Antimicrobial Dosing in Obese Patients

Öz

Obesity is closely associated with a great number of infectious diseases. Certain challenges are experienced in the management of these infections due to the physiological changes in obese individuals. These physiological changes lead to alterations in pharmacokinetics and pharmacodynamics profiles of antimicrobial drugs. In terms of pharmacokinetics, the volume of distribution and the clearance of the drug; with regard to pharmacodynamics, the minimum inhibitory concentration and area under the curve play an important role in drug treatment. Consequently, administration of drug doses which are applicable to normal weight patients causes either inadequate treatment or undesirable outcomes such as nephrotoxicity and hepatotoxicity in obese patients. Since the drug dosing (per kilogram dose) is based on the actual body weight, appropriate changes in the doses of certain drugs may be required. A number of descriptive measurements for body size -total body weight, lean body weight, adjusted body weight, ideal body weight, body mass index, body surface area- have been developed and formulated for this. The method to be used for obese individuals is determined in accordance with the physicochemical properties of a particular drug. This review aimed to investigate pharmacokinetic and pharmacodynamic changes in obese patients and to provide up-to-date information on dose changes that might be required to administer accurate and rational doses of antibiotic, antifungal and antiviral drugs, and also to indicate which body size measurement should be used during drug treatment.

Anahtar Kelimeler

• Obesity
• Pharmacokinetics
• Pharmacodynamics
• Dose
• Antibiotic
• Antifungal
• Antiviral
• Clinical pharmacist

OBEZ HASTALARDA ANTİMİKROBİYAL İLAÇ DOZLARI

Öz

Obezite çok sayıda enfeksiyon hastalığı ile yakından ilişkilidir. Bu enfeksiyonların yönetiminde obez bireylerde görülen fizyolojik değişiklikler sebebiyle zorluklar yaşanmaktadır. Bu fizyolojik değişiklikler ilaç farmakokinetiği ve farmakodinamiğinin değişmesine sebep olmaktadır. Farmakokinetik olarak dağılım hacmi ve ilaç klirensi; farmakodinamik olarak ise, minimum inhibitör konsantrasyon ve eğri altında kalan alan önemli rol oynamaktadır. Sonuç olarak normal kilolu hastalar için verilen ilaç dozları obez hastalarda ya yetersiz tedavi dozu ya da nefrotoksisite, hepatotoksisite gibi istenmeyen durumlara sebep olmaktadır. Özellikle vücut ağırlığına göre dozları belirlenen ilaçlarda hesaplanan doz gerçek vücut ağırlığına dayandığından bazı ilaçların dozlarında değişiklik yapılması gerekebilmektedir. Bunun için çeşitli vücut ölçüsü tanımlayıcıları – toplam vücut ağırlığı, yağsız vücut ağırlığı, düzeltilmiş vücut ağırlığı, ideal vücut ağırlığı, beden kitle indeksi, vücut yüzey alanı – geliştirilmiş ve formüle edilmiştir. Obez bireylerde hangi yöntemin kullanılacağı ilacın fizikokimyasal özelliklerine göre belirlenmektedir. Bu derleme ile obez hastalarda farmakokinetik ve farmakodinamik değişimlerin incelenmesi ve antibiyotik, antifungal ve antiviral ilaç dozlarının doğru ve akılcı şekilde sağlanması için doz değişikliklerinin gerekli olup olmadığı, hangi vücut büyüklüğü tanımlayıcısının kullanılması gerektiği ile ilgili güncel bilgilerin sunulması amaçlanmaktadır. 

Anahtar Kelimeler

• Obezite
• Farmakokinetik
• Farmakodinamik
• Doz
• Antibiyotik
• Antifungal
• Antiviral
• Klinik eczacı

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