Br J Clin Pharmacol. 1981; 11: 523–6.PubMedCrossRef
14.
Zurück zum Zitat Anderson PO, Lane JR. Lean body mass and volume of distribution [letter]. Am J Hosp Pharm. 1984; 4: 658. Anderson PO, Lane JR. Lean body mass and volume of distribution [letter]. Am J Hosp Pharm. 1984; 4: 658.
15.
Zurück zum Zitat Cockcroft DW, Gault MH. Prediction of Creatinine clearance from serum Creatinine. Nephron. 1976; 16: 31–41.PubMedCrossRef Cockcroft DW, Gault MH. Prediction of Creatinine clearance from serum Creatinine. Nephron. 1976; 16: 31–41.PubMedCrossRef
16.
Zurück zum Zitat Jelliffe RW. Estimation of Creatinine clearance when urine cannot be collected. Lancet 1971; I: 975–6.CrossRef Jelliffe RW. Estimation of Creatinine clearance when urine cannot be collected. Lancet 1971; I: 975–6.CrossRef
17.
Zurück zum Zitat Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum Creatinine: a new prediction equation. Ann Intern Med. 1999; 130: 461–70.PubMed Levey AS, Bosch JP, Lewis JB, et al. A more accurate method to estimate glomerular filtration rate from serum Creatinine: a new prediction equation. Ann Intern Med. 1999; 130: 461–70.PubMed
18.
Zurück zum Zitat Dionne RE, Bauer LA, Gibson GA, et al. Estimating Creatinine clearance in morbidity obese patients. Am J Hosp Pharm. 1981; 38: 841–4.PubMed Dionne RE, Bauer LA, Gibson GA, et al. Estimating Creatinine clearance in morbidity obese patients. Am J Hosp Pharm. 1981; 38: 841–4.PubMed
19.
Zurück zum Zitat Snider RD, Kruse JA, Bander JJ, et al. Accuracy of estimated Creatinine clearance in obese patients with stable renal function in the intensive care unit. Pharmacotherapy. 1995; 15: 747–53.PubMed Snider RD, Kruse JA, Bander JJ, et al. Accuracy of estimated Creatinine clearance in obese patients with stable renal function in the intensive care unit. Pharmacotherapy. 1995; 15: 747–53.PubMed
20.
Zurück zum Zitat Winter ME. BasicClinical Pharmacokinetics. 3rd ed. Vancouver (WA): Applied Therapeutics, Inc., 1994. Winter ME. BasicClinical Pharmacokinetics. 3rd ed. Vancouver (WA): Applied Therapeutics, Inc., 1994.
21.
Zurück zum Zitat Sawyer WT, Canaday BR, Poe TE, et al. Variables affecting Creatinine clearance prediction. Am J Hosp Pharm. 1983; 40: 2175–80.PubMed Sawyer WT, Canaday BR, Poe TE, et al. Variables affecting Creatinine clearance prediction. Am J Hosp Pharm. 1983; 40: 2175–80.PubMed
22.
Zurück zum Zitat Bauer LA, Edwards WA, Dellinger EP, et al. Influence of weight on aminoglycoside pharmacokinetics in normal weight and morbidly obese patients. Eur J Clin Pharmacol. 1983; 24: 643–7.PubMedCrossRef Bauer LA, Edwards WA, Dellinger EP, et al. Influence of weight on aminoglycoside pharmacokinetics in normal weight and morbidly obese patients. Eur J Clin Pharmacol. 1983; 24: 643–7.PubMedCrossRef
23.
Zurück zum Zitat Leader WG, Tsubaki T, Chandler MH. Creatinine-clearance estimates for predicting gentamicin pharmacokinetic values in obese patients. Am J Hosp Pharm. 1994; 51: 2125–30.PubMed Leader WG, Tsubaki T, Chandler MH. Creatinine-clearance estimates for predicting gentamicin pharmacokinetic values in obese patients. Am J Hosp Pharm. 1994; 51: 2125–30.PubMed
24.
