A new review published in Clinical Obesity sheds new light on antibiotic dosing recommendations for obese patients. Many existing dosage recommendations come from evidence based on non-obese patients, but morbid obesity can seriously affect drug distribution and clearance from the body.
Despite increasing prevalence of obesity worldwide, drug pharmacokinetics (the study of a drug's journey from administration to exit from the body) are still commonly evaluated in individuals of the traditionally accepted 'normal' body weight of approximately 70 kg, which has ceased to be reflective of the average US adult.
The authors argue that "the one size fits all dogma has assuredly become outdated and could lead to suboptimal outcomes." The review suggests that clinicians should consider higher doses of antibiotics in obese patients. Obese patients can be at increased risk of underdosing and overexposure, both of which are under-recognized and can lead to poor outcomes.
The review suggests alternative dosing strategies, such as front-loading, where an initial short course of a high dose antibiotic in administered, then reduced to a standard dosing. However, the paper's authors acknowledge that there is limited research into alternative dosing strategies in obese patients.
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