spbmedicalrecordsНовые Санкт-Петербургские врачебные ведомостиNew St. Petersburg Medical Records1609-2201Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова10.24884/1609-2201-2025-104-1-11-21spbmedicalrecords-60Research ArticleОБЗОРЫ ЛИТЕРАТУРЫLITERATURE REVIEWSОсобенности выбора режима дозирования и введения антибактериальных препаратов у пациентов с ожирениемPeculiarities of choice of dosing regimen and administration of antibacterial drugs in obese patientshttps://orcid.org/0009-0002-6681-232XСвечкареваИ. Р.SvechkarevaI. R.

Свечкарева Изабелла Размиковна, ординатор кафедры клинической фармакологи и доказательной медицины

197022, Санкт-Петербург, ул. Льва Толстого, д. 6‒8

Izabella R. Svechkareva, resident of the department of Clinical Pharmacology and Evidence-Based Medicine

6–8, L’va Tolstogo str., Saint Petersburg, 197022

Bellaliza@yandex.ruhttps://orcid.org/0009-0001-2228-8565ВалееваА. Х.-М.ValeevaA. H.-M.

Валеева Алтынай Хаджи-Муратовна, ординатор кафедры клинической фармакологии и доказательной медицины

197022, Санкт-Петербург, ул. Льва Толстого, д. 6‒8

Altynai H.-M. Valeeva, resident of the department of Clinical Pharmacology and Evidence-Based Medicine

6–8, L’va Tolstogo str., Saint Petersburg, 197022

sovoglazka2000@yandex.ruhttps://orcid.org/0009-0003-4992-559XБушеваТ. И.BushevaT. I.

Бушева Татьяна Игоревна, ординатор кафедры клинической фармакологи и доказательной медицины

197022, Санкт-Петербург, ул. Льва Толстого, д. 6‒8

Tatiana I. Busheva, resident of the department of Clinical Pharmacology and Evidence-Based Medicine

6–8, L’va Tolstogo str., Saint Petersburg, 197022

boushewa@mail.ruhttps://orcid.org/0000-0002-1919-2909КолбинА. С.KolbinA. S.

Колбин Алексей Сергеевич, доктор медицинских наук, профессор, заведующий кафедрой клинической фармакологии и доказательной медицины; профессор кафедры фармакологии медицинского факультета

197022, Санкт-Петербург, ул. Льва Толстого, д. 6‒8

Alexey S. Kolbin, associate professor Department of Clinical Pharmacology and Evidence-Based Medicine, Pavlov University, associate professor of the Department of Pharmacology, Saint-Petersburg State University

6–8, L’va Tolstogo str., Saint Petersburg, 197022

Первый Санкт-Петербургский государственный медицинский университет имени академика И. П. ПавловаРоссияPavlov UniversityRussian FederationПервый Санкт-Петербургский государственный медицинский университет имени академика И. П. Павлова; Санкт-Петербургский государственный университет, Медицинский институтРоссияPavlov University; Saint-Petersburg State UniversityRussian Federation202523072025011121Copyright © Свечкарева И.Р., Валеева А.Х., Бушева Т.И., Колбин А.С., 20252025Свечкарева И.Р., Валеева А.Х., Бушева Т.И., Колбин А.С.Svechkareva I.R., Valeeva A.H., Busheva T.I., Kolbin A.S.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.docved.ru/jour/article/view/60

Ожирение представляет определенную проблему в подборе медикаментозной терапии, требуя особого внимания при дозировании лекарственных средств, включая антибактериальные препараты. Фармакокинетические и фармакодинамические параметры у пациентов с ожирением могут существенно отличаться от таковых в общей популяции, что влияет на эффективность и безопасность антибиотикотерапии. Целью настоящего обзора является анализ текущих данных о дозировании антибиотиков среди пациентов с ожирением для оптимизации клинической практики и улучшения исходов лечения.Исследование включает анализ современных научных публикаций, клинических рекомендаций и фармакокинетических данных, касающихся применения антибиотиков у пациентов с ожирением. Особое внимание уделяется изменению объема распределения, клиренсу, и коррекции доз в зависимости от индекса массы тела и других метаболических изменений, связанных с ожирением.

