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Critical Care
Published in: Critical Care 1/2016

Open Access 01-12-2016 | Editorial

Antibiotic dosing in obesity: a BIG challenge

Authors: Timothy P. Hanrahan, Jeffrey Lipman, Jason A. Roberts

Published in: Critical Care | Issue 1/2016

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Excerpt

When almost 60 % of the world’s population is predicted to be overweight by 2030 [1], dosing regimens that are developed and tested in non-obese patients will be inappropriate for the future use of drugs. Specifically, should we no longer accept the “one-size-fits-all” mentality of antibiotic dosing and accept that individuals may in fact need to be dosed… individually? Almost all clinicians use antibiotics daily. Most use guidelines as dosing rules rather than a guide. Particularly in critical illness where dramatic changes in antibiotic concentrations can occur with similar doses, accepting guidelines as dosing rules is likely to be flawed [2]. …
Literature
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Kelly T, Yang W, Chen C-S, Reynolds K, He J. Global burden of obesity in 2005 and projections to 2030. Int J Obes (Lond). 2008;32:1431–7.CrossRef
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Roberts JA, Paul SK, Akova M, Bassetti M, De Waele JJ, Dimopoulos G, et al. DALI: defining antibiotic levels in intensive care unit patients: are current β-lactam antibiotic doses sufficient for critically ill patients? Clin Infect Dis. 2014;58:1072–83.CrossRefPubMed
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Alobaid AS, Hites M, Lipman J, Taccone FS, Roberts JA. Effect of obesity on the pharmacokinetics of antimicrobials in critically ill patients: a structured review. Int J Antimicrob Agents. 2016;47:259–68.CrossRefPubMed
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Roberts JA, Lipman J. Pharmacokinetic issues for antibiotics in the critically ill patient. Crit Care Med. 2009;37:840–51.CrossRefPubMed
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Udy AA, Roberts JA, Boots RJ, Paterson DL, Lipman J. Augmented renal clearance: implications for antibacterial dosing in the critically ill. Clin Pharmacokinet. 2010;49:1–16.CrossRefPubMed
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Rybak MJ, Lomaestro BM, Rotschafer JC, Moellering RC, Craig WA, Billeter M, et al. Vancomycin therapeutic guidelines: a summary of consensus recommendations from the infectious diseases Society of America, the American Society of Health-System Pharmacists, and the Society of Infectious Diseases Pharmacists. Clin Infect Dis. 2009;49:325–7.CrossRefPubMed
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Lin H, Dante DY, Levine AR. Daily vancomycin dose requirements as a continuous infusion in obese vs. non-obese SICU patients. Critical Care. 2016.
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Roberts JA, Taccone FS, Udy AA, Vincent J-L, Jacobs F, Lipman J. Vancomycin dosing in critically ill patients: robust methods for improved continuous-infusion regimens. Antimicrob Agents Chemother. 2011;55:2704–9.CrossRefPubMedPubMedCentral
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Neely MN, Youn G, Jones B, Jelliffe RW, Drusano GL, Rodvold KA, et al. Are vancomycin trough concentrations adequate for optimal dosing? Antimicrob Agents Chemother. 2014;58:309–16.CrossRefPubMedPubMedCentral
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Huttner A, Harbarth S, Hope WW, Lipman J, Roberts JA. Therapeutic drug monitoring of the β-lactam antibiotics: what is the evidence and which patients should we be using it for? J Antimicrob Chemother. 2015;70:3178–83.
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Charmillon A, Novy E, Agrinier N, Léone M, Kimmoun A, Levy B, et al. The ANTIBIOPERF study: a nationwide cross-sectional survey about practices for β-lactam administration and therapeutic drug monitoring among critically ill patients in France. Clin Microbiol Infect. 2016. doi:10.​1016/​j.​cmi.​2016.​04.​019.
Metadata
Title
Antibiotic dosing in obesity: a BIG challenge
Authors
Timothy P. Hanrahan
Jeffrey Lipman
Jason A. Roberts
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Critical Care / Issue 1/2016
Electronic ISSN: 1364-8535
DOI
https://doi.org/10.1186/s13054-016-1426-y

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