Severe dysglycemia with the fluoroquinolones: a class effect?
Sherrie L Aspinall1, Chester B Good, Rong Jiang
1Veterans Affairs Center for Medication Safety, Hines, Illinois, USA.
Summary
Fluoroquinolones like gatifloxacin and levofloxacin increase the risk of severe hypo- and hyperglycemia compared to azithromycin. Ciprofloxacin showed no significant difference in these glucose homeostasis risks.
Area of Science:
- Pharmacology
- Clinical Medicine
- Public Health
Background:
- Fluoroquinolones are known to potentially disrupt glucose homeostasis.
- Gatifloxacin, though withdrawn, serves as a reference for comparing risks with other fluoroquinolones.
Purpose of the Study:
- To compare the risk of severe hypoglycemia and hyperglycemia associated with gatifloxacin, levofloxacin, and ciprofloxacin versus azithromycin.
Main Methods:
- Retrospective cohort study of outpatients prescribed gatifloxacin, levofloxacin, ciprofloxacin, or azithromycin.
- Identified hospitalizations for hypoglycemia or hyperglycemia as primary outcomes.
- Used multivariable logistic regression to assess odds ratios for dysglycemic events.
Main Results:
- Gatifloxacin and levofloxacin were associated with significantly higher odds of both hypoglycemia and hyperglycemia compared to azithromycin.
- Ciprofloxacin did not show a statistically significant increased risk for these glucose disturbances.
- Crude incidence rates for severe hypo- and hyperglycemia varied among the antibiotics studied.
Conclusions:
- The risk of clinically significant dysglycemic events differs among fluoroquinolones.
- Gatifloxacin and levofloxacin pose a greater risk for glucose homeostasis interference than azithromycin.
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