The Effect of Bariatric Surgery on Oral Antibiotic Absorption: a Systematic Review
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ORIGINAL CONTRIBUTIONS
The Effect of Bariatric Surgery on Oral Antibiotic Absorption: a Systematic Review Sama Anvari 1,2,3 & Yung Lee 1,2,3 & Megan Lam 1,2,3 & Aristithes G. Doumouras 2,3 & Dennis Hong 2,3,4
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Purpose The purpose of this study was to conduct a systematic review of the existing literature to determine the effect of bariatric surgery on various pharmacokinetic parameters of oral antibiotic absorption as well as overall patient outcomes. Materials and Methods MEDLINE, EMBASE, and Cochrane Central Register of Controlled Trials (CENTRAL) were searched up to February 2020. Outcomes of interest included change in pharmacokinetic parameters of oral antibiotics administered to patients following bariatric surgery, using variables such as maximum plasma concentration (Cmax), time to reach maximum plasma concentration (Tmax), area under the concentration-time curve (AUC), clearance, and volume of distribution. MINORS and Cochrane risk of bias tools were used to assess quality of evidence. Results Ten studies with 100 patients assessing 8 oral antibiotics were included. The majority (77%) of patients underwent Rouxen-Y gastric bypass (RYGB), with fewer undergoing ventral banded gastroplasty (VBG) (14%), jejunoileostomy (6%), and jejunoileal bypass (3%). Antibiotic classes investigated included beta-lactams (5 studies), fluoroquinolones (2 studies), macrolides (2 studies), and oxazolidinones (1 study). Heterogeneity between studies precluded meaningful pooling or metaanalysis of data. Overall risk of bias was fair. Conclusion Patients given oral beta-lactams and macrolides warrant close monitoring due to unpredictable absorption post-bariatric surgery, whereas oral fluoroquinolones and linezolid may not be affected. Several studies also showed decreased absorption following RYGB, as well as lower serum exposure in patients with obesity compared to nonobese controls. Clinicians should monitor patients on a case-by-case basis for signs of antibiotic failure or toxicity and reassess dosing accordingly. Keywords Bariatric surgery . Obesity . Antibiotics . Pharmacokinetics . Gastric bypass . Systematic review
Introduction
Electronic supplementary material The online version of this article (https://doi.org/10.1007/s11695-020-04623-z) contains supplementary material, which is available to authorized users. * Dennis Hong [email protected] 1
Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
2
Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
3
Centre for Minimal Access Surgery (CMAS), St. Joseph’s Healthcare, McMaster University, Hamilton, Ontario, Canada
4
Division of General Surgery, St. Joseph’s Healthcare, Room G814, 50 Charlton Avenue East, Hamilton, Ontario L8N 4A6, Canada
Obesity is a well-established public health concern, and its prevalence continues to increase worldwide [1, 2]. Bariatric surgery has emerged as the most effective t
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