Ceftazidime dosing in obese patients: is it time for more?

ABSTRACT

Introduction

Ceftazidime is used for the treatment of many bacterial infections, including severe P. aeruginosa infections. Like other beta-lactams, inter-individual variability in ceftazidime pharmacokinetics has been described. Due to its related pathophysiological modifications, obesity might influence ceftazidime pharmacokinetics.

Areas covered

The objective of this review is to assess the current state of knowledge about the impact of obesity on ceftazidime treatment. A literature search was conducted on PubMed-MEDLINE (2016–2021) to retrieve pharmacokinetic studies published in English, matching the terms ‘ceftazidime’ AND ‘pharmacokinetics.’

Expert opinion

The impact of obesity on pharmacokinetics is generally poorly known, mainly because obese patients are often excluded from clinical studies. However, the published literature clearly shows that obese patients have significantly lower ceftazidime concentrations. This could be explained by increased volume of distribution and clearance. This low exposure represents a major factor of therapeutic failure, potentially fatal for critically ill patients. While further studies would be useful to better assess the magnitude and understanding of this variability, the use of higher doses of ceftazidime is needed in obese patients. Moreover, therapeutic drug monitoring for dose adaptation is of major interest for these patients, as the efficacy of ceftazidime seems to be directly related to its plasma concentration.

KEYWORDS:

• Beta-lactam
• ceftazidime
• continuous infusion
• obese
• obesity
• therapeutic drug monitoring

Article highlights

• Obese patients treated with β-lactams have higher rates of treatment failure and longer hospitalization periods than non-obese patients.

• Only 25% to 33% of the patients reached target concentrations using a standard dosing regimen.

• This lower exposure may be explained by a greater volume of distribution or clearance.

• Ceftazidime therapeutic drug monitoring should be performed within the first 24 h after treatment introduction to guide dose adjustment, especially in critically ill obese patients.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.