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Amikacin dosing in obese patients have – Amikacin pharmacokinetics in morbidly obese patients

Several disease stages are associated with hypoalbuminemia, such as analbuminemia, starvation, liver or renal disease, cancer, stress response, burns, trauma, surgery or septic shock [ 21 , 23 , 46 , 47 , 48 , 49 , 50 ].

Ethan Walker
Wednesday, November 14, 2018
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  • Antimicrobial dosing in obese patients. Korsager, [ 4 ].

  • An amikacin nomogram can be computed and downloaded from the application for the specific scenario defined. Advanced Settings.

  • Winstead, and A.

  • Elimination, on the other hand, has been shown to be affected.

Usual Adult Dose for Bacteremia

Select one or more newsletters to continue. There have been numerous clinical trials published attempting to determine whether extended-interval dosing is superior in efficacy or safety to conventional dosing. Back to Top. However, this dosage could potentially increase the probability of toxicity in severe renal dysfunction stages, even more pronounced when associated with low ALB levels, and could also increase the risk of lack of efficacy in patients with hypoalbuminemia.

These findings reveal the ohese role of ALB in amikacin dosage optimization based on PKPD criteria and support its potential consideration for future updates of the principal international amikacin dosing guidelines. Department of Health. Zhanel G. Influence of clinical diagnosis in the population pharmacokinetics of amikacin in intensive care unit patients. Amikacin has a concentration-related bacterial killing increasing post antibiotic effect PAE up to 8 h and decreasing adaptive bacteria resistance which represent clinical advantages of a once-daily dosing regimen [ 131 ]. Institutional Review Board Statement Not applicable.

Leykin Y. In: Bauer LA, ed. Figure 1. The present study patietns the efficacy and toxicity associated to the amikacin dosage recommended by the main international dosing guidelines together with the impact of total bodyweight, renal function and serum albumin on amikacin model-informed precision dosing recommendation. All rights reserved. Materials and Methods 2. Data sharing is not applicable to this article.

An example of the AMKnom application is shown in Figure 2. Germovsek E. Evidence of nephrotoxicity: Discontinue the drug OR adjust the dose. A specific scenario defined in input menu is represented across the three graphical representations. Amikacin initial dosage in patients with hypoalbuminaemia: An interactive tool based on a population pharmacokinetic approach. Louis, MObut it is available as an appendix in a meta-analysis that was published from the same institution. Once-daily dosing of aminoglycosides: Review and recommendations for clinical practice.

Advanced aminoglycoside pharmacokinetics tool

The above dosing modification is very important, because calculation of aminoglycoside dosing based on TBW amikacin dosing in obese patients have result in amikacinn serum concentrations, thereby increasing the risk for nephrotoxicity and ototoxicity [ 216 ] in obesity. Conflicts of Interest All authors state that they do not have any conflicts of interest to report. The combination of the above searches revealed a total of 33 articles, case series and letters which were included in this review. Pai and D.

Therapeutic drug monitoring of amikacin in septic patients. Gentamicin therapy. Author Contributions Conceptualization, J. In addition, total parenteral nutrition has been correlated with an expanded V and lower Cmax of amikacin as well as with an increase in creatinine clearance [ 61 ]. Bayesian approach to control of amikacin serum concentrations in critically ill patients with sepsis.

Extended Conventional. This calculator uses four extended-interval nomograms. Renal function calculated by Cockcroft—Gault equation using ideal bodyweight for dosjng patients and Salazar-Corcoran amikacin dosing in obese patients have for obese patients [ 9 ]. Vasoactive drugs are commonly required to improve hemodynamic function in patients with sepsis or septic shock and can modify the extracellular fluid compartment and volume of distribution of water soluble antibiotics such as aminoglycosides [ 60 ]. A new equation to estimate glomerular filtration rate. However, several studies have pointed out that individualized amikacin dosing strategies could improve clinical outcomes with no additional toxicity [ 3738 ].

Is it less toxic than multiple daily doses and how should it be monitored? Tod M. Bayesian approach to control of amikacin serum concentrations in critically ill patients with sepsis. Stankowicz M.

Usual Adult Dose for Intraabdominal Infection

These results were aligned with EUCAST and Queensland guidelines recommending reduced amikacin dose adjustment for a wide range of renal function. Kale-Pradhan P. Assessment of nutritional status in cancer—The relationship between body composition and pharmacokinetics. Use: Treatment of peritonitis.

  • Journal overview. Ross, and R.

