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The findings of a new study reported last week at the annual conference of the American College of Emergency Physicians were quite intriguing. The study found that physicians who work in emergency rooms of hospitals seldom make dose adjustments in antibiotic drugs given to obese patients, which can result in insufficient treatment and trigger resistance to antibiotics.
According to Reuters Health, Dr. Michael Mullins, co-researcher of the study said that for some antibiotic drugs, "people who are larger require a larger dose to get and maintain the proper concentration that will reliably kill the bacteria we're trying to get at."
But Mullins said that for majority of antibiotic medications, they have a "one-size-fits-all dose" in their minds, "and we tend to give that dose regardless of size and other factors that should affect dosing, like age, (kidney) function, and body mass index," he said.
The adjustment is not all that hard to make. Mullins explained that in majority of cases, it means doubling the dose or raising it by up to 50 percent. "Otherwise, you might get half or less of the concentration you wanted," he said.
And he cautioned that "if you give too low a dose, 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."
Mullins and his team, from Washington University School of Medicine, St. Louis, made an analysis of the rate at which their center’s emergency doctors followed the dose adjustment guidelines for certain antibiotics set by the antibiotic utilization review (AUR) committee of the university.
The research team analyzed data gathered from a little more than a thousand emergency room patients who received treatment over a period of three months and weighing more than 100 kilograms (220 pounds), were obese (having a body mass index of more than 40) and were treated with one of the following antibiotic drugs: cefazolin, cefepime, or ciprofloxacin.
The dosing guidelines established for these antibiotics were adhered to in these obese patients for just 48 doses of cefepime (9.5 percent), 12 doses of cefazolin (4.1 percent), and 4 doses of ciprofloxacin (1.3 percent), the researchers said.
Mullins said he thinks this issue is not given enough recognition by emergency room doctors and other specialists. According to him, it is particularly disturbing because of the fact that "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."
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