Obesity poses a particular challenge in the selection of drug therapy, requiring special attention to the dosing of drugs, including antibacterial drugs. Pharmacokinetic and pharmacodynamic parameters in obese patients may differ significantly from those in the general population, which affects the efficacy and safety of antibiotic therapy. The purpose of this review is to analyze current data on antibiotic dosing in obese patients to optimize clinical practice and improve treatment outcomes. The study includes an analysis of current scientific publications, clinical guidelines, and pharmacokinetic data regarding the use of antibiotics in obese patients. Particular attention is paid to changes in distribution volume, clearance, and dose adjustment depending on body mass index and other metabolic changes associated with obesity.

ожирениеантибактериальные препаратыобъем распределениярежим дозированияobesityantibacterial drugsvolume of distributiondosage regimenReferencesDeng J., Zhu X., Chen Z. et al. A review of food-drug interactions on oral drug absorption // Drugs. 2017. Vol. 77. P. 1833–1855. https://doi.org/10.1007/s40265-017-0832-z.Deng J., Zhu X., Chen Z. et al. A review of food-drug interactions on oral drug absorption. Drugs. 2017;77:1833–1855. https://doi.org/10.1007/s40265-017-0832-z.Martinez M. N., Amidon G. L. A mechanistic approach to understandingthe factors affecting drug absorption: a review of fundamentals // J Clin Pharmacol. 2002. Vol. 42. P. 620–643. https://doi.org/10.1177/00970002042006005.Martinez M. N., Amidon G. L. A mechanistic approach to understandingthe factors affecting drug absorption: a review of fundamentals. J Clin Pharmacol. 2002;42:620–643. https://doi.org/10.1177/00970002042006005.Maddox A., Horowitz M., Wishart J., Collins P. Gastric and oesophageal emptying in obesity // Scand J Gastroenterol. 1989. Vol. 24. P. 593–598. https://doi.org/10.3109/00365528909093095.Maddox A., Horowitz M., Wishart J., Collins P. Gastric and oesophageal emptying in obesity. Scand J Gastroenterol. 1989;24:593–598. https://doi.org/10.3109/00365528909093095.Jackson S. J., Leahy F. E., McGowan A. A. et al. Delayed gastric emptying in the obese: an assessment using the noninvasive (13)C-octanoic acid breath test // Diabetes Obes Metab. 2004. Vol. 6. P. 264–270. https://doi.org/10.1111/j.1462-8902.2004.0344.x.Jackson S. J., Leahy F. E., McGowan A. A. et al. Delayed gastric emptying in the obese: an assessment using the non-invasive (13) C-octanoic acid breath test. Diabetes Obes Metab. 2004;6:264–270. https://doi.org/10.1111/j.1462-8902.2004.0344.x.Janson B., Thursky K. Dosing of antibiotics in obesity // Curr Opin Infect Dis 2012. Vol. 25. P. 634–649. https://doi.org/10.1097/QCO.0b013e328359a4c1.Janson B., Thursky K. Dosing of antibiotics in obesity. Curr Opin Infect Dis. 2012;25:634–649. https://doi.org/10.1097/QCO.0b013e328359a4c1.Morrish G. A., Pai M. P., Green B. The effects of obesity on drug pharmacokinetics in humans // Expert Opin Drug Metab Toxicol. 2011. Vol. 7. P. 697–706. https://doi.org/10.1517/17425255.2011.570331.Morrish G. A., Pai M. P., Green B. The effects of obesity on drug pharmacokinetics in humans. Expert Opin Drug Metab Toxicol. 2011;7:697–706. https://doi.org/10.1517/17425255.2011.570331.Hanley M. J., Abernethy D. R., Greenblatt D. J. Effect of obesity on the pharmacokinetics of drugs in humans // Clin Pharmacokinet. 2010. Vol. 49. P. 71–87. https://doi.org/10.2165/11318100-000000000-00000.Hanley M. J., Abernethy D. R., Greenblatt D. J. Effect of obesity on the pharmacokinetics of drugs in humans. Clin Pharmacokinet. 