  • High-dose amikacin for achieving serum target levels in critically ill elderly patients.

  • Pathophysiologic changes in obesity affect most hydrophilic medications [ 101425 ]. A controlled investigation of the pharmacokinetics of gentamicin and tobramycin in obese subjects.

  • Matar K.

  • View at: Publisher Site Google Scholar. CopyrightVelissaris et al.

An interactive R-based application, AMKnom, was developed to pztients interactive amikacin nomograms based on PKPD criteria and subject characteristics. Amikacin dosing in obese patients have, a conservative conclusion is that extended-interval dosing is at least as beneficial and safe, if not better, than conventional dosing. Therapeutic drug monitoring of amikacin in septic patients. Conclusions The present study shows the efficacy and toxicity associated to the amikacin dosage recommended by the main international dosing guidelines together with the impact of total bodyweight, renal function and serum albumin on amikacin model-informed precision dosing recommendation. Aminoglycoside Calculator Advanced aminoglycoside pharmacokinetics tool ClinCalc.

  • Schwartz, G. Patient-specific parameters.

  • It is important to note that this method relies on an accurate creatinine clearance; therefore, this method may not be appropriate in patients with unstable renal function or those with difficult-to-estimate creatinine clearance. Show AMA citation.

  • Diagn Microbiol Infect Dis.

Patient Syst. In consequence, additional considerations may be required in amikacin dose individualization when combined with additional supportive care therapies. Chapter 4. Therapeutic drug monitoring of amikacin in septic patients. Antimicrobial therapy recommendations based on total and adjusted body weight, renal function or age present a wide variability across the international guidelines evaluated in this work Table 1. Bauer LA.

Conclusions The present study shows the efficacy and toxicity associated to the amikacin dosage recommended smikacin the main international dosing guidelines together with the impact of total bodyweight, renal function and serum albumin on amikacin model-informed precision dosing recommendation. Cockcroft D. References 1. These populations include:. Determination of optimal amikacin dosing regimens for pediatric patients with burn wound sepsis.

Associated Data

Once-daily dosing of aminoglycosides: review and recommendations for clinical practice. In addition, because aminoglycoside effect is concentration-dependent, administration of maintenance doses using extended interval regimens is preferred. Low level.

The following criteria are hae by this calculator to determine an aminoglycoside dosing weight:. Robert S. Amikacin population pharmacokinetics among paediatric burn patients. Email address. Effect of body weight on aminoglycoside pharmacokinetics in patients with hypoalbuminemia. Because aminoglycosides are primarily renally eliminated, the elimination constant K el is directly related to the creatinine clearance: 1.

After calculating a ;atients, click on 'Progress Note' for a pharmacokinetic template or 'Equations' for a step-by-step explanation of the recommended dosing regimen. Considering the interactive properties of the AMKnom application, we recommend exploring the online tool to better understand the features implemented and the potential of the tool developed on improving amikacin dosage optimization based on PKPD criteria. BioMed Res. You may select a specific nomogram by clicking the "Config" icon in the top, right-hand corner of this webpage. Drug Intell Clin Pharm.

MeSH terms

Determinants of amikacin first peak concentration in critically ill patients. Results 3. Hartford Nomogram 3 The Hartford hafe was one of the first published extended-interval nomograms. Amikacin dosing recommended by the international dosing guidelines stratified by renal function. Population pharmacokinetic parameters for bayesian monitoring of amikacin therapy in intensive care unit patients.

  • Devine BJ.

  • Accessed August 24,

  • Pharmacotherapy in the critically ill obese patient.

  • US units.

Limited data exist in the morbidly obese population, and none of these studies were done in the era of extended interval aminoglycosides. Optimizing use of aminoglycosides in the critically ill. Traynor et al. Vincent, N. Table 1.

Email: ude. Wurtz, G. A meta-analysis of extended-interval dosing versus multiple daily dosing of aminoglycosides. Obese patients are thought to have an increased glomerular filtration rate, theoretically leading to increased renal elimination of medications. View at: Google Scholar M. Devine BJ.

Details regarding the effects of fluid shifts on aminoglycoside pharmacokinetics have not been well studied in critically ill obese patients. However, traditional or conventional dosing methods were utilized. A value of less than 0.

Child Educ. Comparison of the next-generation aminoglycoside plazomicin to gentamicin, tobramycin and amikacin. Havw other hydrophilic antimicrobials, amikacin exhibits a volume of distribution limited to the extracellular space, which is significantly affected by decrease in ALB concentrations [ 45 ]. Materials and Methods 2. Vertigo may occur and may be evidence of vestibular injury. Post-antibiotic effect. After calculating a dose, click on 'Progress Note' for a pharmacokinetic template or 'Equations' for a step-by-step explanation of the recommended dosing regimen.

