Obesity presents itself as a growing challenge for healthcare, especially in the treatment of infections due to pharmacokinetic changes that compromise the effectiveness of antimicrobials at conventional doses. Furthermore, its association with comorbidities such as type 2 diabetes mellitus impairs the immune response, increasing the risk of severe infections and the need for intensive care unit admissions. To develop a digital calculator for dose adjustment of antimicrobials in obese patients, promoting rational and safe use of these drugs. A literature review from the last 10 years was carried out in the UptoDate, Sanford Guide, and PubMed databases, aiming to identify studies addressing dose adjustment of antibiotics, antivirals, antifungals, and antituberculosis agents in obese adults. Fourteen articles were selected for detailed analysis. Discrepancies in antimicrobial adjustment data were resolved by technical consensus between clinical pharmacists and infectious disease specialists from the Hospital Infection Control Service. The extracted data were then incorporated into a digital platform supported by artificial intelligence for the creation of the calculator to be used in a quaternary private hospital in São Paulo. Of the 48 antimicrobials evaluated, 16 presented adjustment possibilities: 8 antibiotics, 3 antivirals, 2 antifungals, and 3 antituberculosis agents. For dose calculations, the articles indicated the use of ideal body weight (IBW) and adjusted body weight (AdjBW) as strategies for some antimicrobials, applied respectively to 5 and 9 antimicrobials, allowing better adaptation to the pharmacokinetic changes observed in obese patients. Another highlighted approach was the extension of infusion time for time-dependent antimicrobials, applied to 2 drugs, optimizing their efficacy. The adjustments, based on the formulas described in the articles for IBW and AdjBW calculations, resulted in lower doses than those calculated using total body weight, contributing to a lower risk of toxicity. The digital calculator aims to facilitate antimicrobial dose adjustment in obese patients, promoting rational and safe use. Furthermore, it guides healthcare professionals in proper prescribing and supports clinical decisions, especially in critical hospital settings.
Lopes et al. (Sun,) studied this question.