2010;49:71–87. https://doi.org/10.2165/11318100-000000000-00000.Alobaid A. S., Hites M., Lipman J. et al. Effect of obesity on the pharmacokinetics of antimicrobials in critically ill patients: a structured review // Int J Antimicrob Agents. 2016. Vol. 47. P. 259–268. https://doi.org/10.1016/j.ijantimicag.2016.01.009.Alobaid A. S., Hites M., Lipman J. et al. Effect of obesity on the pharmacokinetics of antimicrobials in critically ill patients: a structured review. Int J Antimicrob Agents. 2016;47:259–268. https://doi.org/10.1016/j.ijantimicag.2016.01.009.Poirier P., Giles T. D., Bray G. A. et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss // Circulation. 2006. Vol. 113. P. 898–918. https://doi.org/10.1161/CIRCULATIONAHA.106.171016.Poirier P., Giles T. D., Bray G. A. et al. Obesity and cardiovascular disease: pathophysiology, evaluation, and effect of weight loss. Circulation. 2006;113:898–918. https://doi.org/10.1161/CIRCULATIONAHA.106.171016.Rossi M., Nannipieri M., Anselmino M. et al. Subcutaneous adipose tissue blood flow and vasomotion in morbidly obese patients: long term effect of gastric bypass surgery // Clin Hemorheol Microcirc. 2012. Vol. 51. P. 159–167. https://doi.org/10.3233/CH-2011-1517.Rossi M., Nannipieri M., Anselmino M. et al. Subcutaneous adipose tissue blood flow and vasomotion in morbidly obese patients: long term effect of gastric bypass surgery. Clin Hemorheol Microcirc. 2012;51:159–167. https://doi.org/10.3233/ CH-2011-1517.Suh B., Craig W. A., England A. C., Elliott R. L. Effect of free fatty acids on protein binding of antimicrobial agents // J Infect Dis. 1981. Vol. 143. P. 609–616. https://doi.org/10.1093/infdis/143.4.609.Suh B., Craig W. A., England A. C., Elliott R. L. Effect of free fatty acids on protein binding of antimicrobial agents. J Infect Dis. 1981;143:609–616. https://doi.org/10.1093/infdis/143.4.609.Polso A. K., Lassiter J. L., Nagel J. L. Impact of hospital guideline for weight-based antimicrobial dosing in morbidly obese adults and comprehensive literature review // J Clin Pharm Ther. 2014. Vol. 39. P. 584–608. https://doi.org/10.1111/jcpt.12200.Polso A. K., Lassiter J. L., Nagel J. L. Impact of hospital guideline for weight-based antimicrobial dosing in morbidly obese adults and comprehensive literature review. J Clin Pharm Ther. 2014;39:584–608. https://doi.org/10.1111/jcpt.12200.Morita K., Yamaji A. Changes in the serum protein binding of vancomycin in patients with methicillin-resistant Staphylococcus aureus infection: the role of serum α1-acid glycoprotein levels // Ther Drug Monit. 1995. Vol. 17. P. 107–112. https://doi.org/10.1097/00007691-199504000-00001.Morita K., Yamaji A. Changes in the serum protein binding of vancomycin in patients with methicillin-resistant Staphylococcus aureus infection: the role of serum Α: 1: -acid glycoprotein levels. Ther Drug Monit. 1995;17:107–112. https://doi.org/10.1097/00007691-199504000-00001.Zokufa H. Z., Solem L. D., Rodvold K. A. et al. 1989. The influence of serum albumin and alpha 1-acid glycoprotein on vancomycin protein binding in patients with burn injuries // J Burn Care Rehabil. 1989. Vol. 10. P. 425–428. https://doi.org/10.1097/00004630-198909000-00010.Zokufa H. Z., Solem L. D., Rodvold K. A. et al. 1989. The influenceSmit C., De Hoogd S., Brüggemann R. J. M., Knibbe C. A. J. 2018. Obesity and drug pharmacology: a review of the influence of obesity on pharmacokinetic and pharmacodynamic parameters // Expert Opin Drug Metab Toxicol. 2018. Vol. 14. P. 275–285. https://doi.org/10.1080/17425255.2018.1440287.of serum albumin and alpha 1-acid glycoprotein on vancomycin protein binding in patients with burn injuries. J Burn Care Rehabil. 