In conclusion, Vd seems to be the pharmacokinetic variable most affected in obesity, and can be estimated using an ABW that includes a fraction of the excess body weight TBW-IBW [ 29 ]. Grande et al. Gilbert, B. Sketris, T. Blouin and G. The study by Bauer et al. Medico CJ, Walsh P.

Blouin and G. Medico CJ, Walsh P. View at: Google Scholar R.

  • Caution should be taken with the older patient and possible consideration for some empiric dose reductions based on age and renal function.

  • Materials and Methods 2. A meta-analysis of extended-interval dosing versus multiple daily dosing of aminoglycosides.

  • J Antimicrob Chemother.

  • Table 2.

  • Amikacin Dosage Medically reviewed by Drugs.

Blouin et al, [ hvae ]. Abstract The objective of the paper is to review the literature and provide recommendations for use of aminoglycoside antibiotics in critically ill obese patients. This is the standard therapeutic approach at our institution population on the expected duration of the postantibiotic effect of extended interval aminoglycosides lasting approximately 6—8 hours. Vincent, N. Conclusion Modification of drug dosage in obese patients is very important, particularly when using medications with narrow therapeutic index. Furthermore, the predictive performance of newer formulas such as the MDRD and chronic kidney disease-epidemiology CKD-EPI [ 40 ] compared to the Cockcroft-Gault equation for assessment of kidney function and estimation of aminoglycoside clearance in obesity is unknown [ 41 ]. Casati A, Putzu M.

Amikacin dosing in obese patients have, and P. As aminoglycosides are first-line drugs in sepsis, there is clearly a need for more studies on the appropriate use and dosing of aminoglycosides in critically ill obese patients. A meta-analysis of the relative efficacy and toxicity of single daily dosing versus multiple daily dosing of aminoglycosides. Blouin et al, [ 2 ]. The therapeutic monitoring of antimicrobial agents. Rigorous clinical studies are needed to establish aminoglycoside dosing guidelines in critically ill obese patients with sepsis.

Advances in Pharmacological and Pharmaceutical Sciences

View at: Google Scholar I. A comparison of the Cockroft-Gault vs. Although we evaluated gentamicin and tobramycin, we did not include morbidly obese patients who were administered extended interval doses of amikacin. This subset of patients was assessed for accuracy of achieving therapeutic levels.

J Antimicrob Chemother. We caution practitioners on the dosing of older patients, as they are prone to supratherapeutic levels, even with the estimation of good renal function. Read the winning articles. A meta-analysis of the relative efficacy and toxicity of single daily dosing versus multiple daily dosing of aminoglycosides. Pai, A. Although not preferred based on potential pharmacokinetic discrepancies, we estimated renal function and population kinetics to calculate an estimated mean of Data collected on each patient included age, gender, weight, height, serum creatinine, drug, dose, serum drug concentrations, and timing of sample collection.

Last updated on Dec 1, Use: Treatment of peritonitis. Conclusions The present study shows the efficacy and toxicity associated to the amikacin dosage recommended by the main international dosing guidelines together with the impact of total bodyweight, renal function and serum albumin on amikacin model-informed precision dosing recommendation. Table 1 Amikacin dosing recommended by the international dosing guidelines stratified by renal function. Amikacin is characterized by a narrow therapeutic index and a large intra and interindividual pharmacokinetic PK variability associated with renal function, bodyweight, albumin or age, among others Table S1 [ 141516171819202122232425262728 ].

Loading dose depends on Vd and target plasma concentration Cpboth of which are affected by critical illness: Vd is altered in sepsis, due to alterations in microvascular permeability and abnormalities of extracellular body water. Korsager, [ 4 ]. View at: Google Scholar M.

This subset of patients was assessed for accuracy of achieving therapeutic levels. Effect of obesity on the pharmacokinetics of amikacin dosing in obese patients have in humans. Homan van der Heide, P. Although doeing proteins such as a1 acid-glycoprotein and lipoproteins are highly concentrated in obesity, binding of drugs to albumin does not seem to be altered. Data collected on each patient included age, gender, weight, height, serum creatinine, drug, dose, serum drug concentrations, and timing of sample collection. Br J Clin Pharmacol. All authors state that they do not have any conflicts of interest to report.

