Impact of hospital guideline for weight-based antimicrobial dosing in morbidly obese adults and comprehensive literature review

Polso, A. K.; Lassiter, Jessica; Nagel, Jerod

doi:10.1111/jcpt.12200

Cited by 69 publications

(60 citation statements)

References 55 publications

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“…Consequently, appropriate dosing for obese patients is based on data on "normal weight" nonobese patients. 41 Various weightbased formulas are used to calculate dosages to avoid unsuccessful treatment, toxic effects, and antibiotic resistance. 42 Examples of the weights used are IBW; lean body weight or weight devoid of almost all adipose tissue; and adjusted body weight, which includes an adjustment factor of 40% for patients who are more than 20% of their IBW (Table 1 describes calculations for these formulas).…”

Section: D: Drugsmentioning

confidence: 99%

“…Hepatic clearance is usually normal or even increased in obese patients, and renal clearance can increase because of increases in kidney weight, renal blood flow, and glomerular filtration rate. 41 Volume of distribution in obese patients can be dramatically different than that in normal-weight patients, and the extent of change is based on the intrinsic characteristics of a medication, such as molecular size, degree of ionization, extent of lipid solubility, protein binding, and ability to cross biological membranes. 42 Additionally, obesity can alter activity through the cytochrome P-450 pathway, affecting drug clearance.…”

Section: D: Drugsmentioning

confidence: 99%

“…42 Dosing of renally excreted drugs should be adjusted on the basis of measured, not calculated, creatinine clearance. 41 Active involvement of clinical pharmacologists in the dosing of medications is highly recommended. Important actions include using the appropriate weight-based calculations, educating nursing staff, and establishing protocols for medications used in emergent situations (eg, quick reference guides in medication rooms).…”

Section: D: Drugsmentioning

confidence: 99%

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The ABCDs of Managing Morbidly Obese Patients in Intensive Care Units

Berrios

2016

Critical Care Nurse

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More than one-third of the US adult population and 17% of the youth are now obese, and obesity is associated with more than $147 billion a year in health care costs. Critical care nurses should understand the physiological differences and practice guidelines for patients with a body mass index greater than 30. The ABCD approach encompasses key clinical concepts in the management of critically ill obese and morbidly obese patients, including management of airways and breathing, minimizing nurses' back and other injuries, increasing awareness of bias, circulation problems, risks of decubitus ulcers and other skin breakdown, differences in drug calculations and metabolism, limitations in diagnostic equipment and imaging, diet and nutritional recommendations, and concerns with durable medical equipment. (Critical Care Nurse. 2016;36[5]:17-26) This article has been designated for CE contact hour(s). The evaluation tests your knowledge of the following objectives: 1. Using the ABCD approach, list the key clinical concepts highlighted in this article for managing morbidly obese patients in intensive care units 2. Identify key physiologic differences in airway, breathing, and circulation in morbidly obese patients 3. Identify important considerations in diagnostic and general medical equipment in the management of morbidly obese patients To complete evaluation for CE contact hour(s) for test #C1653, visit www.ccnonline.org and click the "CE Articles" button. No CE test fee for AACN members.

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Section: D: Drugsmentioning

confidence: 99%

Section: D: Drugsmentioning

confidence: 99%

Section: D: Drugsmentioning

confidence: 99%

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The ABCDs of Managing Morbidly Obese Patients in Intensive Care Units

Berrios

2016

Critical Care Nurse

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“…64 Controversy exists about whether actual or adjusted body weight is most appropriate for weight-based dosing in morbidly obese patients, so therapeutic drug monitoring is essential to ensure efficacy and safety of therapy in these patients. 66 Although vancomycin concentrates well in the urine, skin, and soft tissues, it has relatively poor penetration into deeper tissues such as lung and cerebrospinal fluid, necessitating more aggressive dosing strategies for infections in these areas. 65 The nephrotoxic and ototoxic effects historically associated with vancomycin most likely were due to impurities in early formulations.…”

Section: Vancomycinmentioning

confidence: 99%

Application of Antibiotic Pharmacodynamics and Dosing Principles in Patients With Sepsis