1989;10:425–428. https://doi.org/10.1097/00004630-198909000-00010.Kotlyar M., Carson S. W. Effects of obesity on the cytochrome P450 enzyme system // Int J Clin Pharmacol Ther. 1999. Vol. 37. P. 8–19.Smit C., De Hoogd S., Brüggemann R. J. M., Knibbe C. A. J. 2018. Obesity and drug pharmacology: a review of the influence of obesity on pharmacokinetic and pharmacodynamic parameters. Expert Opin Drug Metab Toxicol. 2018;14:275–285. https://doi.org/10.1080/17425255.2018.1440287.Griffin K. A., Kramer H., Bidani A. K. Adverse renal consequences of obesity // Am J Physiol Renal Physiol. 2008. Vol. 294. P. F685–96. https://doi.org/10.1152/ajprenal.00324.2007.Kotlyar M., Carson S. W. Effects of obesity on the cytochrome P450 enzyme system. Int J Clin Pharmacol Ther. 1999;37:8–19.Meng L., Mui E., Ha D. R. et al. Comprehensive guidance for antibiotic dosing in obese adults: 2022 update // Pharmacotherapy. 2023. Vol. 43. P. 226–246. https://doi.org/10.1002/phar.2769.Griffin K. A., Kramer H., Bidani A. K. Adverse renal consequences of obesity. Am J Physiol Renal Physiol. 2008;294:F685–96. https://doi.org/10.1152/ajprenal.00324.2007.Castro-Balado A., Varela-Rey I., Mejuto B. et al. Updated antimicrobial dosing recommendations for obese patients // Antimicrob Agents Chemother. 2024. Vol. 68, № 5. P. e0171923. https://doi.org/10.1128/aac.01719-23. PMID: 38526051; PMCID: PMC11064535.Meng L., Mui E., Ha D. R. et al. Comprehensive guidance for antibiotic dosing in obese adults: 2022 update. Pharmacotherapy. 2023;43:226–246. https://doi.org/10.1002/phar.2769.Velissaris D., Karamouzos V., Marangos M., et al. Pharmacokinetic changes and dosing modification of aminoglycosides in critically ill obese patients: a literature review // J Clin Med Res. 2014. Vol. 6. P. 227–233. https://doi.org/10.14740/jocmr1858w.Castro-Balado A., Varela-Rey I., Mejuto B. et al. Updated antimicrobial dosing recommendations for obese patients. Antimicrob Agents Chemother. 2024;68(5):e0171923. https:// doi.org/10.1128/aac.01719-23. PMID: 38526051; PMCID: PMC11064535.Traynor A. M., Nafziger A. N., Bertino J. S. 1995. Aminoglycoside dosing weight correction factors for patients of various body sizes // Antimicrob Agents Chemother. 1995. Vol. 39. P. 545–548. https://doi.org/10.1128/AAC.39.2.545.Velissaris D., Karamouzos V., Marangos M., et al. Pharmacokinetic changes and dosing modification of aminoglycosides in critically ill obese patients: a literature review. J Clin Med Res. 2014;6:227–233. https://doi.org/10.14740/jocmr1858w.Bergan T. Pharmacokinetics of beta-lactam antibiotics // Scand J Infect Dis Suppl. 1984. Vol. 42. P. 83–98. PMID. P. 6597564.Traynor A. M., Nafziger A. N., Bertino J. S. Aminoglycoside dosing weight correction factors for patients of various body sizes. Antimicrob Agents Chemother. 1995;39:545–548. https:// doi.org/10.1128/AAC.39.2.545.Hites M., Taccone F. S., Wolff F. et al. Broad-spectrum β-lactams in obese non-critically ill patients // Nutr Diabetes. 2014. Vol. 4, № 6. P. e119. https://doi.org/10.1038/nutd.2014.15. PMID: 24956136; PMCID: PMC4079925.Bergan T. Pharmacokinetics of beta-lactam antibiotics. Scand J Infect Dis Suppl. 1984;42:83–98. PMID: 6597564.Kanbay M., Copur S., Bakir C. N. et al. Glomerular hyperfiltration as a therapeutic target for CKD // Nephrol Dial Transplant. 2024. Vol. 39, № 8. P. 1228–1238. https://doi.org/10.1093/ndt/gfae027. PMID: 38308513.Hites M., Taccone F. S., Wolff F. et al. Broad-spectrum β-lactams in obese non-critically ill patients. Nutr Diabetes. 