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Severe dysglycemia with the fluoroquinolones: a class effect?
Clin Infect Dis. 2009 Aug 01; 49(3):402-8.CI

Abstract

BACKGROUND

Although gatifloxacin is no longer available, other fluoroquinolones may significantly interfere with glucose homeostasis. The objective of the present study was to compare the risk of severe hypo- and hyperglycemia in a cohort of patients treated with gatifloxacin, levofloxacin, ciprofloxacin, or azithromycin.

METHODS

This was a retrospective inception cohort study of outpatients with a new prescription for gatifloxacin, levofloxacin, ciprofloxacin, or azithromycin from 1 October 2000 through 30 September 2005 in the Veterans Affairs health care system. For patients who received one of these antibiotics, we identified outcomes of hospitalization with a primary diagnosis of hypo- or hyperglycemia. Multivariable logistic regression was used to determine the odds of hypo- and hyperglycemia with the individual fluoroquinolones versus azithromycin.

RESULTS

The crude incidence rates for severe hypo- and hyperglycemia among those who received gatifloxacin, levofloxacin, ciprofloxacin, and azithromycin were 0.35 and 0.45, 0.19 and 0.18, 0.10 and 0.12, and 0.07 and 0.10 cases per 1000 patients, respectively. Among patients with diabetes, the odds ratios for hypoglycemia compared with azithromycin were 4.3 (95% confidence interval [CI], 2.7-6.6) for gatifloxacin, 2.1 (95% CI, 1.4-3.3) for levofloxacin, and 1.1 (95% CI, 0.6-2.0) for ciprofloxacin. The odds ratios for hyperglycemia were 4.5 (95% CI, 3.0-6.9) for gatifloxacin, 1.8 (95% CI, 1.2-2.7) for levofloxacin, and 1.0 (95% CI, 0.6-1.8) for ciprofloxacin.

CONCLUSIONS

The odds of severe hypo- and hyperglycemia were significantly greater with gatifloxacin and levofloxacin, but not ciprofloxacin, than with azithromycin. Thus, the risk of a clinically relevant dysglycemic event appears to vary among the fluoroquinolones.

Authors+Show Affiliations

Veterans Affairs Center for Medication Safety, Hines, Illinois, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, U.S. Gov't, Non-P.H.S.

Language

eng

PubMed ID

19545207

Citation

Aspinall, Sherrie L., et al. "Severe Dysglycemia With the Fluoroquinolones: a Class Effect?" Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, vol. 49, no. 3, 2009, pp. 402-8.
Aspinall SL, Good CB, Jiang R, et al. Severe dysglycemia with the fluoroquinolones: a class effect? Clin Infect Dis. 2009;49(3):402-8.
Aspinall, S. L., Good, C. B., Jiang, R., McCarren, M., Dong, D., & Cunningham, F. E. (2009). Severe dysglycemia with the fluoroquinolones: a class effect? Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America, 49(3), 402-8. https://doi.org/10.1086/600294
Aspinall SL, et al. Severe Dysglycemia With the Fluoroquinolones: a Class Effect. Clin Infect Dis. 2009 Aug 1;49(3):402-8. PubMed PMID: 19545207.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Severe dysglycemia with the fluoroquinolones: a class effect? AU - Aspinall,Sherrie L, AU - Good,Chester B, AU - Jiang,Rong, AU - McCarren,Madeline, AU - Dong,Diane, AU - Cunningham,Francesca E, PY - 2009/6/24/entrez PY - 2009/6/24/pubmed PY - 2009/9/1/medline SP - 402 EP - 8 JF - Clinical infectious diseases : an official publication of the Infectious Diseases Society of America JO - Clin. Infect. Dis. VL - 49 IS - 3 N2 - BACKGROUND: Although gatifloxacin is no longer available, other fluoroquinolones may significantly interfere with glucose homeostasis. The objective of the present study was to compare the risk of severe hypo- and hyperglycemia in a cohort of patients treated with gatifloxacin, levofloxacin, ciprofloxacin, or azithromycin. METHODS: This was a retrospective inception cohort study of outpatients with a new prescription for gatifloxacin, levofloxacin, ciprofloxacin, or azithromycin from 1 October 2000 through 30 September 2005 in the Veterans Affairs health care system. For patients who received one of these antibiotics, we identified outcomes of hospitalization with a primary diagnosis of hypo- or hyperglycemia. Multivariable logistic regression was used to determine the odds of hypo- and hyperglycemia with the individual fluoroquinolones versus azithromycin. RESULTS: The crude incidence rates for severe hypo- and hyperglycemia among those who received gatifloxacin, levofloxacin, ciprofloxacin, and azithromycin were 0.35 and 0.45, 0.19 and 0.18, 0.10 and 0.12, and 0.07 and 0.10 cases per 1000 patients, respectively. Among patients with diabetes, the odds ratios for hypoglycemia compared with azithromycin were 4.3 (95% confidence interval [CI], 2.7-6.6) for gatifloxacin, 2.1 (95% CI, 1.4-3.3) for levofloxacin, and 1.1 (95% CI, 0.6-2.0) for ciprofloxacin. The odds ratios for hyperglycemia were 4.5 (95% CI, 3.0-6.9) for gatifloxacin, 1.8 (95% CI, 1.2-2.7) for levofloxacin, and 1.0 (95% CI, 0.6-1.8) for ciprofloxacin. CONCLUSIONS: The odds of severe hypo- and hyperglycemia were significantly greater with gatifloxacin and levofloxacin, but not ciprofloxacin, than with azithromycin. Thus, the risk of a clinically relevant dysglycemic event appears to vary among the fluoroquinolones. SN - 1537-6591 UR - https://www.unboundmedicine.com/medline/citation/19545207/Severe_dysglycemia_with_the_fluoroquinolones:_a_class_effect L2 - https://academic.oup.com/cid/article-lookup/doi/10.1086/600294 DB - PRIME DP - Unbound Medicine ER -