Zurück zum Zitat Salazar DE, Corcoran GB. Predicting Creatinine clearance and renal drug clearance in obese patients from estimated fat-free body mass. Am J Med. 1988; 84: 1053–60.PubMedCrossRef Salazar DE, Corcoran GB. Predicting Creatinine clearance and renal drug clearance in obese patients from estimated fat-free body mass. Am J Med. 1988; 84: 1053–60.PubMedCrossRef
25.
Zurück zum Zitat Spinler SA, Nawarskas JJ, Boyce EG, et al. Predictive performance of ten equations for estimating Creatinine clearance in cardiac patients. Iohexol Cooperative Study Group. Ann Pharmacother. 1998; 32: 1275–83. Spinler SA, Nawarskas JJ, Boyce EG, et al. Predictive performance of ten equations for estimating Creatinine clearance in cardiac patients. Iohexol Cooperative Study Group. Ann Pharmacother. 1998; 32: 1275–83.
26.
Zurück zum Zitat Lake KD, Peterson CD. A simplified dosing method for initiating vancomycin therapy. Pharmacotherapy. 1985; 5: 340–4.PubMed Lake KD, Peterson CD. A simplified dosing method for initiating vancomycin therapy. Pharmacotherapy. 1985; 5: 340–4.PubMed
27.
Zurück zum Zitat DuBois D, DuBois ER. Measurement of the surface area of man. Arch Intern Med. 1915; 15: 868–81.CrossRef DuBois D, DuBois ER. Measurement of the surface area of man. Arch Intern Med. 1915; 15: 868–81.CrossRef
28.
Zurück zum Zitat Penzak SR, Gubbins PO, Rodvold KA, et al. Therapeutic drug monitoring of vancomycin in a morbidly obese patient. Ther Drug Monit. 1998; 20: 261–5.PubMedCrossRef Penzak SR, Gubbins PO, Rodvold KA, et al. Therapeutic drug monitoring of vancomycin in a morbidly obese patient. Ther Drug Monit. 1998; 20: 261–5.PubMedCrossRef
29.
Zurück zum Zitat Rodvold KA, Zokufa H, Rotschafer JC. Routine monitoring of serum vancomycin concentrations: can waiting be justified. Clin Pharm. 1987; 6: 655–8.PubMed Rodvold KA, Zokufa H, Rotschafer JC. Routine monitoring of serum vancomycin concentrations: can waiting be justified. Clin Pharm. 1987; 6: 655–8.PubMed
30.
Zurück zum Zitat Moellering RC. Monitoring serum vancomycin levels: climbing the mountain because it is there. Clin Infect Dis. 1994; 18: 544–6.PubMedCrossRef Moellering RC. Monitoring serum vancomycin levels: climbing the mountain because it is there. Clin Infect Dis. 1994; 18: 544–6.PubMedCrossRef
31.
Zurück zum Zitat Cantu TG, Yamanaka-Yuen NA, Lietman PS. Serum vancomycin concentrations: reappraisal of their clinical value. Clin Infect Dis. 1994; 18: 533–43.PubMedCrossRef Cantu TG, Yamanaka-Yuen NA, Lietman PS. Serum vancomycin concentrations: reappraisal of their clinical value. Clin Infect Dis. 1994; 18: 533–43.PubMedCrossRef
32.
Zurück zum Zitat Rodvold KA, Everett JA, Pryka RD, et al. Pharmacokinetics and administration regimens of vancomycin in neonates, infants and children. Clin Pharmacokinet. 1997; 33: 32–51.PubMedCrossRef Rodvold KA, Everett JA, Pryka RD, et al. Pharmacokinetics and administration regimens of vancomycin in neonates, infants and children. Clin Pharmacokinet. 1997; 33: 32–51.PubMedCrossRef
33.
Zurück zum Zitat Moellering RC, Krogstad DJ, Greenblatt DJ. Vancomycin therapy in patients with impaired renal function: a nomogram for dosage. Ann Intern Med. 1981; 94: 343–6.PubMed Moellering RC, Krogstad DJ, Greenblatt DJ. Vancomycin therapy in patients with impaired renal function: a nomogram for dosage. Ann Intern Med. 1981; 94: 343–6.PubMed
34.
