title: Underdosing of common antibiotics for obese patients in the ED.
abstract: BACKGROUND
  Obesity is a growing problem in the United States. Obesity alters the pharmacokinetic profiles of various drugs. Although there are guidelines for dose adjustments for many of the antibiotics commonly used in the emergency department (ED), they are seldom used.
  
  
  METHODS
  This is an institutional review board-approved retrospective study at an American Society of Metabolic and Bariatric Surgery Center of Excellence and a level I trauma center with annual ED volumes of more than 80,000 visits. Data were retrospectively collected from ED pharmacy records during a 3-month period in 2008. Any first dose of cefepime, cefazolin, or ciprofloxacin administered in our ED to a patient recorded as both more than 100 kg and with a body mass index greater than 40 kg/m(2) was compared with our hospital guidelines and found to either adhere or not adhere to those guidelines.
  
  
  RESULTS
  There were 1910 orders found to meet the study criteria: 775 orders for cefepime, 625 orders for cefazolin, and 510 orders for ciprofloxacin. Adherence rates for first dose of cefepime, cefazolin, and ciprofloxacin administered, respectively, were 8.0%, 3.0%, and 1.2%.
  
  
  CONCLUSIONS
  Emergency physicians frequently underdose cefepime, cefazolin, and ciprofloxacin in obese patients. Underdosing antimicrobials presents risk of treatment failure and may promote antimicrobial resistance. Education is necessary to improve early antibiotic administration to obese patients.
authors.affiliation: Washington University School of Medicine, Campus Box 8072, Saint Louis, MO 63110, USA.
authors.forename: Jada L
authors.initials: JL
authors.lastname: Roe
authors.forename: Joseph M
authors.initials: JM
authors.lastname: Fuentes
authors.forename: Michael E
authors.initials: ME
authors.lastname: Mullins
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage* / Q000627:therapeutic use; D001424:Bacterial Infections / Q000150:complications / Q000188:drug therapy; D001835:Body Weight; D002437:Cefazolin / Q000008:administration & dosage / Q000627:therapeutic use; D000077723:Cefepime; D002511:Cephalosporins / Q000008:administration & dosage / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000008:administration & dosage / Q000627:therapeutic use; D004636:Emergency Service, Hospital; D006801:Humans; D009765:Obesity / Q000150:complications* / Q000188:drug therapy; D012189:Retrospective Studies
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D002939:Ciprofloxacin; D000077723:Cefepime; D002437:Cefazolin