For obese patients, which weight calculation is recommended for aminoglycoside dosing?

For dosing aminoglycosides in obese patients, the recommended weight calculation is adjusted body weight. This approach recognizes the necessity of accounting for both the fat and lean components of body mass to ensure effective and safe pharmacotherapy.

Aminoglycosides have a narrow therapeutic index and exhibit concentration-dependent killing, meaning their effectiveness is closely tied to achieving appropriate serum concentrations. In obese patients, using absolute body weight can lead to overdosing due to the increased volume of distribution associated with excess body fat. Conversely, using ideal body weight does not adequately account for the increased volume in obese individuals, potentially leading to suboptimal dosing.

Adjusted body weight provides a balanced method that mitigates the risk of overdose while still ensuring sufficient drug levels. It is calculated using a formula that incorporates a patient’s ideal body weight and their actual weight. This balance helps to optimize dosing of aminoglycosides, improving therapeutic effectiveness while minimizing the risk of toxicity. Therefore, adjusted body weight is the most suitable choice for aminoglycoside dosing in obese patients.