2014;4(6):e119.https://doi.org/10.1038/nutd.2014.15. PMID: 24956136; PMCID: PMC4079925.Roberts J. A., Croom K., Adomakoh N. Continuous infusion of beta lactam antibiotics: narrative review of systematic reviews, and implications for outpatient parenteral antibiotic therapy // Expert Rev Anti Infect Ther. 2023. Vol. 21. P. 375–385. https://doi.org/10.1080/14787210.2023.2184347.Kanbay M., Copur S., Bakir C. N. et al. Glomerular hyperfiltration as a therapeutic target for CKD. Nephrol Dial Transplant. 2024;39(8):1228–1238. https://doi.org/10.1093/ndt/gfae027.PMID: 38308513.Клинические рекомендации: Внебольничная пневмония у взрослых. URL: https://cr.minzdrav.gov.ru/preview-cr/654_2 (дата обращения: 29.01.2025).Roberts J. A., Croom K., Adomakoh N. Continuous infusion of beta lactam antibiotics: narrative review of systematic reviews, and implications for outpatient parenteral antibiotic therapy. Expert Rev Anti Infect Ther. 2023;21:375–385. https://doi.org/10.1080/14787210.2023. 2184347.Клинические рекомендации: Сепсис (у взрослых). Электронный доступ: https://cr.minzdrav.gov.ru/previewcr/898_1 (дата обращения: 29.01.2025).Clinical Recommendations: Out-of-hospital pneumonia in adults. URL: https://cr.minzdrav.gov.ru/preview-cr/654_2 (accessed: 29.01.2025). (In Russ.).Клинические рекомендации: Острый пиелонефрит. Электронный доступ: https://cr.minzdrav.gov.ru/previewcr/9_3 (дата обращения: 29.01.2025).Clinical Recommendations: Sepsis (in adults). URL: https:// cr.minzdrav.gov.ru/preview-cr/898_1 (accessed: 29.01.2025). (In Russ.).Van Rhee K. P., Smit C., Wasmann R. E. et al. Ciprofloxacin Pharmacokinetics After Oral and Intravenous Administration in (Morbidly) Obese and Non-obese Individuals: A Prospective Clinical Study // Clin Pharmacokinet. 2022. Vol. 61, № 8. P. 1167–1175. https://doi.org/10.1007/s40262-022-01130-5. PMID: 35641862; PMCID: PMC9349153.Clinical Recommendations: Acute pyelonephritis. URL: https:// cr.minzdrav.gov.ru/preview-cr/9_3 (accessed: 29.01.2025). (In Russ.).Allard S., Kinzig M., Boivin G. et al. Intravenous ciprofloxacin disposition in obesity // Clin Pharmacol Ther. 1993. Vol. 54, № 4. P. 368–73. https://doi.org/10.1038/clpt.1993.162. PMID: 8222478.Van Rhee K. P., Smit C., Wasmann R. E. et al. Ciprofloxacin Pharmacokinetics After Oral and Intravenous Administration in (Morbidly) Obese and Non-obese Individuals: A Prospective Clinical Study. Clin Pharmacokinet. 2022;61(8):1167–1175. https://doi.org/10.1007/s40262-022-01130-5. PMID: 35641862; PMCID: PMC9349153.Hollenstein U. M., Brunner M., Schmid R. et al Soft tissue concentrations of ciprofloxacin in obese and lean subjects following weight-adjusted dosing // Int J Obes Relat Metab Disord. 2001. Vol. 25. P. 354–8.Allard S., Kinzig M., Boivin G. et al. Intravenous ciprofloxacin disposition in obesity. Clin Pharmacol Ther. 1993;54(4):368–73. https://doi.org/10.1038/clpt.1993.162. PMID: 8222478.Hopkins M. K., Tewari S., Yao M. et al. Standard-dose azithromycin in class III obese patients undergoing unscheduled cesarean delivery // Am J Perinatol. 2024. Vol. 41, № S 01. P. e2645–e2650. https://doi.org/10.1055/a-2135-7084.Hollenstein U. M., Brunner M., Schmid R. et al Soft tissue concentrations of ciprofloxacin in obese and lean subjects following weight-adjusted dosing. Int J Obes Relat Metab Disord. 2001;25:354–8.Peyriere H., Makinson A., Marchandin H., Reynes J. Doxycycline in the management of sexually transmitted infections // J Antimicrob Chemother. 2018. Vol. 73. P. 553–563. https://doi.org/10.1093/jac/dkx420.Hopkins M. K., Tewari S., Yao M. et al. Standard-dose azithromycin in class III obese patients undergoing unscheduled cesarean delivery. Am J Perinatol. 