SUMMARYWhat is known and objective: Obesity is a significant burden on the healthcare system in the United States, and determining the appropriate antimicrobial dosing regimen in morbidly obese patients is challenging. Morbidly obese patients have documented differences in pharmacokinetic and pharmacodynamic properties compared to normal-weight patients, which impact antibiotic efficacy and toxicity. The Food and Drug Administration does not recognize obesity as a special population and does not require pharmaceutical companies to perform studies specific to obese patients. However, there are an increasing number of post-approval studies in obese patients, and this manuscript reviews available clinical and pharmacokinetic literature regarding weight-based antimicrobial agents. Additionally, we describe a single-centre approach to optimize dosing in morbidly obese patients. Methods: A comprehensive literature search was performed on 15 weight-based antimicrobials in the setting of obesity: acyclovir, aminoglycosides, amphotericin B, cidofovir, colistimethate, daptomycin, flucytosine, foscarnet, ganciclovir, quinupristin/ dalfopristin, trimethoprim/sulfamethoxazole, vancomycin and voriconazole. A weight-based antimicrobial dosing guideline for morbidly obese patients was developed. An analysis of guideline compliance and cost analysis were performed following guideline implementation. Results and discussion: This review describes the pharmacokinetic changes that occur in obese patients, including increased volume of distribution, altered hepatic metabolism, renal excretion and changes in protein binding. The majority of weightbased antimicrobials result in increased serum concentrations in morbidly obese patients compared to normal-weight patients when the calculated dose is based on actual body weight. What is new and conclusion: This review demonstrates different antibiotic pharmacokinetic properties are altered in obese patients that could impact efficacy and toxicity. A single-centre guideline for weight-based antimicrobial dosing in obesity was developed and provides recommendations for using ideal body weight, adjusted body weight or actual body weight when calculating antimicrobial doses. However, more research is needed to better elucidate optimal dosing of weight-based antimicrobials in obesity, with particular focus on efficacy and toxicity. WHAT IS KNOWN AND OBJECTIVEObesity is a major issue in the United States, with 78 million US adults and 12Á5 million children and adolescents classified as obese [body mass index (BMI) greater than or equal to 30].1 This equates to an obesity rate of 35% and 16Á9% in adults and children in the United States, respectively.1 Physiological changes in obesity can alter immunological pathways and increase the risk of central line infection, post-operative surgical site infections, intensive care unit length of stay and risk for severe pneumonia and influenza. [2][3][4][5] Additionally, changes in antimicrobial pharmacokinetic and pharmacodynamic properties are well docume...

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Implementation of an ASP-driven comprehensive care bundle for SAB improved adherence with performance measures and was associated with a decrease in hospital readmission for SAB.

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Purpose -The purpose of this paper is to consider the difference in the development of the central bank in two states in transition from communism to capitalism and from being parts of the Soviet Union to being independent states. Design/methodology/approach -Data and theoretical analysis were gathered from various sources in order to evaluate the approach to central banking taken by these two countries. Findings -Substantial variations were found in the resulting monetary policies and rates of inflation which demonstrate the differences in the institutions developed and illustrate the importance of independence for the central bank. Originality/value -The contrasting experience of Belarus and Estonia, both of which gained independence from the Soviet Union in 1991, provide examples of success and failure in this endeavor, thus providing valuable insight to those involved with transitioning economies.