Pharmacy Department, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
Curr Opin Infect Dis. 2012 Dec;25(6):634-49. doi: 10.1097/QCO.0b013e328359a4c1.
Obesity is becoming a major burden on healthcare systems worldwide. The management of infections is problematic due to both an increased risk of morbidity and mortality, as well as a lack of information about dosing of antibiotics in the obese population. Recommendations in this patient group are severely lacking, so clinicians need to consider pharmacokinetic/pharmacodynamic parameters and the relative risks of overdosing and underdosing.
Since 2011, articles on a number of antibiotics have been published, including cefazolin/cephazolin, cefepime, cefoxitin, clindamycin, cotrimoxazole, daptomycin, ertapenem, levofloxacin, linezolid, meropenem, moxifloxacin, piperacillin/tazobactam and vancomycin.
Obesity causes a number of changes, including an increase in volume of distribution and changes in hepatic metabolism and renal excretion. Several antibiotics have sufficient data to be able to make recommendations, whereas other antibiotics may need to make use of doses at the upper end of the recommended range, or utilize other dose modifications based on pharmacokinetic/pharmacodynamic parameters, in an attempt to reach adequate levels and achieve similar efficacy.
肥胖正在成为全球医疗体系的主要负担。由于肥胖人群中抗生素剂量的信息缺乏，感染的管理存在问题，既增加了发病率和死亡率的风险。该患者群体严重缺乏相关建议，因此临床医生需要考虑药代动力学/药效学参数以及药物过量和剂量不足的相对风险。
自 2011 年以来，已经发表了许多关于抗生素的文章，包括头孢唑林/头孢唑啉、头孢吡肟、头孢西丁、克林霉素、复方磺胺甲噁唑、达托霉素、厄他培南、左氧氟沙星、利奈唑胺、美罗培南、莫西沙星、哌拉西林/他唑巴坦和万古霉素。
肥胖会引起许多变化，包括分布容积增加以及肝代谢和肾排泄的改变。有几种抗生素有足够的数据可以提出建议，而其他抗生素可能需要使用推荐范围上限的剂量，或者根据药代动力学/药效学参数使用其他剂量调整，以试图达到足够的水平并实现类似的疗效。
