Optimizing Treatments in Obese Patients With SSTIs

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The pharmacokinetic/pharmacodynamic approach provides valuable data in preventing and treating SSTIs in the obese population.
The pharmacokinetic/pharmacodynamic approach provides valuable data in preventing and treating SSTIs in the obese population.

When treating skin and soft tissue infections (SSTIs) in obese patients, the pharmacokinetic/pharmacodynamic approach offers important data and decision-making tools for optimizing regimens used for both prevention and treatment of SSTIs in this population, according to a review published in Current Opinion in Infectious Diseases

Many antibiotic treatments are available to prevent and treat SSTIs but their profile in obese patients is not a regulatory requirement. Data that contains importance for optimizing the dosing regimen in obese patients "may not be readily available," noted study author Mordechai Grupper. Grupper and coauthor David P. Nicolau conducted a review addressing the latest pharmacokinetic/pharmacodynamic data with a focus on cefazolin for surgical prophylaxis as well as antibiotics that are effective against methicillin-resistant Staphylococcus aureus (MRSA). The review also discussed the implications of optimizing SSTI prevention and treatment among obese patients.

Most studies found prophylactic cefazolin 2g to be appropriate in the case of obese patients undergoing bariatric surgery or cesarean delivery. There seemed to be inadequate data regarding the pharmacokinetic/pharmacodynamic characteristics of antimicrobials active against MRSA in the obese population.  Therapeutic drug monitoring was recommended in these cases as they were tied to pharmacokinetic/pharmacodynamic optimization for vancomycin and teicoplanin. Grupper and Nicolau found more supportive evidence for use of oxazolidinones (eg, linezolid and tedizolid), daptomycin, and lipoglycopeptides (eg, telavancin, dalbavancin, oritavancin) in the management of SSTIs in this population. 

The researchers concluded that "important pharmacokinetic/pharmacodynamic characteristics of antibiotics, such as the penetration into the subcutaneous tissue and the probability of reaching the pharmacodynamic target dictate efficacy, and thus should be taken into account and further investigated."

Reference

Grupper M, Nicolau DP. Obesity and skin and soft tissue infections: how to optimize antimicrobial usage for prevention and treatment? [published online January 23, 2017] Curr Opin Infect Dis. doi: 10.1097/QCO.0000000000000356

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