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:
- http://formularyjournal.modernmedicine.com/formulary-journal/content/tags/antibiotics/underdosing-obesity-epidemic-focus-antibiotics
- Drug Dosing in Obesity: Volume I: Antimicrobials.
- https://idsa.confex.com/idsa/2015/webprogram/Paper51176.html
- http://docs.lib.purdue.edu/dissertations/AAI3719044/
- http://pusware.com/testpus/drug_Obesity_dosing.html
- UKCPA: Drug Dosing in Extremes of Body Weight in critically ill patients. 1st Edition (v1.0)September 2013
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