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The Effect of Bariatric Surgery on Oral Antibiotic Absorption: a Systematic Review

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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 Roux-en-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 meta-analysis 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 non-obese controls. Clinicians should monitor patients on a case-by-case basis for signs of antibiotic failure or toxicity and reassess dosing accordingly.

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References

  1. Flegal KM, Carroll D, Kit BK, et al. Prevalence of obesity and trends in the distribution of body mass index among US adults, 1999-2010. JAMA - J Am Med Assoc. 2012;307:491–7.

    Article  Google Scholar 

  2. Afshin A, Forouzanfar MH, Reitsma MB, et al. Health effects of overweight and obesity in 195 countries over 25 years. N Engl J Med. 2017;377:13–27.

    Article  PubMed  Google Scholar 

  3. Colquitt JL, Pickett K, Loveman E, et al. Surgery for weight loss in adults. Cochrane Database Syst Rev. 2014;

  4. Buchwald H, Estok R, Fahrbach K, et al. Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis. Am J Med. 2009;122:248–56.

    Article  PubMed  Google Scholar 

  5. Sjöström L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351:2683–93.

    Article  PubMed  Google Scholar 

  6. Crémieux PY, Ledoux S, Clerici C, et al. The impact of bariatric surgery on comorbidities and medication use among obese patients. Obes Surg. 2010;20:861–70.

    Article  PubMed  Google Scholar 

  7. Mulla CM, Middelbeek RJW, Patti ME. Mechanisms of weight loss and improved metabolism following bariatric surgery. Ann N Y Acad Sci. 2018;1411:53–64.

    Article  PubMed  Google Scholar 

  8. Davies NK, O’Sullivan JM, Plank LD, Murphy R. Altered gut microbiome after bariatric surgery and its association with metabolic benefits: a systematic review. Surg Obes Relat Dis. Elsevier Inc.; 2019;15:656–665. Available from: https://doi.org/10.1016/j.soard.2019.01.033

  9. Angrisani L, Santonicola A, Iovino P, et al. IFSO Worldwide Survey 2016: primary, endoluminal, and revisional procedures. Obes Surg. 2018;28:3783–94.

    Article  PubMed  Google Scholar 

  10. Huttunen R, Syrjänen J. Obesity and the risk and outcome of infection. Int J Obes. 2013;37:333–40.

    Article  CAS  Google Scholar 

  11. Sioka E, Tzovaras G, Perivoliotis K, et al. Impact of laparoscopic sleeve gastrectomy on gastrointestinal motility. Gastroenterol Res Pract. 2018;

  12. Dirksen C, Damgaard M, Bojsen-Møller KN, et al. Fast pouch emptying, delayed small intestinal transit, and exaggerated gut hormone responses after Roux-en-Y gastric bypass. Neurogastroenterol Motil. 2013;25:346–e255.

    Article  CAS  PubMed  Google Scholar 

  13. Thelen K, Dressman JB. Cytochrome P450-mediated metabolism in the human gut wall. J Pharm Pharmacol. 2009;61:541–58.

    Article  CAS  PubMed  Google Scholar 

  14. Smit C, De Hoogd S, Brüggemann RJM, et al. Obesity and drug pharmacology: a review of the influence of obesity on pharmacokinetic and pharmacodynamic parameters. Expert Opin Drug Metab Toxicol. 2018;14:275–85.

    Article  CAS  PubMed  Google Scholar 

  15. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Open Med. 2009;3:e123–30.

    PubMed  PubMed Central  Google Scholar 

  16. Slim K, Nini E, Forestier D, et al. Methodological index for non-randomized studies (Minors): development and validation of a new instrument. ANZ J Surg. 2003;73:712–6.

    Article  PubMed  Google Scholar 

  17. Higgins JPT, Altman DG, Gøtzsche PC, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;18:343–d5928.

    Google Scholar 

  18. De Smet J, Colin P, De Paepe P, et al. Oral bioavailability of moxifloxacin after Roux-en-Y gastric bypass surgery. J Antimicrob Chemother. 2012;67:226–9.

    Article  PubMed  Google Scholar 

  19. Hamilton R, Thai XC, Ameri D, et al. Oral bioavailability of linezolid before and after Roux-en-Y gastric bypass surgery: is dose modification necessary in obese subjects? J Antimicrob Chemother. 2013;68:666–73.

    Article  CAS  PubMed  Google Scholar 

  20. Kampmann JP, Klein H, Lumholtz B, et al. Ampicillin and propylthiouracil pharmacokinetics in intestinal bypass patients followed up to a year after operation. Clin Pharmacokinet. 1984;9:168–76.

    Article  CAS  PubMed  Google Scholar 

  21. Miskowiak J, Andersen B, Nielsen VG. Absorption of oral penicillin before and after gastroplasty for morbid obesity. Pharmacology. 1985;31:115–20.