Zurück zum Zitat Matzke GR, McGory RW, Halstenson CE, et al. Pharmacokinetics of vancomycin in patients with various degrees of renal function. Antimicrob Agents Chemother. 1984; 25: 433–7.PubMedCrossRef Matzke GR, McGory RW, Halstenson CE, et al. Pharmacokinetics of vancomycin in patients with various degrees of renal function. Antimicrob Agents Chemother. 1984; 25: 433–7.PubMedCrossRef
35.
Zurück zum Zitat Rodvold KA, Blum RA, Fischer JH, et al. Vancomycin pharmacokinetics in patients with various degrees of renal function. Antimicrob Agents Chemother. 1988; 32: 848–52.PubMedCrossRef Rodvold KA, Blum RA, Fischer JH, et al. Vancomycin pharmacokinetics in patients with various degrees of renal function. Antimicrob Agents Chemother. 1988; 32: 848–52.PubMedCrossRef
36.
Zurück zum Zitat Vance-Bryan K, Guay DR, Gilliland SS, et al. Effect of obesity on vancomycin pharmacokinetic parameters as determined by using a Bayesian forecasting technique. Antimicrob Agents Chemother. 1993; 37: 436–40.PubMedCrossRef Vance-Bryan K, Guay DR, Gilliland SS, et al. Effect of obesity on vancomycin pharmacokinetic parameters as determined by using a Bayesian forecasting technique. Antimicrob Agents Chemother. 1993; 37: 436–40.PubMedCrossRef
37.
Zurück zum Zitat Ducharme MP, Slaughter RL, Edwards DJ. Vancomycin pharmacokinetics in a patient population: effect of age, gender, and body weight. Ther Drug Monit. 1994; 16: 513–8.PubMedCrossRef Ducharme MP, Slaughter RL, Edwards DJ. Vancomycin pharmacokinetics in a patient population: effect of age, gender, and body weight. Ther Drug Monit. 1994; 16: 513–8.PubMedCrossRef
38.
Zurück zum Zitat Bauer LA, Black DJ, Lill JS. Vancomycin dosing in morbidly obese patients. Eur J Clin Pharmacol. 1998; 54: 621–5.PubMedCrossRef Bauer LA, Black DJ, Lill JS. Vancomycin dosing in morbidly obese patients. Eur J Clin Pharmacol. 1998; 54: 621–5.PubMedCrossRef
39.
Zurück zum Zitat Blouin RA, Bauer LA, Miller DD, et al. Vancomycin pharmacokinetics in normal and morbidly obese subjects. Antimicrob Agents Chemother. 1982; 21: 575–80.PubMedCrossRef Blouin RA, Bauer LA, Miller DD, et al. Vancomycin pharmacokinetics in normal and morbidly obese subjects. Antimicrob Agents Chemother. 1982; 21: 575–80.PubMedCrossRef
40.
Zurück zum Zitat Moore RD, Smith CR, Lietman PS. Association of aminoglycoside plasma levels with therapeutic outcome in gram-negative pneumonia. Am J Med. 1984; 77: 657–62.PubMedCrossRef Moore RD, Smith CR, Lietman PS. Association of aminoglycoside plasma levels with therapeutic outcome in gram-negative pneumonia. Am J Med. 1984; 77: 657–62.PubMedCrossRef
41.
Zurück zum Zitat Moore RD, Lietman PS, Smith CR. Clinical response to aminoglycoside therapy: importance of the ratio of peak concentration to minimal inhibitory concentration. J Infect Dis. 1987; 155: 93–9.PubMedCrossRef Moore RD, Lietman PS, Smith CR. Clinical response to aminoglycoside therapy: importance of the ratio of peak concentration to minimal inhibitory concentration. J Infect Dis. 1987; 155: 93–9.PubMedCrossRef
42.
Zurück zum Zitat Deziel-Evans LM, Murphy JE, Job ML. Correlation of pharmacokinetic indices with therapeutic outcome in patients receiving aminoglycosides. Clin Pharm. 1986; 5: 319–24.PubMed Deziel-Evans LM, Murphy JE, Job ML. Correlation of pharmacokinetic indices with therapeutic outcome in patients receiving aminoglycosides. Clin Pharm. 1986; 5: 319–24.PubMed
43.