Similarly, antimicrobial guidelines also have no consensus on the weight measure best describing the variability of amikacin PK. Akikacin drugs are commonly required to improve hemodynamic function in patients with sepsis or septic shock and can modify the extracellular fluid compartment and volume of distribution of water soluble antibiotics such as aminoglycosides [ 60 ]. Wicha S. Determination of optimal amikacin dosing regimens for pediatric patients with burn wound sepsis. Male Female.

Amikacin is one of the most effective aminoglycoside antibiotics used against severe gram-negative bacterial infections and initial empirical antimicrobial treatments. Bartal C. Medically reviewed by Drugs. Clin Pharmacokinet. Use: Treatment of healthcare-associated ventriculitis and meningitis. Romano S. Consider the following:.

Introduction

Data sharing is not applicable to this patiemts. De Winter S. Barnes-Jewish 4 Although the Barnes-Jewish nomogram has not been formally published, it is commonly used as an extended-interval nomogram. Duszynska W. When a regimen is calculated, each step in the dosing process is fully enumerated and visible by clicking the "Equations" tab.

The absorption of most drugs is thought to be relatively unaffected by obesity [ 16 ]. Learn More. Vincent, N. Pharmacotherapy in the critically ill obese patient. Although aminoglycoside pharmacokinetics have been described in detail, data on aminoglycoside use and appropriate dose modification in critically ill obese patients are very limited. Nicolau, C.

There are four main issues that merit discussion when evaluating pharmacokinetic alterations in obesity: absorption, distribution, metabolism, and elimination. Park GR. Author information Article notes Copyright and License information Disclaimer. Knowledge on aminoglycoside pharmacokinetics and use in critically ill obese patients is incomplete.

A comparison of the Cockroft-Gault vs. There are many limitations of this study. Clinical response to aminoglycoside therapy: importance of the ratio of peak concentration to minimal inhibitory concentration. In order to reach therapeutic levels, some medications require dosing adjustments in obese patients, especially in the presence of critical illness. Bertino Jr. This increased clearance is most likely multifactorial.

Evaluation of amikacin pharmacokinetics and pharmacodynamics for pptimal initial dosing regimen. Indian J. AMKnom outputs are also helpful for better understanding of the quantitative impact of physiological factors on amikacin exposure and probability of treatment success. Uses : -Adjunctive treatment of drug-resistant tuberculosis -Adjunctive treatment of drug-susceptible meningitis caused by M bovis in geographic areas where resistance to streptomycin is common. Drug Metab.

Rigorous clinical studies are needed to establish aminoglycoside dosing guidelines in critically ill obese patients with sepsis. Antimicrob Agents Chemother. Actual pharmacokinetic calculations could be done on three patients due to the availability of a second serum concentration checked within the dosing interval Table 3. This article has been cited by other articles in PMC. Aminoglycosides act synergistically with other antimicrobial agents, and are very important for treatment of serious infections.

References 1. There are four main issues that merit discussion when evaluating amikafin alterations in obesity: absorption, distribution, metabolism, and elimination. This review shows that currently available literature supports the need for aminoglycoside dosage modification in critically ill obese patients. Gentamicin volume of distribution in critically ill septic patients. Cerny, N.

The primary objective of yave study was to assess whether previously published DWCF result in appropriate aminoglycoside drug levels in the morbidly obese population utilizing extended interval dosing. References 1. Traynor et al. A controlled investigation of the pharmacokinetics of gentamicin and tobramycin in obese subjects. The search included all types of articles, including case reports and review articles, and the bibliography of all extracted manuscripts was reviewed in attempt to identify additional references. Am J Kidney Dis.

Evaluation of the Impact of Intrinsic Factors on Amikacin Dosing Regimens AMKnom outputs are also helpful for better understanding of the quantitative impact of physiological factors on amikacin exposure and probability of treatment success. Renal function calculated by an easily available estimated glomerular filtration rate equation. Pharmacokinetic considerations in the obese.

Table 3. A value of less than 0. Margison, T. Antimicrobial dosing considerations in obese adult patients. Ann Intern Med.

Special pharmacokinetic considerations in the obese; pp. View at: Google Scholar M. Aminoglycoside dosing is based on weight, according to either of two strategies: traditional, more frequent dosing, vs. Open in a separate window. By using IBW to define morbidly obese patients, we anticipate that our data can be utilized by clinicians more easily and with more confidence that it relates to their daily practice. Table 3.

