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Emergency Doctors Rarely Adjust Antibiotic Doses for Obese Patients

Posted: Wednesday, October 21, 2009

Emergency department physicians rarely adjust antimicrobial medication doses for obese patients, according to new research.

Dr. Michael Mullins, study co-researcher stated that, "We have a one-size-fits-all dose in our minds for most antibiotics, and we tend to give that dose regardless of size and other factors that should affect dosing, like age, renal function, and body mass index."

Dr. Mullins and his colleagues, from Washington University School of Medicine, St. Louis, MO, analyzed the rate at which their center's emergency physicians adhered to dose adjustment guidelines for selected antibiotics established by the university's antibiotic utilization review (AUR) committee.

They reviewed data for all emergency department patients treated over a 3-month period who weighed more than 100 kg, had a body mass index greater than 40 kg/m2, and were given cefazolin, cefepime, or ciprofloxacin.

Slightly more than a thousand patients met the study criteria. Overall, they were treated with 503 doses of cefepime, 293 doses of cefazolin, and 306 doses of ciprofloxacin. Thirty received more than one antibiotic.

Based on AUR guidelines, the initial dose for these patients should be 2 g IV for cefazolin or cefepime and 800 mg IV or 750 mg PO for ciprofloxacin.

These guidelines were followed for only 48 doses of cefepime (9.5%), 12 doses of cefazolin (4.1%), and 4 doses of ciprofloxacin (1.3%).

"Obesity is an epidemic in North America in particular, and unfortunately, we're seeing more people in the obese and severely obese range than we used to," Dr. Mullins observed. "I think this problem is under-recognized by emergency physicians and other specialists."

"If you give too low a dose," he cautioned, "you'll have treatment failure even if you pick the right antibiotic -- and increase the likelihood that some of the bacteria you're trying to kill will form a mutation and become less sensitive to the drug."

Source: Diabetes In Control: Reported Oct. 6, 2009, at the American College of Emergency Physicians annual meeting in Boston.