Infektionen und antimikrobielle Therapie bei übergewichtigen Patienten – Was ist bei der Dosierung von Antibiotika zu beachten?

Zusammenfassung

Die Zahl der adipösen Patienten nimmt in Deutschland und anderen Ländern zu. Die Bedeutung des erhöhten Körpergewichts als Risikofaktor für diverse Erkrankungen ist gut untersucht, zur Frage der Adipositas-bedingten Disposition für Infektionen gibt es allerdings relativ wenige Studien. Pulmonale Infektionen, Hautinfektionen, postoperative Infektionen und einige andere werden aber offenbar durch eine Adipositas begünstigt. Angesichts der abnehmenden Empfindlichkeit vieler Erreger gegen die verfügbaren antibakteriellen Wirkstoffe, erscheint eine optimale Dosierung der Antibiotika notwendiger als je zuvor. Durch individuell berechnete Dosierungen sollte eine optimierte Therapie zur Anwendung kommen. Ein solches Vorgehen kann den Erfolg der Therapie erhöhen, einer Resistenzausbreitung entgegenwirken und schließlich auch das Risiko für unerwünschte Wirkungen reduzieren. Als eine wesentliche Voraussetzung für eine optimierte Therapie wird die Durchführung entsprechender Studien bei übergewichtigen Patienten gefordert, da die Theorie-basierten Möglichkeiten der Dosisberechnung begrenzt sind.

Summary

Prevalence of overweight and obesity is rising in Germany and other countries. Significance of increased body weight as a risk factor for several diseases has been well studied, however, only few studies exist with respect to the disposition for infectious diseases. Pulmonary infections, skin and soft tissue infections, postoperative infections and several others obviously are promoted by obesity. In light of decreasing sensitivity of many pathogens against available antibacterial agents an optimal dosing of antibiotics is required more than ever before. An optimized therapy should be based on individually calculated doses. Such an approach can increase success of therapy, counteract development of resistance and last not least reduce the risk for adverse reactions. An essential prerequisite for an optimized therapy are studies in obese patients, because the possibilities for a theory-based dose calculation are limited.

Key words

Antibiotics - obesity - infections - dosing

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