Amikacin dosing in obese patients have C. Abstract This study aimed to evaluate the potential efficacy and safety of the amikacin dosage proposed by the main guidelines and to develop an interactive nomogram, especially focused on the potential impact of albumin on initial dosage recommendation. These results show a significant influence of ALB on amikacin dosing optimization with a larger impact on treatment efficacy than CKD-EPI, the latest being currently the main driver of amikacin dosage selection. Mensa: Amikacin dose based on adjusted bodyweight. Lack of clinical response within 3 to 5 days : -Stop treatment and recheck antibiotic susceptibility of the organism. Increase in the volume of distribution is likely to decrease Cmax and total amikacin concentrations over time. Sadeghi K.

Prediction of creatinine clearance from hav creatinine. Wurtz, G. Although plasma proteins such as a1 acid-glycoprotein and lipoproteins are highly concentrated in obesity, binding of drugs to albumin does not seem to be altered. Literature search in PubMed for all articles on the use of aminoglycosides in critically ill obese patients was conducted, and all articles related to pharmacokinetics in obesity were reviewed.

  • IBW was calculated as 2. Rigorous clinical studies are needed to establish aminoglycoside dosing guidelines in critically ill obese patients with sepsis.

  • Low serum albumin and the increased risk of amikacin nephrotoxicity.

  • However, studies in obese patients have shown an altered volume of distribution due to their increased blood flow and cardiac output, changes in protein binding, and organ mass [ 1617 ].

  • The therapeutic monitoring of antimicrobial agents. Anesthesia in the obese patient: pharmacokinetic considerations.

Obese patients are thought to bave an increased glomerular filtration rate, theoretically leading to increased renal elimination of medications. To calculate an estimated CrCl, the Salazar-Corcoran formula was utilized [ 23 — 26 ]. Bosma, J. Open in a separate window. This is most likely related to declining renal function resulting in less aminoglycoside clearance in the older population.

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External link. We recommend caution when dosing aminoglycosides in morbidly obese patients who are of older age. Email: ude. Lesar, D. Crit Care.

As relevant published data are very limited [ 47 ], there is great need for well-conducted clinical trials on obese critically ill patients [ 15 ]. Although dose modification is described in studies by Leader, Corcoran and Blouin, appropriate aminoglycoside doses in critically patiejts obese patients are still debated [ 2 dosin, 111317 ]. Homan van der Heide, P. Schwartz et al evaluated the pharmacokinetics of gentamicin and tobramycin and calculated elimination constants and volumes of distribution in 13 obese vs. Although aminoglycosides have been administered using multiple daily dosing regimens for decades, newer clinical and laboratory studies suggest that once-daily dosing confers advantages with regard to efficacy [ 4344 ]. As Vd increases, aminoglycoside loading doses need to be increased in sepsis [ 15 ], and plasma level monitoring also known as TDM has been recommended to improve safety and effectiveness [ 343637 ].

Support Center Support Center. Amikacin Dosage Medically reviewed by Drugs. Population pharmacokinetics of single-dose amikacin in critically ill patients with suspected ventilator-associated pneumonia. Similarly, antimicrobial guidelines also have no consensus on the weight measure best describing the variability of amikacin PK. Open Menu.

Antimicrob Agents Chemother. This subset of patients was assessed for accuracy of achieving therapeutic levels. Blouin et al, [ 2 ]. Finally, the advantages of large once-daily aminoglycoside doses have been questioned, because of apparent pyrogen-mediated toxicity [ 47 ]. We made this decision under the assumption that most clinicians treating adult patients are more accustomed to drug dosing based on ideal, adjusted, or total body weight.

ALSO READ: Effects Of Being Obese And Overweight

Population pharmacokinetic parameters for bayesian monitoring of amikacin therapy in intensive care unit patients. Hollenberg S. Considering the interactive properties of the AMKnom application, we recommend exploring the online tool to better obese patients the features implemented and the potential of the tool developed on improving amikacin dosage optimization based on PKPD criteria. Home Academy Blog About. Although several studies have shown that amikacin extended interval dose regimen was as effective as multiple-dose per day regimens, with lower risk of toxicity, the once-daily dosing regimen should be used with caution in specific populations [ 133133 ]. Evidence of nephrotoxicity: Discontinue the drug OR adjust the dose.

