Pharmacokinetics and protein binding of cefazolin in morbidly obese patients View Full Text


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Article Info

DATE

2011-10

AUTHORS

Simone van Kralingen, Margot Taks, Jeroen Diepstraten, Ewoudt M. van de Garde, Eric P. van Dongen, Marinus J. Wiezer, Bert van Ramshorst, Bart Vlaminckx, Vera H. Deneer, Catherijne A. Knibbe

ABSTRACT

PURPOSE: The aim of this study was to assess the pharmacokinetics and protein binding of cefazolin in morbidly obese patients undergoing bariatric surgery, to study the influence of bodyweight measures and age on pharmacokinetic parameters and to evaluate unbound cefazolin concentrations over time in this population. METHODS: Twenty morbidly obese patients (bodyweight 112-260 kg, body mass index 38-79 kg m(-2)) were studied following the administration of cefazolin 2 g at induction of anaesthesia. Blood samples were collected up to 4 h post-dosing to determine total and unbound plasma cefazolin concentrations. Non-compartmental pharmacokinetic data analysis was performed. RESULTS: Cefazolin clearance was 4.2 ± 1.0 L h(-1) (mean ± standard deviation) and showed a negative correlation with age (p = 0.003) but not with bodyweight measures (p > 0.05). Volume of distribution was 13.0 ± 3.1 L and correlated positively with bodyweight measures (p ≤ 0.001). Saturable protein binding was observed with a median protein binding of 79% (interquartile range 74-82), which proved similar to reported protein binding in non-obese patients. In all patients, unbound cefazolin concentrations remained above 1 mg L(-1) (minimal inhibitory concentration for 90% (MIC(90)) of methicillin-sensitive isolates of Staphylococcus aureus in Europe) until 4 h post-dosing. CONCLUSIONS: Younger age--and not bodyweight--was significantly associated with higher cefazolin clearance. However, as in all patients with bodyweights up to 260 kg, unbound plasma cefazolin concentrations remained above 1 mg L(-1) until 4 h after the intravenous administration of a 2-g dose. As such, re-dosing within 4 h or dosing with another antibiotic class should only be considered in the case of a higher MIC(90) of the local isolates. More... »

PAGES

985-992

References to SciGraph publications

  • 2007-11. Dosing in Obesity: A Simple Solution to a Big Problem in CLINICAL PHARMACOLOGY & THERAPEUTICS
  • 2000-04. Obesity as a medical problem in NATURE
  • 1999-12. An additional dose of cefazolin for intraoperative prophylaxis in SURGERY TODAY
  • Identifiers

    URI

    http://scigraph.springernature.com/pub.10.1007/s00228-011-1048-x

    DOI

    http://dx.doi.org/10.1007/s00228-011-1048-x

    DIMENSIONS

    https://app.dimensions.ai/details/publication/pub.1040129909

    PUBMED

    https://www.ncbi.nlm.nih.gov/pubmed/21499760


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