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High Concurrent Use of Sulfonylureas and Antimicrobials With Drug Interactions Causing Hypoglycemia.
J Patient Saf. 2020 Jun 19 [Online ahead of print]JP

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.

Authors+Show Affiliations

From the Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine. Welch Center for Prevention, Epidemiology, and Clinical Research.From the Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine. The Johns Hopkins Armstrong Institute for Patient Safety and Quality, The Johns Hopkins University School of Medicine.From the Department of Medicine, Division of General Internal Medicine, The Johns Hopkins University School of Medicine. Welch Center for Prevention, Epidemiology, and Clinical Research. Department of Epidemiology, The Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32569099

Citation

Pilla, Scott J., et al. "High Concurrent Use of Sulfonylureas and Antimicrobials With Drug Interactions Causing Hypoglycemia." Journal of Patient Safety, 2020.
Pilla SJ, Pitts SI, Maruthur NM. High Concurrent Use of Sulfonylureas and Antimicrobials With Drug Interactions Causing Hypoglycemia. J Patient Saf. 2020.
Pilla, S. J., Pitts, S. I., & Maruthur, N. M. (2020). High Concurrent Use of Sulfonylureas and Antimicrobials With Drug Interactions Causing Hypoglycemia. Journal of Patient Safety. https://doi.org/10.1097/PTS.0000000000000739
Pilla SJ, Pitts SI, Maruthur NM. High Concurrent Use of Sulfonylureas and Antimicrobials With Drug Interactions Causing Hypoglycemia. J Patient Saf. 2020 Jun 19; PubMed PMID: 32569099.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - High Concurrent Use of Sulfonylureas and Antimicrobials With Drug Interactions Causing Hypoglycemia. AU - Pilla,Scott J, AU - Pitts,Samantha I, AU - Maruthur,Nisa M, Y1 - 2020/06/19/ PY - 2020/6/23/entrez PY - 2020/6/23/pubmed PY - 2020/6/23/medline JF - Journal of patient safety JO - J Patient Saf N2 - 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. SN - 1549-8425 UR - https://www.unboundmedicine.com/medline/citation/32569099/High_Concurrent_Use_of_Sulfonylureas_and_Antimicrobials_With_Drug_Interactions_Causing_Hypoglycemia L2 - https://doi.org/10.1097/PTS.0000000000000739 DB - PRIME DP - Unbound Medicine ER -
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