title: Pharmacokinetics and protein binding of cefazolin in morbidly obese patients.
abstract: OBJECTIVE
  The aim of this study was to assess the pharmacokinetics and protein binding of cefazolin in morbidly obese patients undergoing bariatric surgery, to study the influence of bodyweight measures and age on pharmacokinetic parameters and to evaluate unbound cefazolin concentrations over time in this population.
  
  
  METHODS
  Twenty morbidly obese patients (bodyweight 112-260 kg, body mass index 38-79 kg m(-2)) were studied following the administration of cefazolin 2 g at induction of anaesthesia. Blood samples were collected up to 4 h post-dosing to determine total and unbound plasma cefazolin concentrations. Non-compartmental pharmacokinetic data analysis was performed.
  
  
  RESULTS
  Cefazolin clearance was 4.2 ± 1.0 L h(-1) (mean ± standard deviation) and showed a negative correlation with age (p = 0.003) but not with bodyweight measures (p > 0.05). Volume of distribution was 13.0 ± 3.1 L and correlated positively with bodyweight measures (p ≤ 0.001). Saturable protein binding was observed with a median protein binding of 79% (interquartile range 74-82), which proved similar to reported protein binding in non-obese patients. In all patients, unbound cefazolin concentrations remained above 1 mg L(-1) (minimal inhibitory concentration for 90% (MIC(90)) of methicillin-sensitive isolates of Staphylococcus aureus in Europe) until 4 h post-dosing.
  
  
  CONCLUSIONS
  Younger age--and not bodyweight--was significantly associated with higher cefazolin clearance. However, as in all patients with bodyweights up to 260 kg, unbound plasma cefazolin concentrations remained above 1 mg L(-1) until 4 h after the intravenous administration of a 2-g dose. As such, re-dosing within 4 h or dosing with another antibiotic class should only be considered in the case of a higher MIC(90) of the local isolates.
authors.affiliation: Department of Anaesthesiology, St. Antonius Hospital, Koekoekslaan 1, 3435 CM Nieuwegein, The Netherlands. svankralingen@hotmail.com
authors.forename: Simone
authors.initials: S
authors.lastname: van Kralingen
authors.forename: Margot
authors.initials: M
authors.lastname: Taks
authors.forename: Jeroen
authors.initials: J
authors.lastname: Diepstraten
authors.forename: Ewoudt M
authors.initials: EM
authors.lastname: van de Garde
authors.forename: Eric P
authors.initials: EP
authors.lastname: van Dongen
authors.forename: Marinus J
authors.initials: MJ
authors.lastname: Wiezer
authors.forename: Bert
authors.initials: B
authors.lastname: van Ramshorst
authors.forename: Bart
authors.initials: B
authors.lastname: Vlaminckx
authors.forename: Vera H
authors.initials: VH
authors.lastname: Deneer
authors.forename: Catherijne A
authors.initials: CA
authors.lastname: Knibbe
mesh_terms: D000328:Adult; D000367:Age Factors; D000900:Anti-Bacterial Agents / Q000097:blood / Q000493:pharmacokinetics / Q000494:pharmacology; D050110:Bariatric Surgery; D002437:Cefazolin / Q000097:blood / Q000493:pharmacokinetics* / Q000494:pharmacology; D005260:Female; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D009767:Obesity, Morbid / Q000097:blood / Q000378:metabolism* / Q000601:surgery; D011446:Prospective Studies; D011485:Protein Binding
chemical_list: D000900:Anti-Bacterial Agents; D002437:Cefazolin