Dosing of antifungal agents in obese people

Payne, Kenna D.; Hall, Ronald G.

doi:10.1586/14787210.2016.1128822

Cited by 33 publications

(24 citation statements)

References 54 publications

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“…Antifungals, antiretrovirals, antiparasitic, and antituberculosis agents are excluded. For a review of antifungal dosing in obesity, interested readers should refer to a review referenced at the end of this article …”

Section: Body Mass Index Classificationmentioning

confidence: 99%

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Comprehensive Guidance for Antibiotic Dosing in Obese Adults

et al. 2017

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Physiologic alterations seen in obesity commonly impact the pharmacokinetics (PK) and pharmacodynamics (PD) of antibiotics and may result in suboptimal dosing in this expanding but understudied population. Much of the published clinical and PK evidence to date consists of small patient populations and are retrospective with, not infrequently, heterogeneous results that in some cases are contradictory. In the last 10 years, additional antimicrobial PK/PD and clinical data encompassing prolonged infusion strategies and examination of critically ill populations have emerged to inform antimicrobial dosing in obesity. In this narrative review, we critically review literature on dosing, PK, and possible dosing strategies in obese adults. We searched PubMed, Scopus, and the Cochrane Library using Medical Subject Headings including anti-infectives, specific antimicrobial names, obese, pharmacokinetics, and others. We reviewed articles, cross-referenced select cited references, and when applicable, referenced drug databases and package inserts to develop dosing recommendations. We provide an overall critical review of the available data regarding PK and dosing issues including dosing recommendations in both critically ill and noncritically ill patients with significant obesity. We developed dosing recommendations for 34 antimicrobials based on 121 articles of the 2336 identified by the search strategy. Although 11 of these do not appear to require dose adjustment, obesity-specific dosing guidance is provided for the remaining 23 antimicrobials. Additional studies are needed to better understand and resolve discrepant published results regarding the PK of antibiotics to establish optimal dosing strategies in obese adults. Alternative dosing strategies, such as extended infusions, should be considered for time-dependent antibiotics (e.g., β-lactams) in obese patients to achieve PD targets reliably. Therapeutic drug monitoring across the spectrum of antimicrobials is of increasing importance in this and other populations to ensure optimized dosing.

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Section: Body Mass Index Classificationmentioning

confidence: 99%

“…For a review of antifungal dosing in obesity, interested readers should refer to a review referenced at the end of this article. 10…”

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confidence: 99%

Comprehensive Guidance for Antibiotic Dosing in Obese Adults

et al. 2017

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“…There are conflicting data on dosing recommendations in obese patients [ 3 ]. Payne and Hall [ 4 ] found that lower caspofungin AUC was achieved in obese people than in thinner ones, suggesting that dose optimization in heavier patients might improve clinical success rates. If the labelled dose of 70 mg/day had been used in our patient, AUC/MIC would have been 786, below the target AUC/MIC value.…”

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confidence: 99%

“…Figure 1 shows caspofungin concentrations over time for doses of 100 and 70 mg/day. A dose of 150 mg/day has been recommended in obese patients until simulation studies are completed to provide a bedside dosing formula for caspofungin [ 4 ]. There are reports of deterioration of hemodynamic parameters during loading doses in critically ill patients [ 5 ].…”

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confidence: 99%

Plasma concentrations of caspofungin in a critically ill patient with morbid obesity

et al. 2017

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“…Furthermore, the reduction in body weight post‐RYGB can have an impact on the disposition of posaconazole. However, posaconazole dosages should not be changed for increased body weight, although follow‐up studies are needed to investigate the impact of obesity on the disposition of posaconazole .…”

Section: Discussionmentioning

confidence: 99%