    Article  CAS  PubMed  Google Scholar 

  22. Montanha MC, dos Santos Magon TF, de Souza AC, et al. Reduced bioavailability of oral amoxicillin tablets compared to suspensions in Roux-en-Y gastric bypass bariatric subjects. Br J Clin Pharmacol. 2019;85:2118–25.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Padwal RS, Ben-Eltriki M, Wang X, et al. Effect of gastric bypass surgery on azithromycin oral bioavailability. J Antimicrob Chemother. 2012;67:2203–6.

    Article  CAS  PubMed  Google Scholar 

  24. Prince RA, Pincheira JC, Mason EE, et al. Influence of bariatric surgery on erythromycin absorption. J Clin Pharmacol. 1984;24:523–7.

    Article  CAS  PubMed  Google Scholar 

  25. Rivas AB, Lopez-Picado A, del R S-BM, et al. Effect of Roux-en-Y gastric surgery on ciprofloxacin pharmacokinetics: an obvious effect? Eur J Clin Pharmacol. 2019;75:647–54.

    Article  CAS  PubMed  Google Scholar 

  26. Rocha MBS, De Nucci G, Lemos FN, et al. Impact of bariatric surgery on the pharmacokinetics parameters of amoxicillin. Obes Surg. 2019;29:917–27.

    Article  PubMed  Google Scholar 

  27. Terry SI, Gould JC, McManus JPA, et al. Absorption of penicillin and paracetamol after small intestinal bypass surgery. Eur J Clin Pharmacol. 1982;23:245–8.

    Article  CAS  PubMed  Google Scholar 

  28. Janson B, Thursky K. Dosing of antibiotics in obesity. Curr Opin Infect Dis. 2012;25:634–49.

    Article  CAS  PubMed  Google Scholar 

  29. Goday Arno A, Farré M, Rodríguez-Morató J, et al. Pharmacokinetics in morbid obesity: influence of two bariatric surgery techniques on paracetamol and caffeine metabolism. Obes Surg. 2017;27:3194–201.

    PubMed  Google Scholar 

  30. Schmitt C, Kuhn B, Zhang X, et al. Disease-drug-drug interaction involving tocilizumab and simvastatin in patients with rheumatoid arthritis. Clin Pharmacol Ther. 2011;89:735–40.

    Article  CAS  PubMed  Google Scholar 

  31. Ulvestad M, Skottheim IB, Jakobsen GS, et al. Impact of OATP1B1, MDR1, and CYP3A4 expression in liver and intestine on interpatient pharmacokinetic variability of atorvastatin in obese subjects. Clin Pharmacol Ther. 2013;93:275–82.

    Article  CAS  PubMed  Google Scholar 

  32. Blouin RA, Warren GW. Pharmacokinetic considerations in obesity. J Pharm Sci. 1999;88:1–7.

    Article  CAS  PubMed  Google Scholar 

  33. Cheymol G. Effects of obesity on pharmacokinetics: implications for drug therapy. Clin Pharmacokinet. 2000;39:216–31.

    Article  Google Scholar 

  34. Seeley RJ, Chambers AP, Sandoval DA. The role of gut adaptation in the potent effects of multiple bariatric surgeries on obesity and diabetes. Cell Metab. 2015;21:369–78.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Roy DJ, Langworthy DR, Thurber KM, et al. Comparison of oral antibiotic failure rates in post-Roux-en-Y gastric bypass patients versus controls. Surg Obes Relat Dis. 2017;13:1524–9.

    Article  PubMed  Google Scholar 

  36. Lee Y, Ellenbogen Y, Doumouras AG, et al. Single- or double-anastomosis duodenal switch versus Roux-en-Y gastric bypass as a revisional procedure for sleeve gastrectomy: a systematic review and meta-analysis. Surg Obes Relat Dis. 2019;15:556–66.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada

    Sama Anvari, Yung Lee & Megan Lam

  2. Division of General Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada

    Sama Anvari, Yung Lee, Megan Lam, Aristithes G. Doumouras & Dennis Hong

  3. Centre for Minimal Access Surgery (CMAS), St. Joseph’s Healthcare, McMaster University, Hamilton, Ontario, Canada

    Sama Anvari, Yung Lee, Megan Lam, Aristithes G. Doumouras & Dennis Hong

  4. Division of General Surgery, St. Joseph’s Healthcare, Room G814, 50 Charlton Avenue East, Hamilton, Ontario, L8N 4A6, Canada

    Dennis Hong

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  1. Sama Anvari
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  2. Yung Lee
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Correspondence to Dennis Hong.

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Anvari, S., Lee, Y., Lam, M. et al. The Effect of Bariatric Surgery on Oral Antibiotic Absorption: a Systematic Review. OBES SURG 30, 2883–2892 (2020). https://doi.org/10.1007/s11695-020-04623-z

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  • DOI: https://doi.org/10.1007/s11695-020-04623-z

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