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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.

Clinical Infectious Diseases : an Official Publication of the Infectious Diseases Society of America
|June 24, 2009
PubMed
Abstract

Insights

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  • Gatifloxacin, though withdrawn, serves as a reference for comparing risks with other fluoroquinolones.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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