Risk of Severe Dysglycemia Among Diabetic Patients Receiving Levofloxacin, Ciprofloxacin, or Moxifloxacin in Taiwan

Chou, Hsu Wen; Wang, Jiun‐Ling; Chang, Chia‐Hsuin; Lee, Jen Jyh; Shau, Wen Yi; Lai, Mei‐Shu

doi:10.1093/cid/cit439

Cited by 102 publications

(93 citation statements)

References 27 publications

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“…Our findings support the recommendations of other studies calling for prevention and careful management of different types of infections in patients with diabetes, as infections can impair the maintenance of a strict glycemic control (37,38). The correct choice of compound and efficient treatment of infections could be helpful in controlling blood glucose and preventing bacterial resistance (33,39). Therefore, studies on the rational use of anti-infectives in children and adolescents with type 1 diabetes are recommended.…”

Section: Discussionsupporting

confidence: 86%

“…Furthermore, a recent FDA warning about fluoroquinolone antibiotics mentioned that several drugs in this class of antibiotics may disrupt blood glucose control in individuals with diabetes because of the insulinotropic or other effects of fluoroquinolones on beta cells in the pancreas. However, the incidence of hyperglycemia in patients taking quinolones (i.e., 6.9 per 1,000 people for moxifloxacin, 3.9 per 1,000 for levofloxacin, and 4.0 per 1,000 for ciprofloxacin) seems rather low and may only have partial contribution to the development of type 1 diabetes in the present cohort (32,33). As can be seen from our results, children and adolescents in the T1D cohort had higher prevalence of quinolone use in the years prior to the diagnosis of type 1 diabetes and other follow-up years.…”

Section: Discussionmentioning

confidence: 53%

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Population-Based Cohort Study of Anti-Infective Medication Use before and after the Onset of Type 1 Diabetes in Children and Adolescents

Farsani¹,

Souverein²,

Vorst³

et al. 2014

Antimicrob Agents Chemother

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A population-based cohort study was conducted in the Dutch PHARMO database to investigate prevalence and patterns of antiinfective medication use in children and adolescents with type 1 diabetes (T1D) before and after the onset of this disease. All patients <19 years with at least 2 insulin prescriptions (1999 to 2009) were identified (T1D cohort) and compared with an age-and sex-matched (ratio: 1 up to 4) diabetes-free reference group. The prevalence and average number of anti-infective use was studied from (up to) 8 years before until a maximum of 4 years after the onset of T1D. A total of 925 patients with T1D and 3,591 children and adolescents in the reference cohort (51% boys, mean age of 10.1 [standard deviation, 4.5] years) were included. The overall prevalence of anti-infective use (62.6 compared to 52.6%, P < 0.001) and average number of prescriptions (2.71 compared to 1.42 per child, P < 0.001) in the T1D cohort were significantly higher than those in the reference cohort after the onset of diabetes. This pattern was consistent across sex and age categories and already observed in the year before the onset of type 1 diabetes. Patients in the T1D cohort received more antibacterials (49.8 compared to 40%, P < 0.001), antimycotics (4.0 compared to 1.3%, P < 0.001), antivirals (2.5 compared to 0.4%, P < 0.001), and second-line antibiotics, such as aminoglycosides, quinolones, and third-generation cephalosporins and carbapenems. Our findings that elevated anti-infective use in the T1D cohort exists in the period before the onset of type 1 diabetes and the consumption of more second-line anti-infective compounds in this time period warrant further research.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 53%

Population-Based Cohort Study of Anti-Infective Medication Use before and after the Onset of Type 1 Diabetes in Children and Adolescents

Farsani¹,

Souverein²,

Vorst³

et al. 2014

Antimicrob Agents Chemother

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“…Increased use of these drugs has raised concern regarding rare but severe dysglycemia that may be fatal [105,106]. FQs have higher rates of both hyperglycemia and hypoglycemia compared to macrolides [107]. Higher risk of hypoglycemia was noted in patients concomitantly receiving antidiabetic agents in a nationwide cohort study [107].…”

Section: Fluoroquinolones (Fq)mentioning

confidence: 99%

“…FQs have higher rates of both hyperglycemia and hypoglycemia compared to macrolides [107]. Higher risk of hypoglycemia was noted in patients concomitantly receiving antidiabetic agents in a nationwide cohort study [107]. Hypoglycemia has also been reported in patients without DM or not on hypoglycemic medication.…”

