High Concurrent Use of Sulfonylureas and Antimicrobials With Drug Interactions Causing Hypoglycemia

Abstract

Objectives: Sulfonylureas, the second most common oral diabetes treatment, have interactions with antimicrobials that substantially increase the risk of hypoglycemia. The objectives of this study are to quantify the concurrent use of sulfonylureas and interacting antimicrobial in U.S. ambulatory care and to examine whether interacting antimicrobials are used for an appropriate indication. Methods:We analyzed the 2006-2016 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey, annual probability samples of visits to U.S. office-based physicians. We determined nationally representative estimates of visits for adults with concurrent use of sulfonylureas and 7 antimicrobials with established interactions. We examined whether visit diagnoses included appropriate indications for antibiotics according to national guidelines.Results: There were 2.5 million visits per year (95% confidence interval[CI] 2.2-2.9) in which sulfonylureas were used with systemic antimicrobials, of which 1 million (95% CI, 0.8-1.2) or 38.0% (95% CI, 32.3%-44.0%) were interacting antimicrobials. Sulfonylurea users had similar odds of interacting antimicrobial use as patients using diabetes medications without antimicrobial interactions (adjusted odds ratio, 1.07; 95% CI, 0.82-1.40). The most common interacting antimicrobials used with sulfonylureas were fluoroquinolones, accounting for 59.9% (95% CI, 50.7%-68.2%) of antimicrobials, and sulfamethoxazole-trimethoprim, accounting for 21.1% (95% CI, 14.8%-29.2%). There was no appropriate antibiotic indication in 69.7% (95% CI, 55.2%-81.1) of visits with interacting antibiotic use.Conclusions: Sulfonylureas and antimicrobials with potentially hazardous interactions are frequently used together. To reduce resultant hypoglycemic events, there is a need for interventions to increase physician awareness and promote antibiotic stewardship.

6. Glycemic Goals and Hypoglycemia: Standards of Care in Diabetes—2024

“…Clinicians should be aware of medication interactions that may precipitate hypoglycemia. Notably, sulfonylureas interact with a number of commonly used antimicrobials (fluoroquinolones, clarithromycin, sulfamethoxazole-trimethoprim, metronidazole, and fluconazole) that can dramatically increase their effective dose, leading to hypoglycemia (143)(144)(145). Clinicians should consider temporarily decreasing or stopping sulfonylureas when these antimicrobials are prescribed.…”

Triple therapy for Helicobacter pylori eradication and the risk of hypoglycemia in patients with diabetes: a population-based cohort study

“…The standard treatment for H. pylori infection is triple therapy, which involves amoxicillin, clarithromycin, and a proton pump inhibitor (PPI). However, several case reports have revealed hypoglycemia can occur when these regiments are in patients taking diabetes medication [ 11 ]. Another case report described an 82-year-old man with type 2 diabetes using insulin detemir who experienced severe hypoglycemia during treatment for H. pylori infection [ 12 ].…”