Fleet

Mueller

2016

Critical Care Nurse

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Sepsis is associated with marked mortality, which may be reduced by prompt initiation of adequate, appropriate doses of antibiotic. Critically ill patients often have physiological changes that reduce blood and tissue concentrations of antibiotic and high rates of multidrug-resistant pathogens, which may affect patients' outcomes. All critical care professionals, including critical care nurses, should understand antibiotic pharmacokinetics and pharmacodynamics to ensure sound antibiotic dosing and administration strategies for optimal microbial killing and patients' outcomes. Effective pathogen eradication occurs when the dose of antibiotic reaches or maintains optimal concentrations relative to the minimum inhibitory concentration for the pathogen. Time-dependent antibiotics, such as β-lactams, can be given as extended or continuous infusions. Concentration-dependent antibiotics such as aminoglycosides are optimized by using high, once-daily dosing strategies with serum concentration monitoring. Vancomycin and fl uoroquinolones are dependent on both time and concentration above the minimum inhibitory concentration. (Critical Care Nurse. 2016;36[2]:22-32) S epsis is a major cause of morbidity and mortality in the United States, affecting more than 650 000 patients per year. The spectrum of sepsis to septic shock is associated with crude mortality rates of 20% to 70%. [1][2][3][4] From the onset of hypotension, the probability of survival is reduced by 12% for each hour of delay before administration of adequate empiric antibiotics. 5Hence, current guidelines advocate early administration of adequate, broad-spectrum, local antibiogram-based antibiotic therapy in appropriate doses to penetrate the suspected site of infection (eg, lungs, cerebral spinal fl uid, intra-abdominal fl uid).1 Physiological changes associated with sepsis can complicate antibiotic dosing, effectiveness, and safety.

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“…studies are designed to evaluate potentially unique dosing needs for the obese population [2]. Similarly, few studies have been conducted among surgical patients with intraabdominal infection to evaluate whether treatment failure occurs at greater rates among the obese with conventional dosing strategies versus normal weight comparators.…”

mentioning

confidence: 99%

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

Dietch

Duane

Cook

et al. 2016

Surgical Infections

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Background: Obesity and commonly associated comorbidities are known risk factors for the development of infections. However, the intensity and duration of antimicrobial treatment are rarely conditioned on body mass index (BMI). In particular, the influence of obesity on failure of antimicrobial treatment for intra-abdominal infection (IAI) remains unknown. We hypothesized that obesity is associated with recurrent infectious complications in patients treated for IAI. Methods: Five hundred eighteen patients randomized to treatment in the Surgical Infection Society Study to Optimize Peritoneal Infection Therapy (STOP-IT) trial were evaluated. Patients were stratified by obese (BMI ‡30) versus non-obese (BMI ‡30) status. Descriptive comparisons were performed using Chi-square test, Fisher exact test, or Wilcoxon rank-sum tests as appropriate. Multivariable logistic regression using a priori selected variables was performed to assess the independent association between obesity and treatment failure in patients with IAI. Results: Overall, 198 (38.3%) of patients were obese (BMI ‡30) versus 319 (61.7%) who were non-obese. Mean antibiotic d and total hospital d were similar between both groups. Unadjusted outcomes of surgical site infection (9.1% vs. 6.9%, p = 0.36), recurrent intra-abdominal infection (16.2% vs. 13.8, p = 0.46), death (1.0% vs. 0.9%, p = 1.0), and a composite of all complications (25.3% vs. 19.8%, p = 0.14) were also similar between both groups. After controlling for appropriate demographics, comorbidities, severity of illness, treatment group, and duration of antimicrobial therapy, obesity was not independently associated with treatment failure (c-statistic: 0.64). Conclusions: Obesity is not associated with antimicrobial treatment failure among patients with IAI. These results suggest that obesity may not independently influence the need for longer duration of antimicrobial therapy in treatment of IAI versus non-obese patients.

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Impact of hospital guideline for weight-based antimicrobial dosing in morbidly obese adults and comprehensive literature review

Cited by 69 publications

References 55 publications

The ABCDs of Managing Morbidly Obese Patients in Intensive Care Units

The ABCDs of Managing Morbidly Obese Patients in Intensive Care Units

Application of Antibiotic Pharmacodynamics and Dosing Principles in Patients With Sepsis

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

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