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Risk for hypoglycemic emergency with levofloxacin use, a population-based propensity score matched nested
Shu-Hui Liao1, Sung-Yuan Hu2,3, Chorng-Kuang How4,5,6
1Department of Pathology and Laboratory, Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan, Taiwan.
Plos One
|April 4, 2022
Summary
Oral levofloxacin use significantly increases the risk of hypoglycemic emergency (HE) in type 2 diabetes (T2D) patients. Caution is advised, especially when combined with insulin or sulfonylurea.
Area of Science:
- Pharmacovigilance
- Epidemiology
- Diabetology
Background:
- Oral levofloxacin is a commonly prescribed antibiotic.
- An established potential association exists between levofloxacin and hypoglycemic emergencies (HE).
- Large-scale epidemiological data are needed to confirm this association in type 2 diabetes (T2D) patients.
Purpose of the Study:
- To investigate the association between oral levofloxacin use and the risk of HE in T2D patients.
- To compare the risk of HE associated with levofloxacin against other antibiotic classes.
- To evaluate the combined risk of levofloxacin with common T2D medications.
Main Methods:
- A nested case-control study using a nationwide database (1999-2013) of 1.6 million T2D patients.
- Cases were T2D patients with HE, controls were T2D patients without HE, matched by propensity score (10:1 ratio).
- Multivariate logistic regression analysis was employed, adjusting for T2D severity.
Main Results:
- Antibiotic use was associated with a 6.08-fold increased risk of HE.
- Fluoroquinolones (aOR=12.05) and sulfonamides (aOR=7.20) showed the highest HE risks.
- Levofloxacin use demonstrated a significantly higher risk of HE compared to cephalosporins and penicillin.
- Combined use of levofloxacin with insulin (aOR=8.42) or sulfonylurea (aOR=3.56) further increased HE risk.
Conclusions:
- Oral levofloxacin use is significantly associated with an increased risk of HE in T2D patients.
- The risk is notably higher compared to other commonly used antibiotics.
- Prescribers should exercise caution when prescribing levofloxacin, particularly for patients on insulin or sulfonylurea therapy.
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