Chiba K, Tsuchiya M, Kato J, Ochi K, Kawa Z, Ishizaki T
Division of Clinical Pharmacology, National Medical Center, Tokyo, Japan.
Antimicrob Agents Chemother. 1989 Aug;33(8):1188-92. doi: 10.1128/AAC.33.8.1188.
Markedly obese athletes like Japanese sumo wrestlers may frequently suffer various traumas which result in the prophylaxis or treatment of posttraumatic infection with antibiotics. However, appropriate dosage regimens in this group of patients have not been fully known for many antibiotics. Therefore, we studied the kinetic disposition of cefotiam, a parenteral, broad-spectrum cephalosporin with activity against gram-positive and -negative bacteria, after an intravenous dose (2 g) infused over 30 min into 15 sumo wrestler patients with an excess body weight (130 to 220% of ideal body weight) and 10 control patients with a normal weight (90 to 102% of ideal body weight). Mean (+/- standard deviation) clearance and steady-state volume of distribution were significantly greater in the sumo wrestler than in the control group (38.3 +/- 9.4 versus 23.5 +/- 6.0 liters/h, P less than 0.001, and 30.2 +/- 8.0 versus 17.9 +/- 6.1 liters, P less than 0.001). Mean elimination half-life was slightly but significantly longer in the sumo wrestler than in the control group (0.91 +/- 0.14 versus 0.74 +/- 0.20 h, P less than 0.05). However, mean residence time did not differ between the two groups (0.79 +/- 0.10 versus 0.75 +/- 0.14 h). The statistical differences in clearance and volume of distribution between the two groups disappeared when these kinetic parameters were corrected for body surface area, but not for total body weight or ideal body weight. The results suggest that the dosage calculation of cefotiam, a hydrophilic antibiotic, should be made on the basis of body surface area in morbidly obese athlete or sumo wrestler patients. However, whether this recommendation should extend to other nonathlete obese subjects remains to be determined.
像日本相扑选手这样明显肥胖的运动员可能经常遭受各种创伤，这就需要使用抗生素来预防或治疗创伤后感染。然而，对于许多抗生素来说，这组患者的合适给药方案尚未完全明确。因此，我们研究了头孢替安（一种对革兰氏阳性菌和阴性菌均有活性的胃肠外广谱头孢菌素）在静脉注射剂量（2克）、30分钟内输注给15名超重（理想体重的130%至220%）的相扑选手患者和10名体重正常（理想体重的90%至102%）的对照患者后的动力学处置情况。相扑选手组的平均（±标准差）清除率和稳态分布容积显著高于对照组（分别为38.3±9.4升/小时和23.5±6.0升/小时，P<0.001；以及30.2±8.0升和17.9±6.1升，P<0.001）。相扑选手组的平均消除半衰期略长于对照组，但差异有统计学意义（分别为0.91±0.14小时和0.74±0.20小时，P<0.05）。然而，两组的平均驻留时间没有差异（分别为0.79±0.10小时和0.75±0.14小时）。当根据体表面积而非总体重或理想体重对这些动力学参数进行校正时，两组之间清除率和分布容积的统计学差异消失。结果表明，对于病态肥胖的运动员或相扑选手患者，亲水性抗生素头孢替安的剂量计算应以体表面积为基础。然而，这一建议是否应扩展到其他非运动员肥胖受试者仍有待确定。
