Pharmacokinetics of Antimicrobials in Obese Children.

Journal Article

Childhood obesity is common and results in substantial morbidity. The most commonly prescribed drugs in obese children are antibiotics. However, physiologic changes associated with childhood obesity can alter antibiotic pharmacokinetics and optimal body size measures to guide dosing in his population are ill defined. This combination can result in therapeutic failures or drug-related toxicities. This review summarizes pharmacokinetic information for antibiotics in obese children and implications for dosing.We conducted a comprehensive literature search of PubMed, EMBASE, and International Pharmaceutical Abstracts to identify pharmacokinetic studies of antimicrobial agents in obese children. We included the following search terms: obesity, pharmacokinetics, pharmacodynamics, drug toxicity, dosing, anti-infective agents, antiviral agents, and antifungal agents.We identified four pharmacokinetic studies of antibiotics in obese children: one for cefazolin and tobramycin, one for gentamicin, and two for vancomycin. Only the cefazolin/tobramycin trial was prospective. The drugs studied differ in their tissue and body water distribution characteristics. Two of the studies (tobramycin and gentamicin) reported pharmacokinetic differences and required dosing modifications in obese children.The lack of pharmacokinetic studies in obese children is pronounced. The scarcity of pharmacokinetic data limits the ability to predict drug disposition using drug physicochemical properties and impedes a rational approach to selection of appropriate body size measures for dosing. Given this knowledge gap, additional trials in obese children are urgently needed and is a public health concern.Pharmacokinetic studies of antimicrobials in obese children are desperately needed to guide dosing and avoid therapeutic failures or unwanted toxicities.

Full Text

Duke Authors

Cited Authors

  • Sampson, M; Cohen-Wolkowiez, M; Benjamin, D; Capparelli, E; Watt, K

Published Date

  • January 2013

Published In

Volume / Issue

  • 2 / 2

Start / End Page

  • 76 - 81

PubMed ID

  • 25009734

Electronic International Standard Serial Number (EISSN)

  • 2033-6772

International Standard Serial Number (ISSN)

  • 2033-6403

Digital Object Identifier (DOI)

  • 10.5639/gabij.2013.0202.025

Language

  • eng