TBW (Total Body Weight)
Use In Children Affected By Obesity
Amoxicillin/clavulanic acid (combination of amoxicillin, a β-lactam antibiotic, and potassium clavulanate, a β-lactamase inhibitor)
The practice of capping the dose at the usual adult maximum did not seem to differ whether prescribing for children with obesity or for normal-weight children . Use TBW dosing, possibly evaluating the posology based on the severity and site of infection 
Underdosing the TBW: risk of overdose due to difficult elimination .
Cefazolin (first generation cephalosporine)
40 mg/kg IV q6h
The administration maximized the model-based probability of target attainment PTA in children and adolescents with obesity and GFR ≥ 80 mL/min/1.73 m2 
20-40 mg/kg/day in three or four equal doses.
Ceftriaxone (third-generation cephalosporin)
TBW dosing has proven safe and effective in childhood obesity .
10 mg/kg day, max 600 m
Weight-based dosing in children remains unclear. Data from adult patients suggest risks of linezolid underdosing in empirical antibiotic therapy of most resistant bacteria .
20 mg/kg IV every 8 hours
8 mg/kg/day trimethoprim
Patients with overweight/obesity may have decreased weight-normalized clearance and volume of distribution of the drug, so that should require higher absolute doses under recommended pediatric weight-based dosing regimens [2, 21, 24]
No dose adjustment for obesity .
ANALGESICS AND ANESTHETICS
10–15 mg/kg/day every 4-6 h <12y
No significant differences in circulating acetaminophen concentrations after a 5-mg/kg (up to 325 mg) single oral dose administration in children with NAFLD
In adults there are higher concentrations of hepatotoxic CYP2E1-mediated acetaminophen metabolites. Adults with obesity may not tolerate high doses due the overproduction of hepatotoxic acetaminophen metabolites .
Dexmedetomidine (selective a2-agonist)
No differences in the dosage required for sedation in children suffering from obesity and those with normal weight .
Rolle et al. have found in their study that lean body mass (LBM) is an appropriate dosing scalar for size in adult patients with obesity .
Fentanyl (opiate agonist)
1–2 μg/kg/dose IM
Lipophilic. Adjusted Body Weight (cofactor of 0.25) has been recommended .
Mortensen et al. recommended TBW for induction and lean body weight (LBW) for maintenance of anesthesia .
0.1–0.3 mg/kg, max 5 mg IV,IM
Potential need for higher initial drug dose administration for continuous infusion .
Morphine (opiate agonist)
0.1–0.15 mg/kg/dose every 4 h IM or 0.2–0.4 mg/kg/dose every 4 h OD
Dosing morphine is based on IBW because it is a hydrophilic opioid .
TBW not recommended.
Propofol (short-acting, lipophilic intravenous general anesthetic)
1–2 mg/kg pro dose
Diepstraten et al. proposed TBW-based dosing to achieve maintenance anesthesia .
Amlodipine (Calcium channel blocker)
Angiotensin-Converting Enzyme Inhibitor (Ramipril)
0.05–0.15 mg/kg/day max 40 mg/day
(e.g. haloperidol, thioridazine, risperidone, aripiprazole)
Few studies on their correct dosing and therapeutic drug monitoring. Start low, go slow and careful monitoring of patients’ metabolism Discontinuation attempts after long-term use can also be beneficial [33, 34, 35].
> 10y: 10-20 mg/day
Due to the correlation of statins with the genotypic variability of SLCO1B1, cases of statin overtreatment may occur .
Depending on the drug and protocols
Doses of chemotherapy are commonly calculated based on a patient’s Body surface area, using TBW. Baillargeon et al. by studying children with leukemia found that 7% of those with obesity received less than the protocol-specified dose .
Inhaled corticosteroids (e.g. beclomethasone, budesonide, flunisolide, fluticasone)
Depending on the drug
Liraglutide (analogous to glucagon-like peptide)
Same dose of adults (i.e. 3 mg, s.c.).
Children over 10 years of age with an indication of type 2 diabetes mellitus not correctly compensated with metformin
indications also for the treatment of obesity in patients aged> 12 years weighing > 60 kg
Low-molecular weight Heparin
Depending on the drug and indication
500 mg day, max 2 g/day
TBW dosing: higher drug doses than patients without obesity 
Use of adult doses of metformin in older children and adolescents with obesity 
PPIs e.g., Pantoprazole
Depending on indication
Need for standardization of drug dosing guidelines for children with obesity to avoid risk of harm .
1000 and 2000 IU 25(OH)D /day
The highest percentages of patients affected by obesity with values ≥20 ng/ mL were seen only among the 2000-IU group, implying therefore the superiority in effectiveness of this dose in comparison to the lower ones