Background and Objectives: To evaluate the effect of obesity parameters on the pharmacokinetics of cefoxitin administered for antibiotic prophylaxis during bariatric surgery.Methods: This a secondary analysis of a pharmacokinetic study involving 174 obese patients scheduled for bariatric surgery and receiving a 4-g dose of cefoxitin. Blood samples were collected at incision and wound closure. The total plasma concentrations were assessed utilising a validated high-performance liquid chromatographytandem mass spectrometry method. The pharmacokinetic and pharmacodynamic target was defined as an estimated free concentration of cefoxitin at the time of wound closure >8 mg/L. Specific evaluated obesity parameters were fat body mass, fat body mass/height 2 , lean body mass, lean body mass/height 2 , visceral adipose tissue and presence of a metabolic syndrome.Results: A total of 174 patients (median age 47 years) with a majority of women (75.3%) and a median BMI of 44 kg/m 2 were analysed. The percentage of patients who met the pharmacokinetic and pharmacodynamic target was 85.1%. In the whole population, a tendency to fail to reach the target was observed with a higher lean mass over height² (OR = 0.79; 95% CI [0.62 to 1.01]; P = 0.060). In the female subgroup, higher lean mass over height² (OR = 0.63; 95% CI [0.41 to 0.97]; P = 0.037) and the presence of a metabolic syndrome (OR = 0.17; 95% CI [0.03 to 0.83]; P = 0.030) were associated with failure to reach the pharmacokinetic and pharmacodynamic target.Conclusion: Obese patients with a higher lean mass and a metabolic syndrome could constitute a subgroup at risk for cefoxitin under-dosage.
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