title: Pharmacokinetics of Antimicrobials in Obese Children.
abstract: BACKGROUND
  Childhood obesity is common and results in substantial morbidity. The most commonly prescribed drugs in obese children are antibiotics. However, physiologic changes associated with childhood obesity can alter antibiotic pharmacokinetics and optimal body size measures to guide dosing in his population are ill defined. This combination can result in therapeutic failures or drug-related toxicities. This review summarizes pharmacokinetic information for antibiotics in obese children and implications for dosing.
  
  
  METHODS
  We conducted a comprehensive literature search of PubMed, EMBASE, and International Pharmaceutical Abstracts to identify pharmacokinetic studies of antimicrobial agents in obese children. We included the following search terms:obesity, pharmacokinetics, pharmacodynamics, drug toxicity, dosing, anti-infective agents, antiviral agents,andantifungal agents.
  
  
  RESULTS
  We identified four pharmacokinetic studies of antibiotics in obese children: one for cefazolin and tobramycin, one for gentamicin, and two for vancomycin. Only the cefazolin/tobramycin trial was prospective. The drugs studied differ in their tissue and body water distribution characteristics. Two of the studies (tobramycin and gentamicin) reported pharmacokinetic differences and required dosing modifications in obese children.
  
  
  CONCLUSIONS
  The lack of pharmacokinetic studies in obese children is pronounced. The scarcity of pharmacokinetic data limits the ability to predict drug disposition using drug physicochemical properties and impedes a rational approach to selection of appropriate body size measures for dosing. Given this knowledge gap, additional trials in obese children are urgently needed and is a public health concern.
  
  
  CONCLUSIONS
  Pharmacokinetic studies of antimicrobials in obese children are desperately needed to guide dosing and avoid therapeutic failures or unwanted toxicities.
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA ; UNC Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, NC, USA.
authors.forename: Mr
authors.initials: M
authors.lastname: Sampson
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA ; Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
authors.forename: M
authors.initials: M
authors.lastname: Cohen-Wolkowiez
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA ; Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
authors.forename: Dk
authors.initials: D
authors.lastname: Benjamin
authors.affiliation: Department of Pediatrics, School of Medicine and Department of Clinical Pharmacy, Skaggs School of Pharmacy, University of California-San Diego, La Jolla, CA, USA.
authors.forename: Ev
authors.initials: E
authors.lastname: Capparelli
authors.affiliation: Duke Clinical Research Institute, Durham, NC, USA ; Department of Pediatrics, Duke University Medical Center, Durham, NC, USA.
authors.forename: Km
authors.initials: K
authors.lastname: Watt
keywords: Pediatrics; antimicrobial agents; obesity; pharmacokinetics