Dosing of antimicrobials in obesity: Difference between revisions

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| Use ABW<sub>0/4</sub>
 
| Use ABW<sub>0/4</sub>
 
| 200 mg or 2 MU daily (toxicity)
 
| 200 mg or 2 MU daily (toxicity)
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| [[Ceftaroline]]
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| Consider 18h
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| [[Clindamycin]]
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| 600 mg IV q6h<br/>900 mg IV q8h<br/>450-600 mg PO q6h<br/>600-900 mg PO q8h
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| 2700 mg daily; or 4800 mg daily IV if life-threatening
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| [[Dalbavancin]]
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| Usual dose
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| [[Daptomycin]]
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| Use ABW<sub>0.4</sub>
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| [[Linezolid]]
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| 600 mg PO/IV q12h
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| Usual dose
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| [[Oritavancin]]
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| Usual dose
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| [[Cotrimoxazole]]
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| Up to 320 mg(TMP) PO q12h<br/>8-10 mg(TMP)/kg<sub>ABW</sub> in divided doses
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| Consider ABW<sub>0.4</sub> when doing high dose
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| [[Telavancin]]
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| Usual dose
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| [[Tigecycline]]
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| Usual dose
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| [[Vancomycin]]
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| 20-25 mg/kg load (max 2.5 g)<br />10-15 mg/kg q12h (maintenance)
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| Use TBW; or 25-30 mg/kg load and 15 mg/kg q12h with ABW<sub>0.4</sub>
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Revision as of 12:21, 9 December 2019

Calculating Body Weight

Statistic Equation (Male) Equation (Female) Notes
Body mass index (BMI) (kg/m2) weight, kg / (height, m)2
Body surface area (BSA) (m2) (height, cm × weight, kg / 3600)1/2
Ideal body weight (IBW) (kg) 50 + 2.3 × (inches over 5 ft) 45.5 + 2.3 × (inches over 5 ft)
Adjusted body weight (ABW) (kg) IBW + C × (TBW - IBW) C = 0.3 to 0.4
Lean body weight (LBW) (kg) 9270 × TBW / 6680 + 216 x BMI 9270 × TBW / 8780 + 244 x BMI
Fat-free weight (FFW) (kg) 0.00139 × (height, cm)2 - 0.0801 × R + 0.187 × TBW + 39.83 0.00151 × (height, cm)2 - 0.0344 × R + 0.14 × TBW - (0.158 × age) + 20.387 R = resistance

Antibiotics

β-lactams

Penicillins

Drug Usual Dose Obesity Max dose
Amoxicillin 1 g PO q8h No data
Ampicillin 2 g IV q4h
Nafcillin 2 g IV q4h No data
Piperacillin-tazobactam 4.5 g IV q6-8h Prolonged infusion 18 g daily

Cephalosporins

Drug Usual Dose Obesity Max dose
Cefazolin 1-2 g IV q8h 2-3 g IV q6-8h No data; 12 g daily
Cephalexin 500-1000 g PO qid 1000 g PO qid No data
Cefipime 2 g IV q8h 2 g IV q8h prolonged infusion 2 g IV q8h prolonged infusion
Ceftazidime 2 g IV q8h 2 g IV q8h prolonged infusion 2 g IV q8h prolonged infusion
Ceftazidime-avibactam Usual dose
Ceftolozane-tazobactam Usual dose

Carbapenems

Drug Usual Dose Obesity Max dose
Doripenem Consider extended infusion
Ertapenem 1 g IV q24h Usual dose
Imipenem
Meropenem Consider prolonged infusion

Quinolones

Drug Usual Dose Obesity Max dose
Ciprofloxacin 500-750 mg PO q12h or 400 mg IV q6-8h 400 mg IV q8h or 750 mg PO q12h
Levofloxacin 750 mg PO q24h Consider up to 1000 mg PO q24h
Moxifloxacin Usual dose

Macrolides

Drug Usual Dose Obesity Max dose

Tetracyclines

Drug Usual Dose Obesity Max dose

Aminoglycosides

Drug Usual Dose Obesity Max dose
Amikacin Use ABW0.4
Gentamicin Use ABW0.4
Tobramycin Use ABW0.4

Others

Drug Usual Dose Obesity Max dose
Aztreonam 2 g IV q6-8h
Colistin Use IBW 360 mg daily (nephrotoxicity)
Polymyxin B Use ABW0/4 200 mg or 2 MU daily (toxicity)
Ceftaroline Consider 18h
Clindamycin 600 mg IV q6h
900 mg IV q8h
450-600 mg PO q6h
600-900 mg PO q8h
2700 mg daily; or 4800 mg daily IV if life-threatening
Dalbavancin Usual dose
Daptomycin Use ABW0.4
Linezolid 600 mg PO/IV q12h Usual dose
Oritavancin Usual dose
Cotrimoxazole Up to 320 mg(TMP) PO q12h
8-10 mg(TMP)/kgABW in divided doses
Consider ABW0.4 when doing high dose
Telavancin Usual dose
Tigecycline Usual dose
Vancomycin 20-25 mg/kg load (max 2.5 g)
10-15 mg/kg q12h (maintenance)
Use TBW; or 25-30 mg/kg load and 15 mg/kg q12h with ABW0.4

Further Reading

  • Comprehensive Guidance for Antibiotic Dosing in Obese Adults. Pharmacotherapy. 2017;37(11):1415-1431. doi: 10.1002/phar.2023