Cefotiam disposition in markedly obese athlete patients, Japanese sumo wrestlers

Abstract

Markedly obese athletes like Japanese sumo wrestlers may frequently suffer various traumas which result in the prophylaxis or treatment of posttraumatic infection with antibiotics. However, appropriate dosage regimens in this group of patients have not been fully known for many antibiotics. Therefore, we studied the kinetic disposition of cefotiam, a parenteral, broad-spectrum cephalosporin with activity against gram-positive and -negative bacteria, after an intravenous dose (2 g) infused over 30 min into 15 sumo wrestler patients with an excess body weight (130 to 220% of ideal body weight) and 10 control patients with a normal weight (90 to 102% of ideal body weight). Mean (± standard deviation) clearance and steady-state volume of distribution were significantly greater in the sumo wrestler than in the control group (38.3 ± 9.4 versus 23.5 ± 6.0 liters/h, P < 0.001, and 30.2 ± 8.0 versus 17.9 ± 6.1 liters, P < 0.001). Mean elimination half-life was slightly but significantly longer in the sumo wrestler than in the control group (0.91 ± 0.14 versus 0.74 ± 0.20 h, P < 0.05). However, mean residence time did not differ between the two groups (0.79 ± 0.10 versus 0.75 ± 0.14 h). The statistical differences in clearance and volume of distribution between the two groups disappeared when these kinetic parameters were corrected for body surface area, but not for total body weight or ideal body weight. The results suggest that the dosage calculation of cefotiam, a hydrophilic antibiotic, should be made on the basis of body surface area in morbidly obese athlete or sumo wrestler patients. However, whether this recommendation should extend to other nonathlete obese subjects remains to be determined.Sumo, a unique form of wrestling with a 2,000-year-old history, is the national sport of Japan (5, 18). There are more than 700 professional sumo wrestlers in the country. The most prominent physical characteristic of sumo wrestlers is obesity (5, 18). Since physical essentials for success in sumo wrestling are heavy weight and low center of gravity, wrestlers desire to gain weight and ingest many calories so that they have a tendency to be markedly obese. The heaviest professional sumo wrestler in the major league weighs 241 kg with a height of 187 cm.

Comparative Pharmacokinetics and Pharmacodynamic Target Attainment of Ertapenem in Normal-Weight, Obese, and Extremely Obese Adults

“…The effect of altered body composition on drug disposition and therapeutic outcome with increasing obesity is particularly pertinent in antimicrobial therapy. Suboptimal drug exposure can lead to clinical failure and increase the risk of drug resistance.Several studies that specifically examined drug disposition of ␤-lactam antibiotics in obesity found an increase in the volume of distribution and/or drug clearance in obese subjects (3,12,24). This suggests that such patients may require higher doses or more frequent administration in order to achieve adequate drug exposure.…”

“…Several studies that specifically examined drug disposition of ␤-lactam antibiotics in obesity found an increase in the volume of distribution and/or drug clearance in obese subjects (3,12,24). This suggests that such patients may require higher doses or more frequent administration in order to achieve adequate drug exposure.…”

Obesity Is Not Associated with Antimicrobial Treatment Failure for Intra-Abdominal Infection

“…This phenomenon is magnified for lipophilic medications, which tend to more readily distribute than hydrophilic drugs. Previous work has identified larger V d in obese patients for most classes of antimicrobial agents, including penicillins, cephalosporins, carbapenems, aminoglycosides, vancomycin, and others [16][17][18][19][20][21][22][23][24][25]. The extent to which a medication is protein-bound also affects V d , and obesity has been shown to alter lipoproteins and alpha1-acid glycoprotein [2].…”

Gewachsene Erfordernisse im anspruchsvollen viszeralchirurgischen Management bei morbider Adipositas - Was muss der Viszeralchirurg wissen?

“…Studien für den Einsatz von Cephalosporinen zeigen, dass bei Adipositas die Clearance und das Verteilungsvolumen der Cephalosporine vergrößert sind. Hieraus ergibt sich die Notwendigkeit einer Dosisanpassung beim Einsatz von Cephalosporinen, insbesondere als Single-Shot-Prophylaxe [14,15]. Auch für Betalaktam-Antibiotika wurde dieser Effekt nachgewiesen [16].…”