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Tuesday, May 2, 2017

Meropenam: Dosing in Obesity

Pharmacokinetic
  • time dependent activity
  • tend to have higher volume of distribution and clearance, which may cause lower meropenam levels
  • however, meropenem pharmacokinetics are similar between obese and non-obese patients, so same dosages provide comparable pharmacodynamic exposures for susceptible organisms between obese and non-obese patients
Effectiveness
  • routine dose escalation not recommended as standard dosing regimen able to achieve adequate PD exposure for susceptible pathogen (MIC <2mg/ml)
  • only the dosing 2g TDS and 1g QID was able to achieve MIC > 4mg/ml
  • prolonging the infusion time to 3h enhanced the dosage regimen 
Alternative Dosings
  • similar clinical outcomes seen between traditional (1g TDS) and alternative meropenem dosing (500mg QID) strategies in previous studies may extend to obese patients
Conclusion
  • dose escalation not recommended as standard dosing regimen able to achieve adequate PD exposure
  • however doses can be increased if higher MIC is required, exm multi resistant p.aeruginosa. 
References:
  1. http://formularyjournal.modernmedicine.com/formulary-journal/content/tags/antibiotics/underdosing-obesity-epidemic-focus-antibiotics
  2. Drug Dosing in Obesity: Volume I: Antimicrobials. 
  3. https://idsa.confex.com/idsa/2015/webprogram/Paper51176.html
  4. http://docs.lib.purdue.edu/dissertations/AAI3719044/
  5. http://pusware.com/testpus/drug_Obesity_dosing.html
  6. UKCPA: Drug Dosing in Extremes of Body Weight in critically ill patients. 1st Edition (v1.0)September 2013

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