Zurück zum Zitat Rodvold KA, Danziger LH, Quinn JP. Single daily doses of aminoglycosides [letter]. Lancet. 1997; 350: 1412.PubMedCrossRef Rodvold KA, Danziger LH, Quinn JP. Single daily doses of aminoglycosides [letter]. Lancet. 1997; 350: 1412.PubMedCrossRef
44.
Zurück zum Zitat Kashuba AD, Bertino Jr JS, Nafziger AN. Dosing of aminoglycosides to rapidly attain pharmacodynamic goals and hasten therapeutic response by using individualized pharmacokinetic monitoring of patients with pneumonia caused by gram-negative organisms. Antimicrob Agents Chemother. 1998; 42: 1842–4.PubMed Kashuba AD, Bertino Jr JS, Nafziger AN. Dosing of aminoglycosides to rapidly attain pharmacodynamic goals and hasten therapeutic response by using individualized pharmacokinetic monitoring of patients with pneumonia caused by gram-negative organisms. Antimicrob Agents Chemother. 1998; 42: 1842–4.PubMed
45.
Zurück zum Zitat Kashuba AD, Nafziger AN, Drusano GL, et al. Optimizing aminoglycoside therapy for nosocomial pneumonia caused by gram-negative bacteria. Antimicrob Agents Chemother 1989; 43: 623–9. Kashuba AD, Nafziger AN, Drusano GL, et al. Optimizing aminoglycoside therapy for nosocomial pneumonia caused by gram-negative bacteria. Antimicrob Agents Chemother 1989; 43: 623–9.
46.
Zurück zum Zitat Corcoran GB, Salazar DE. Obesity as a risk factor in drug-induced organ injury. IV. Increased gentamicin nephrotoxicity in the obese overfed rat. J Pharmacol Exp Ther. 1989; 248: 17–22. Corcoran GB, Salazar DE. Obesity as a risk factor in drug-induced organ injury. IV. Increased gentamicin nephrotoxicity in the obese overfed rat. J Pharmacol Exp Ther. 1989; 248: 17–22.
47.
Zurück zum Zitat Corcoran GB, Salazar DE, Shentag JJ. Excessive aminoglycoside nephrotoxicity in obese patients [letter]. Am J Med. 1988; 85: 279.PubMedCrossRef Corcoran GB, Salazar DE, Shentag JJ. Excessive aminoglycoside nephrotoxicity in obese patients [letter]. Am J Med. 1988; 85: 279.PubMedCrossRef
48.
Zurück zum Zitat Salazar DE, Shentag JJ, Corcoran GB. Obesity as a risk factor in drug-induced organ injury. V Toxicokinetics of gentamicin in the obese overfed rat. Drug Metab Dispos. 1992; 20: 402–6. Salazar DE, Shentag JJ, Corcoran GB. Obesity as a risk factor in drug-induced organ injury. V Toxicokinetics of gentamicin in the obese overfed rat. Drug Metab Dispos. 1992; 20: 402–6.
49.
Zurück zum Zitat Schwartz SN, Pazin GJ, Lyon JA, et al. A controlled investigation of the pharmacokinetics of gentamicin and tobramycin in obese subjects. J Infect Dis. 1978; 138: 499–505.PubMedCrossRef Schwartz SN, Pazin GJ, Lyon JA, et al. A controlled investigation of the pharmacokinetics of gentamicin and tobramycin in obese subjects. J Infect Dis. 1978; 138: 499–505.PubMedCrossRef
50.
Zurück zum Zitat Blouin RA, Mann HJ, Griffen WO, et al. Tobramycin pharmacokinetics in morbidly obese patients. Clin Pharmacol Ther. 1979; 26: 508–12.PubMed Blouin RA, Mann HJ, Griffen WO, et al. Tobramycin pharmacokinetics in morbidly obese patients. Clin Pharmacol Ther. 1979; 26: 508–12.PubMed
51.
Zurück zum Zitat Bauer LA, Blouin RA, Griffen WO, et al. Amikacin pharmaco-kinetics in morbidly obese patients. Am J Hosp Pharm. 1980; 37: 519–22.PubMed Bauer LA, Blouin RA, Griffen WO, et al. Amikacin pharmaco-kinetics in morbidly obese patients. Am J Hosp Pharm. 1980; 37: 519–22.PubMed
52.
