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Fluoroquinolones increased dysglycemia risk in diabetics
Patients with diabetes are at risk for severe dysglycemia if they use oral fluoroquinolones, researchers from National Taiwan University have found.
“It has previously been reported that several classes of antibiotics can increase the risk of severe hypoglycemia among users of glipizide or glyburide, as the result of known combined drug effects,” the researchers wrote in Clinical Infectious Diseases. “Therefore, prescribing safe antimicrobial agents with regard to their effects on glucose homeostasis is important due to the risk of dysglycemia episodes associated with infection or sepsis.”
The researchers conducted a population-based inception cohort study, using National Health Insurance claims to identify patients with diabetes who received an antibiotic prescription from 2006 to Nov. 30, 2007. The final analysis included 78,433 patients who received ciprofloxacin, moxifloxacin, levofloxacin, cephalosporins or macrolides.
There were 215 hyperglycemic events and 425 hypoglycemic events. For hyperglycemia, the absolute risk per 1,000 patients was 1.6 for macrolides, 2.1 for cephalosporins, 6.9 for moxifloxacin, 3.9 for levofloxacin and 4 for ciprofloxacin. For hypoglycemia, the absolute risk per 1,000 patients was: 3.7 for macrolides, 3.2 for cephalosporins, 10 for moxifloxacin, 9.3 for levofloxacin and 7.9 for ciprofloxacin.
Compared with macrolides, the adjusted ORs for hyperglycemia were 2.48 (95% CI, 1.50-4.12) for moxifloxacin, 1.75 (95% CI, 1.12-2.73) for levofloxacin and 1.87 (95% CI, 1.20-2.93) for ciprofloxacin. For hypoglycemia, the adjusted ORs were 2.13 (95% CI, 1.44-3.14) for moxifloxacin, 1.79 (95% CI, 1.33-2.42) for levofloxacin and 1.45 (95% CI, 1.07-2.00) for ciprofloxacin. Moxifloxacin increased the hypoglycemia risk significantly compared with ciprofloxacin. Moxifloxacin also increased the hypoglycemia risk among patients receiving insulin.
“Hypoglycemic risk varied according to the specifics of each drug and was most commonly associated with moxifloxacin,” the researchers wrote. “Clinicians should consider these risks when treating patients with diabetes and prescribe fluoroquinolones cautiously.”
Disclosure: The researchers report no relevant financial disclosures.