2024;41(S 01):e2645–e2650. https://doi.org/10.1055/a-2135-7084.Bouazza N., Pestre V., Jullien V. et al. Population pharmacokinetics of clindamycin orally and intravenously administered in patients with osteomyelitis // Br J Clin Pharmacol. 2012. Vol. 74, № 6. P. 971–7. https://doi.org/10.1111/j.1365-2125.2012.04292.x. PMID: 22486719; PMCID: PMC3522810.Peyriere H., Makinson A., Marchandin H., Reynes J. Doxycycline in the management of sexually transmitted infections. J Antimicrob Chemother. 2018;73:553–563. https://doi.org/10.1093/jac/dkx420.Nicholas P., Meyers B. R., Levy R. N., Hirschman S. Z. Concentration of clindamycin in human bone // Antimicrob Agents Chemother. 1975. Vol. 8, № 2. P. 220–1. https://doi.org/10.1128/AAC.8.2.220. PMID: 1180546; PMCID: PMC429291.Bouazza N., Pestre V., Jullien V. et al. Population pharmacokinetics of clindamycin orally and intravenously administered in patients with osteomyelitis. Br J Clin Pharmacol. 2012;74(6):971–7. https://doi.org/10.1111/j.1365-2125.2012.04292.x. PMID: 22486719; PMCID: PMC3522810.Nikolos P., Osorio J., Mohrien K., Rose C. Pharmacokinetics of linezolid for methicillin-resistant Staphylococcus aureus pneumonia in an adult receiving extracorporeal membrane oxygenation // Am J Health Syst Pharm. 2020. Vol. 77, № 11. P. 877–881. https://doi.org/10.1093/ajhp/zxaa066. PMID: 32426841.Nicholas P., Meyers B. R., Levy R. N., Hirschman S. Z. Concentration of clindamycin in human bone. Antimicrob Agents Chemother. 1975;8(2):220–1. https://doi.org/10.1128/AAC.8.2.220. PMID: 1180546; PMCID: PMC429291.Heidari S., Khalili H. Linezolid pharmacokinetics: a systematic review for the best clinical practice // Eur J Clin Pharmacol. 2023. Vol. 79. P. 195–206. https://doi.org/10.1007/s00228-022-03446-4.Nikolos P, Osorio J, Mohrien K, Rose C. Pharmacokinetics of linezolid for methicillin-resistant Staphylococcus aureus pneumonia in an adult receiving extracorporeal membrane oxygenation. Am J Health Syst Pharm. 2020;77(11):877–881. https://doi.org/10.1093/ajhp/zxaa066. PMID: 32426841.Белобородов В. Б., Голованов О.В., Гусаров В.Г., и др. Обновленные методические рекомендации «Диагностика и антимикробная терапия инфекций, вызванных полирезистентными штаммами микроорганизмов». 2022. URL: https://www.antibiotic.ru/files/334/mr-abt.pdf (дата обращения: 19.03.24).Heidari S., Khalili H. Linezolid pharmacokinetics: a systematic review for the best clinical practice. Eur J Clin Pharmacol. 2023;79:195–206. https://doi.org/10.1007/s00228-022-03446-4.Polso A. K., Lassiter J. L., Nagel J. L. Impact of hospital guideline for weight-based antimicrobial dosing in morbidly obese adults and comprehensive literature review // J Clin Pharm Ther. 2014. Vol. 39. P. 584–608. https://doi.org/10.1111/jcpt.12200.Beloborodov V. B., Golovanov O. V., Gusarov V. G. et al. Updated guidelines “Diagnosis and antimicrobial therapy of infections caused by multidrug-resistant strains of microorganisms”. 2022. URL: https://www.antibiotic.ru/files/334/mr-abt.pdf (accessed: 19.03.24). (In Russ.).Garrett E. R., Süverkrup R. S., Eberst K. et al. Surgically affected sulfisoxazole pharmacokinetics in the morbidly obese // Biopharm Drug Dispos. 1981. Vol. 2. P. 329–365. https://doi.org/10.1002/bdd.2510020405.Polso A. K., Lassiter J. L., Nagel J. L. Impact of hospital guideline for weight-based antimicrobial dosing in morbidly obese adults and comprehensive literature review. J Clin Pharm Ther. 2014;39:584–608. https://doi.org/10.1111/jcpt.12200.Hall R. G., Pasipanodya J. G., Meek C. et al. Fractal geometry-based decrease in trimethoprim-sulfamethoxa zole concentrations in overweight and obese people // CPT Pharmaco metrics Syst Pharmacol. 