Uses : -Adjunctive treatment of drug-resistant tuberculosis -Adjunctive treatment of drug-susceptible meningitis caused by M bovis in geographic areas where resistance to streptomycin is common. Amikacin population pharmacokinetics in critically ill Kuwaiti patients. Zazo H. Dosed mg IV Q hrs. Thus, results obtained in obese patients and its impact on dosage recommendation together with efficacy and toxicity associated with alternative body sizes proposed in each guideline must be considered carefully.

Am J Kidney Dis. Although we evaluated gentamicin and tobramycin, we did not include morbidly obese patients who were administered extended interval doses of amikacin. Amikacin pharmacokinetics in morbidly obese patients undergoing gastric-bypass surgery. J Clin Med Res. Bauer, G. Creatinine-clearance estimates for predicting gentamicin pharmacokinetic values in obese patients.

Surviving Sepsis Campaign: obesse guidelines for management of severe sepsis and septic shock: Although the Cockcroft-Gault formula is the predominant methodology to estimate CrCl by clinicians, the Salazar-Corcoran formula has been shown through retrospective trials to be the most precise when dealing with obese patients [ 32324 ]. Dworkin et al.

Amikacin is one dosjng the most effective aminoglycoside antibiotics used against severe gram-negative bacterial infections and initial empirical antimicrobial treatments. Efficacy and safety criteria of amikacin dosage recommended by the guidelines, based on renal function, were not achieved simultaneously in most of the clinical scenarios evaluated. De Montmollin E. Materials and Methods 2.

Drug Intell Clin Pharm. The absorption patientts most drugs is thought to be relatively unaffected by obesity [ 16 ]. In: Applied pharmacokinetics: principles of therapeutic drug monitoring. Patient information was collected from a computerized physician order entry system, an electronic patient database, nursing and physician notes, and billing records. The primary objective of this study was to assess whether previously published DWCF result in appropriate aminoglycoside drug levels in the morbidly obese population utilizing extended interval dosing.

Therapeutic Guide Mensa References 1. Joubert P. Daily dosage of aminoglycosides.

Once-daily dosing of aminoglycosides. Accessed August 24, This calculator uses the amikacin dosing in obese patients have equation to estimate aminoglycoside clearance. Influence of clinical diagnosis in the population pharmacokinetics of amikacin in intensive care unit patients. Monte Carlo simulations performed for the dosage recommended in the international amikacin guidelines evaluated in this work showed the high relevance of ALB for treatment efficacy and toxicity Figure 1. The majority of the antimicrobial therapy guidelines evaluated in this work recommended to adjust amikacin dose and frequency of administration based on renal function calculated with Cockcroft—Gault, CKD-EPI and Salazar—Corcoran equations [ 78910 ].

Moreover, AMKnom has been designed obesr a priori amikacin initial dosage optimization and not for dosage adjustment. Delattre I. Drug Intell Clin Pharm. Large efficacy and safety differences were observed for the evaluated amikacin dosing guidelines together with a significant impact of albumin concentrations on efficacy and safety. In addition, total parenteral nutrition has been correlated with an expanded V and lower Cmax of amikacin as well as with an increase in creatinine clearance [ 61 ].

Nachaisit, P. The Cockcroft-Gault equation can be used to estimate GFR in lean patients, but its use in obesity is questionable due to disparity between muscle mass and body weight ratio [ 18 ]. Winstead, and A.

  • Nightingale, J.

  • Pharmacokinetic considerations in the obese. Int J Clin Pharmacol Ther.

  • Financial Disclosures This manuscript was supported solely by Department Funds. Medico CJ, Walsh P.

  • The Cockcroft-Gault equation can be used to estimate GFR in lean patients, but its use in obesity is questionable due to disparity between muscle mass and body weight ratio [ 18 ].

Once versus multiple daily dosing of aminoglycosides for patients with febrile neutropenia: A systematic review and patienrs. Serum Albumin: Touchstone or totem? Delattre I. Most institutions are using IDMS by this point, but you should contacting your laboratory if you are unsure of your assay. Aminoglycosides nephrotoxicity can limit their use in clinical practice. Institutional Review Board Statement Not applicable.

Am J Kidney Dis. Academic Editor: Karim A. Overall, we found very limited data on aminoglycoside pharmacokinetics and dose modification in obesity. Accepted 25 Jul Because aminoglycoside dosing in critically ill obese patients has not been extensively studied, we could only find limited data, including a literature review by Erstad, which showed that circulatory changes in sepsis affect dosing and pharmacokinetics [ 15 ]. As aminoglycosides are first-line drugs in sepsis, there is clearly a need for more studies on the appropriate use and dosing of aminoglycosides in critically ill obese patients.

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