Section: Fluoroquinolones (Fq)mentioning

confidence: 99%

“…Episodes occurred mostly at the beginning of FQ therapy and most occur after several days [108,109]. Moxifloxacin has been associated with the highest risk of hypoglycemia, followed by levofloxacin and ciprofloxacin [107]. FQ may cause hypoglycemia by increasing the release of insulin via a blockade of ATP-sensitive K+ channels in a dose-dependent manner and FQ itself may enhance the glucose-induced insulin secretion [110].…”

Section: Fluoroquinolones (Fq)mentioning

confidence: 99%

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Medications affecting glycemic control

Korayem¹

2017

Int Clin Med

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Hypoglycemia After Antimicrobial Drug Prescription for Older Patients Using Sulfonylureas

Parekh¹,

Raji

Lin

et al. 2014

JAMA Intern Med

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IMPORTANCE Certain antimicrobial drugs interact with sulfonylureas to increase the risk of hypoglycemia.OBJECTIVE To determine the risk of hypoglycemia and associated costs in older patients prescribed glipizide or glyburide who fill a prescription for an antimicrobial drug. DESIGN, SETTING, AND PARTICIPANTSThis was a retrospective cohort study of Texas Medicare claims from 2006 to 2009 for patients 66 years or older who were prescribed glipizide or glyburide and who also filled a prescription for 1 of the 16 antimicrobials most commonly prescribed for this population.METHODS We assessed hypoglycemia events and associated Medicare costs in patients prescribed 1 of 7 antimicrobial agents thought to interact with sulfonylureas, using noninteracting antimicrobials as a comparison. We used a repeated measure logistic regression, controlling for age, sex, ethnicity, Medicaid eligibility, comorbidity, prior emergency department visits for hypoglycemia, prior hospitalizations for any cause, nursing home residence, and indication for the antimicrobial. We estimated odds of hypoglycemia, number needed to harm, deaths during hospitalization for hypoglycemia, and Medicare costs for hypoglycemia treatment. MAIN OUTCOMES AND MEASURESAny hospitalization or emergency department visit owing to hypoglycemia within 14 days of antimicrobial exposure. RESULTSIn multivariable analyses controlling for patient characteristics and indication for antimicrobial drug use, clarithromycin (odds ratio [OR], 3.96 [95% CI, 2.42-6.49]), levofloxacin (OR, 2.60 [95% CI, 2.18-3.10]), sulfamethoxazole-trimethoprim (OR, 2.56 [95% CI, 2.12-3.10]), metronidazole (OR, 2.11 [95% CI,), and ciprofloxacin (OR, 1.62 [95% CI, 1.33-1.97]) were associated with higher rates of hypoglycemia compared with a panel of noninteracting antimicrobials. The number needed to harm ranged from 71 for clarithromycin to 334 for ciprofloxacin. Patient factors associated with hypoglycemia included older age, female sex, black or Hispanic race/ethnicity, higher comorbidity, and prior hypoglycemic episode. In 2009, 28.3% of patients prescribed a sulfonylurea filled a prescription for 1 of these 5 antimicrobials, which were associated with 13.2% of all hypoglycemia events in patients taking sulfonylureas. The treatment of subsequent hypoglycemia adds $30.54 in additional Medicare costs to each prescription of 1 of those 5 antimicrobials given to patients taking sulfonylureas.CONCLUSIONS AND RELEVANCE Prescription of interacting antimicrobial drugs to patients on sulfonylureas is very common, and is associated with substantial morbidity and increased costs.

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Risk of Severe Dysglycemia Among Diabetic Patients Receiving Levofloxacin, Ciprofloxacin, or Moxifloxacin in Taiwan

Abstract: Diabetics using oral fluoroquinolones faced greater risk of severe dysglycemia. The risk of hypoglycemia varied according to the type of fluoroquinolone administered, and was most commonly associated with moxifloxacin.

Cited by 102 publications

References 27 publications

Population-Based Cohort Study of Anti-Infective Medication Use before and after the Onset of Type 1 Diabetes in Children and Adolescents

Population-Based Cohort Study of Anti-Infective Medication Use before and after the Onset of Type 1 Diabetes in Children and Adolescents

Medications affecting glycemic control

Hypoglycemia After Antimicrobial Drug Prescription for Older Patients Using Sulfonylureas

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