2016. Vol. 5. P. 674–681. https://doi.org/10.1002/psp4.12146.Garrett E. R., Süverkrup R. S., Eberst K. et al. Surgically affected sulfisoxazole pharmacokinetics in the morbidly obese. Biopharm Drug Dispos. 1981;2:329–365. https://doi.org/10.1002/bdd.2510020405.Dorn C., Petroff D., Neumann N. et al. Plasma and tissue pharmacokinetics of fosfomycin in morbidly obese and non-obese surgical patients: a controlled clinical trial // J Antimicrob Chemother. 2019. Vol. 74. P. 2335–2340. https://doi.org/10.1093/jac/dkz203.Hall R. G., Pasipanodya J. G., Meek C. et al. Fractal geometrybased decrease in trimethoprim-sulfamethoxa zole concentrations in overweight and obese people. CPT Pharmaco metrics Syst Pharmacol. 2016;5:674–681. https://doi.org/10.1002/psp4.12146.Busse D., Simon P., Petroff D. et al. 2022. High-dosage fosfomycin results in adequate plasma and target-site exposure in morbidly obese and nonobese nonhyperfiltration patients // Antimicrob Agents Chemother. 2022. Vol. 66, № 6. P. e0230221. https://doi.org/10.1128/aac.02302-21.Dorn C., Petroff D., Neumann N. et al. Plasma and tissue pharmacokinetics of fosfomycin in morbidly obese and nonobese surgical patients: a controlled clinical trial. J Antimicrob Chemother. 2019;74:2335–2340. https://doi.org/10.1093/jac/dkz203.Crass R. L., Dunn R., Hong J. et al. Dosing vancomycin in the super obese: less is more // J Antimicrob Chemother. 2018. Vol. 73. P. 3081–3086. https://doi.org/10.1093/jac/dky310.Busse D., Simon P., Petroff D. et al. 2022. High- dosage fosfomycin results in adequate plasma and target-site exposure in morbidly obese and nonobese nonhyperfiltration patients. Antimicrob Agents Chemother. 2022;66(6):e0230221. https:// doi.org/10.1128/aac.02302-21.Monteiro J. F., Hahn S. R., Gonçalves J., Fresco P. Vancomycin therapeutic drug monitoring and population pharmacokinetic models in special patient subpopulations // Pharmacol Res Perspect. 2018. Vol. 6. P. e00420. https://doi.org/10.1002/prp2.420.Crass R. L., Dunn R., Hong J. et al. Dosing vancomycin in the super obese: less is more. J Antimicrob Chemother. 2018;73:3081–3086. https://doi.org/10.1093/jac/dky310.Rybak M. J., Le J., Lodise T. P. et al. Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: a revised consensus guideline and review by the American society of health-system pharmacists, the infectious diseases society of America, the pediatric infectious diseases society, and the society of infectious diseases pharmacists // Am J Health Syst Pharm. 2020. Vol. 77. P. 835–864. https://doi.org/10.1093/ajhp/zxaa036.Monteiro J. F., Hahn S. R., Gonçalves J., Fresco P. Vancomycin therapeutic drug monitoring and population pharmacokinetic models in special patient subpopulations. Pharmacol Res Perspect. 2018;6:e00420. https://doi.org/10.1002/prp2.420.Elrggal M. E., Haseeb A., AlGethamy M. et al. Dose optimization of vancomycin in obese patients: a systematic review // Front Pharmacol. 2023. Vol. 14. P. 965284. https://doi.org/10.3389/fphar.2023.965284.Rybak M. J., Le J., Lodise T. P. et al. Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: a revised consensus guideline and review by the American society of health- system pharmacists, the infectious diseases society of America, the pediatric infectious diseases society, and the society of infectious diseases pharmacists. Am J Health Syst Pharm. 2020;77:835–864. https://doi.org/10.1093/ajhp/zxaa036.Zhang T., Smit C., Sherwin C. M. T. et al. Vancomycin clearance in obese adults is not predictive of clearance in obese adolescents // Clin Pharmacokinet. 2023. Vol. 62. P. 749–759. https://doi.org/10.1007/s40262-023-01227-5.Elrggal M. E., Haseeb A., AlGethamy M. et al. Dose optimization of vancomycin in obese patients: a systematic review. Front Pharmacol. 