Obesity Antibiotics: Should your weight determine the drugs you get?

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Doctors have called for a new approach to antibiotic dosing – one that is based on your weight. The rationale is that obesity, traditionally, has been regarded – pharmacologically speaking – as a rare phenomenon. The authors in the Lancet argue (in a classic science journal well, duh moment) that obesity is no longer rare. And, with rising rates of antibiotic resistance, the authors state that patients who are obese may NOT be getting a sufficient dose of antibiotics. Sub-standard dosing can definitely lead to drug resistance in germs. They argue that a “one-size-fits-all” approach to antibiotics is not only outdated, it’s dangerous.

But here’s the first kicker. Antibiotic pills for adults generally only come in one size (two max for some types). AND, given the state of runaway drug prices, creating a range of custom dose-sized pills is likely to be an opportunity for price-gouging by drug companies, even with generic medicines (ka-ching).

Which means that patients who don’t “fit” the one-size-fits-all existing pill are likely, in my predictive model, to get stuck with a very pricey surcharge. Is this fair? Should people be penalized for their size? If you think so, then why stop there – why not penalize people for their kidney function, or their cardiac output, or their smoking history (which can rev up some liver enzymes that break down drugs…).

Because the second kicker is that the whole “pill-size matching body-size” theory may be a relatively minor factor in nasty-germ emergence (but a HUGE factor in price-gouging). More and more data are showing that the REAL factor behind germs’ emerging drug resistance is not so much UNDER-dosing of antibiotics, as OVER-prescribing by doctors. Decades of handing out antibiotic pills like candy was a really, really bad idea, no matter what the dose. In fact, Norway is one of the few countries to eradicate almost all MRSA (the nasty superbug). How did they achieve that? Purely because, with their universal health coverage, they were able to simultaneously severely restrict antibiotic usage while also giving high-quality care to people with infections in order to make sure they get well without antibiotics. And, when it comes to emerging germ resistance, let’s not even start with the data on the mind-blowing tonnage of antibiotics we’ve peed into our water supply, or dumped into our water tables, or spewed nationwide throughout our livestock food supply. All of which makes the supposedly weighty dose-size issue seem, well, frankly anorexic by comparison…

But the bottom line is that what all of us wants when we’re sick, more than anything, is effective treatment and a return to health – so take this sliver of dosing controversy and advocate now for yourself and those you love. If you or someone you love has an infection bad enough to require intravenous antibiotics (whose doses are MUCH more easy to adjust than pill size), gently remind/ask doctors and/or nurses if they’re using weight when calculating the IV dose (you can even cite this article). Often the doctor already will be making a precise calculation – but if not, minimizing errors and maximizing health is a group effort, and reminders help!

What do you think? Is it fair to price gouge people who are overweight? WILL drug companies spread this new theory far and wide to encourage more and bigger antibiotic usage based on fear? Should we, instead, focus our efforts to combat emerging drug-resistance in other areas, like factory farms’ use of, literally, tons of antibiotics? Share in the comments section – and keep up on the latest health issues in the news, and healthcare reform insanity/hilarity by signing up for a Doc Gurley RSS feed with the tiny orange button at the top. Look for future weekly Dodging Death articles here at Doc Gurley – discover the weird, the wacky and the everyday symptoms you want to know about, as well as practical expert tips on staying well. And do you want to be on the inside, fast track of news and tips? Get on the Twitter bandwagon and follow Doc Gurley! Also check out Doc Gurley’s joyhabit and iwellth twitter feeds – so you can get topic-specific fun, effective, affordable tips on how to nurture your joy and grow your wellth this coming year.

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