Zurück zum Zitat Korsager S. Administration of gentamicin to obese patients. Int J Clin Pharmacol TherToxicol. 1980; 18: 549–53. Korsager S. Administration of gentamicin to obese patients. Int J Clin Pharmacol TherToxicol. 1980; 18: 549–53.
53.
Zurück zum Zitat Sketris I, Lesar T, Zaske DE, et al. Effect of obesity on gentamicin pharmacokinetics. J Clin Pharmacol. 1981; 2: 288–93. Sketris I, Lesar T, Zaske DE, et al. Effect of obesity on gentamicin pharmacokinetics. J Clin Pharmacol. 1981; 2: 288–93.
54.
Zurück zum Zitat Traynor AM, Nafziger AN, Bertino JS. Aminoglycoside dosing weight correction factors for patients of various body sizes. Antimicrob Agents Chemother. 1995; 39: 545–8.PubMedCrossRef Traynor AM, Nafziger AN, Bertino JS. Aminoglycoside dosing weight correction factors for patients of various body sizes. Antimicrob Agents Chemother. 1995; 39: 545–8.PubMedCrossRef
55.
Zurück zum Zitat Blouin RA, Brouwer KL, Record KE, et al. Amikacin pharmacokinetics in morbidly obese patients undergoing gastric-bypass surgery. Clin Pharm. 1985; 4: 70–2.PubMed Blouin RA, Brouwer KL, Record KE, et al. Amikacin pharmacokinetics in morbidly obese patients undergoing gastric-bypass surgery. Clin Pharm. 1985; 4: 70–2.PubMed
56.
Zurück zum Zitat Chiba K, Tsuchiya M, Kato J, et al. Cefotiam disposition in markedly obese athlete patients, Japanese sumo wrestlers. Antimicrob Agents Chemother. 1989; 33: 1188–92.PubMedCrossRef Chiba K, Tsuchiya M, Kato J, et al. Cefotiam disposition in markedly obese athlete patients, Japanese sumo wrestlers. Antimicrob Agents Chemother. 1989; 33: 1188–92.PubMedCrossRef
57.
Zurück zum Zitat Yost RL, Derendorf H. Disposition of cefotaxime and its des-acetyl metabolite in morbidly obese male and female subjects. Ther Drug Monit. 1986; 8: 189–94.PubMedCrossRef Yost RL, Derendorf H. Disposition of cefotaxime and its des-acetyl metabolite in morbidly obese male and female subjects. Ther Drug Monit. 1986; 8: 189–94.PubMedCrossRef
58.
Zurück zum Zitat Kampmann JP, Klein H, Lumholtz B, et al. Ampicillin and Propylthiouracil pharmacokinetics in intestinal bypasss patients followed up to a year after operation. Clin Pharmacokinet. 1984; 9: 168–76.PubMedCrossRef Kampmann JP, Klein H, Lumholtz B, et al. Ampicillin and Propylthiouracil pharmacokinetics in intestinal bypasss patients followed up to a year after operation. Clin Pharmacokinet. 1984; 9: 168–76.PubMedCrossRef
59.
Zurück zum Zitat Allard S, Kinzig M, Bovin G, et al. Intravenous Ciprofloxacin disposition in obesity. Clin Pharmacol Ther. 1993; 54: 368–73.PubMedCrossRef Allard S, Kinzig M, Bovin G, et al. Intravenous Ciprofloxacin disposition in obesity. Clin Pharmacol Ther. 1993; 54: 368–73.PubMedCrossRef
60.
Zurück zum Zitat Caldwell JB, Nilsen AK. Intravenous Ciprofloxacin dosing in a morbidly obese patient [letter]. Ann Pharmacother. 1994; 28: 806.PubMed Caldwell JB, Nilsen AK. Intravenous Ciprofloxacin dosing in a morbidly obese patient [letter]. Ann Pharmacother. 1994; 28: 806.PubMed
61.