2023;14:965284. https://doi.org/10.3389/fphar.2023.965284.Soule A. F., Green S. B., Blanchette L. M. Clinical efficacy of 12-h metronidazole dosing regimens in patients with anaerobic or mixed anaerobic infections // Ther Adv Infect Dis. 2018. Vol. 5. P. 57–62. https://doi.org/10.1177/2049936118766462.Zhang T., Smit C., Sherwin C. M. T. et al. Vancomycin clearance in obese adults is not predictive of clearance in obese adolescents. Clin Pharmacokinet. 2023;62:749–759. https://doi.org/10. 1007/s40262-023-01227-5.Martin C., Auboyer C., Boisson M. et al. Antibiopro phylaxis in surgery and interventional medicine (adult patients). Update 2017 // Anaesth Crit Care Pain Med. 2019. Vol. 38. P. 549–562. https://doi.org/10.1016/j.accpm.2019.02.017.Soule A. F., Green S. B., Blanchette L. M. Clinical efficacy of 12-h metronidazole dosing regimens in patients with anaerobic or mixed anaerobic infections. Ther Adv Infect Dis. 2018;5:57–62. https://doi.org/10. 1177/2049936118766462.Nation R. L., Garonzik S. M., Thamlikitkul V. et al. Dosing guidance for intravenous colistin in critically-ill patients // Clin Infect Dis. 2017. Vol. 64. P. 565–571. https://doi.org/10.1093/cid/ciw839.Martin C., Auboyer C., Boisson M. et al. Antibiopro phylaxis in surgery and interventional medicine (adult patients). Upd ate 2017. Anaesth Crit Care Pain Med. 2019;38:549–562. https:// doi.org/10.1016/j.accpm.2019.02.017.Tsuji B. T., Pogue J. M., Zavascki A. P. et al. Interna tional consensus guidelines for the optimal use of the polymyxins. P. endorsed by the American college of clinical pharmacy (ACCP), European society of clinical microbiology and infectious diseases (ESCMID), infectious diseases society of America (IDSA), international society for anti-infective pharmacology (ISAP), society of critical care medicine (SCCM), and society of infectious diseases pharmacists (SIDP) // Pharmacotherapy. 2019. Vol. 39. P. 10–39.Nation R. L., Garonzik S. M., Thamlikitkul V. et al. Dosing guidance for intravenous colistin in critically-ill patients. Clin Infect Dis. 2017;64:565–571. https://doi.org/10.1093/cid/ciw839.WHO (2020), Obesity and overweight. URL: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight (дата обращения: 29.01.2025)Tsuji B. T., Pogue J. M., Zavascki A. P. et al. Interna tional consensus guidelines for the optimal use of the polymyxins: endorsed by the American college of clinical pharmacy (ACCP), European society of clinical microbiology and infectious diseases (ESCMID), infectious diseases society of America (IDSA), international society for anti-infective pharmacology (ISAP), society of critical care medicine (SCCM), and society of infectious diseases pharmacists (SIDP). Pharmacotherapy. 2019;39:10–39.Ожирение: этиология, патогенез, клинические аспекты. Под редакцией И. И. Дедова, Г. А. Мельниченко. Москва, Медицинское информационное агентство, 2004. P. 16–21.WHO (2020), Obesity and overweight. URL: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight (accessed: 29.01.2025).OECD (2021), Overweight or obese population (indicator). https://doi.org/10.1787/86583552-en (accessed: 28.08.2021).Obesity: etiology, pathogenesis, clinical aspects. Edited by I. I. Dedov, G. A. Melnichenko. Moscow, Medical Information Agency, 2004:16–21. (In Russ.).OECD (2021), Overweight or obese population (indicator). https://doi.org/10.1787/86583552-en (accessed: 28.08.2021).OECD (2021), Overweight or obese population (indicator). https://doi.org/10.1787/86583552-en (accessed: 28.08.2021).

The authors declare that there are no conflicts of interest present.