Perioperative systemic antibiotic prophylaxis constitutes an important pharmacological approach to prevent surgical site infections (SSI) in patients undergoing invasive procedures. Epidemiological data show a progressive rise in the prevalence of overweight patients. There is increasing evidence that the obese population especially is at risk for SSI, underlining the need for adequate antimicrobial effects at the target site. Given that applied pharmacological substances including antibiotics display different pharmacodynamic and pharmacokinetic features in obese versus normal-weight subjects, this raises the question whether the recommended antimicrobial standard doses are adequate for perioperative antibiotic prophylaxis for the former. Therefore, our PubMed-based literature search sought to i.) survey the current evidence on antibiotic dosing in obese patients undergoing surgery, to ii.) address, which systemic antibiotic prophylaxes reach adequate (unbound) tissue concentrations for the duration of surgery subsequently preventing SSI and to iii.) assess, whether certain tissue types are particularly prone to SSI. Results indicate that current standard dosing is appropriate to ensure effective antimicrobial tissue concentrations in obese patients, but support evidence possibly on earlier re-dosing and a high inter-individual variability, which puts certain patients at particular risk for the development of SSI. Future clinical research is needed to further specify guidelines for appropriate antibiotic surgical prophylaxis in obese patients.
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