Zurück zum Zitat Garrett ER, Suverkrup RS, Eberst K, et al. Surgically affected sulfisoxazole pharmacokinetics in the morbidly obese. Biopharm Drug Dispos 1980; 2: 329–65.CrossRef Garrett ER, Suverkrup RS, Eberst K, et al. Surgically affected sulfisoxazole pharmacokinetics in the morbidly obese. Biopharm Drug Dispos 1980; 2: 329–65.CrossRef
62.
Zurück zum Zitat Yuk J, Nightingale CH, Sweeney K, et al. Pharmacokinetics of nafcillin in obesity. J Infect Dis. 1988; 157: 1088–9.PubMedCrossRef Yuk J, Nightingale CH, Sweeney K, et al. Pharmacokinetics of nafcillin in obesity. J Infect Dis. 1988; 157: 1088–9.PubMedCrossRef
63.
Zurück zum Zitat Cohen LG, DiBiasio A, Lisco SJ, et al. Fluconazole serum concentrations and pharmacokinetics in an obese patient. Pharmacother. 1997; 17: 1023–6. Cohen LG, DiBiasio A, Lisco SJ, et al. Fluconazole serum concentrations and pharmacokinetics in an obese patient. Pharmacother. 1997; 17: 1023–6.
64.
Zurück zum Zitat Gillum JG, Johnson M, Lavoie S, et al. Flucytosine dosing in an obese patient with extrameningeal cryptococcal infection. Pharmacother. 1995; 15: 251–3. Gillum JG, Johnson M, Lavoie S, et al. Flucytosine dosing in an obese patient with extrameningeal cryptococcal infection. Pharmacother. 1995; 15: 251–3.
65.
Zurück zum Zitat Geiseler PJ, Manis RD, Maddux MS. Dosage of antituberculosis drugs in obese patients. Am Rev Respir Dis. 1985; 131: 944–6.PubMed Geiseler PJ, Manis RD, Maddux MS. Dosage of antituberculosis drugs in obese patients. Am Rev Respir Dis. 1985; 131: 944–6.PubMed
66.
Zurück zum Zitat Forse RA, Karam B, MacLean LD, et al. Antibiotic prophylaxis for surgery in morbidly obese patients. Surgery. 1989; 106: 750–7.PubMed Forse RA, Karam B, MacLean LD, et al. Antibiotic prophylaxis for surgery in morbidly obese patients. Surgery. 1989; 106: 750–7.PubMed
67.
Zurück zum Zitat Mann HJ, Buchwald H. Cefamandole distribution in serum, adipose tissue, and wound drainage in morbidly obese patients. Drug Intell Clin Pharm. 1986; 20: 869–73.PubMed Mann HJ, Buchwald H. Cefamandole distribution in serum, adipose tissue, and wound drainage in morbidly obese patients. Drug Intell Clin Pharm. 1986; 20: 869–73.PubMed
68.
Zurück zum Zitat Pories WJ, van Rij AM, Burlingham BT, et al. Prophylactic cefazolin in gastric bypass surgery. Surgery. 1981; 90: 426–32.PubMed Pories WJ, van Rij AM, Burlingham BT, et al. Prophylactic cefazolin in gastric bypass surgery. Surgery. 1981; 90: 426–32.PubMed
69.
Zurück zum Zitat Mehta U, Malone M, Alger S. Cefazolin use in clinically severe obese patients undergoing gastric restrictive surgery. Ann Pharmacother. 1995; 29: 935–6.PubMed Mehta U, Malone M, Alger S. Cefazolin use in clinically severe obese patients undergoing gastric restrictive surgery. Ann Pharmacother. 1995; 29: 935–6.PubMed
Metadaten
Titel
Dosage Adjustments for Antibacterials in Obese Patients
Applying Clinical Pharmacokinetics
verfasst von
David T. Bearden
Dr Keith A. Rodvold
Publikationsdatum
01.05.2000
Verlag
Springer International Publishing
Erschienen in
Clinical Pharmacokinetics / Ausgabe 5/2000
Print ISSN: 0312-5963
Elektronische ISSN: 1179-1926
DOI
https://doi.org/10.2165/00003088-200038050-00003

Weitere Artikel der Ausgabe 5/2000

Clinical Pharmacokinetics 5/2000 Zur Ausgabe