Antimicrobial dosing in obese patients

Although the dose of some drugs is commonly adjusted for weight, weight- related dosage adjustments are rarely made for most antimicrobials. We reviewed the English-language literature on antimicrobial pharmacokinetics and dosing in obesity. Although there are many potential pharmacokinetic consequences of obesity, the actual effect on the pharmacokinetics and clinical efficacy of most antimicrobials is unknown. Since ~30% of adipose is water, an empirical approach is use of the Devine formula to calculate ideal body weight (IBW), to which is added a dosing weight correction factor (DWCF) of 0.3 times the difference between actual body weight (ABW) and IBW (IBW + 0.3 x [ABW-IBW]) to arrive at a weight on which to base dosage of hydrophilic antibiotics. No studies confirm this approach for β-lactam drugs. Clinical studies suggest a DWCF of ~0.40 for aminoglycosides and 0.45 for quinolones. Final dosage adjustments for antimicrobials with a narrow toxic-therapeutic window should be based on serum concentrations.