title: Influence of Morbid Obesity on the Clinical Pharmacokinetics of Various Anti-Infective Drugs: Reappraisal Using Recent Case Studies-Issues, Dosing Implications, and Considerations.
abstract: Owing to availability of scanty pharmacokinetic data, dosing decisions in morbid obesity is increasingly challenging in the field of anti-infective drugs. However, in recent years data are emerging that describe the pharmacokinetics of anti-infective drugs in morbidly obese subjects. The objectives of the present work were: (1) to collate the recent reports pertaining to the pharmacokinetics in morbidly obese subjects for several anti-infective drugs and provide an overview of the pharmacokinetic data along with the applicable pharmacodynamics and/or clinical outcome; (2) to perform regression analysis on limited dataset for a few drugs to verify the existence of relationships between Cmax/Ctrough versus steady-state volume of distribution (Vss)/clearance to enable data prediction in morbid obesity subjects; (3) to provide a general discussion on issues and dosing implications. The key findings of this review were: (a) drugs such as vancomycin, ethambutol, and fluconazole, where the VSS is substantially greater in morbidly obese patients, need a dosing strategy with the appropriate body mass descriptors; (b) other drugs such as moxifloxacin, linezolid, doripenem, meropenem, voriconazole, oseltamivir, tigecycline, levofloxacin may not ordinarily need dosing adjustments;
authors.forename: Nuggehally R
authors.initials: NR
authors.lastname: Srinivas
mesh_terms: D000890:Anti-Infective Agents / Q000493:pharmacokinetics* / Q000592:standards / Q000627:therapeutic use; D003141:Communicable Diseases / Q000188:drug therapy* / Q000453:epidemiology / Q000378:metabolism; D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D006801:Humans; D009767:Obesity, Morbid / Q000453:epidemiology / Q000378:metabolism*; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents