Clinical Infectious Diseases

Certain Antibiotics Tied to Blood Sugar Swings in Diabetics.

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Diabetes patients who take a certain class of antibiotics are more likely to have severe blood sugar fluctuations than those who take other types of the drugs, a new study finds.

The increased risk was low but doctors should consider it when prescribing the class of antibiotics, known as fluoroquinolones, to people with diabetes, the researchers said. This class of antibiotics, which includes drugs such as Cipro(ciprofloxacin), Levaquin (levofloxacin) and Avelox(moxifloxacin), is commonly used to treat conditions such as urinary tract infections and community-acquired pneumonia.

One expert said the study should serve as a wake-up call for doctors.

“Given a number of alternatives, physicians may consider prescribing alternate antibiotics … in the place of fluoroquinolones (particularly moxifloxacin) to patients with diabetes,” said Dr. Christopher Ochner, assistant professor of pediatrics and adolescent medicine at the Icahn School of Medicine at Mount Sinai, in New York City. “In general, this study demonstrates that closer attention needs to be paid to particular drug-condition interactions.”

The study included about 78,000 people with diabetes in Taiwan. The researchers looked at the patients’ use of three classes of antibiotics: fluoroquinolones; second-generation cephalosporins (cefuroxime, cefaclor, or cefprozil); or macrolides (clarithromycin or azithromycin).

The investigators also looked for any emergency-room visits or hospitalizations for severe blood sugar swings among the patients in the 30 days after they started taking the antibiotics.

The results showed that patients who took fluoroquinolones were more likely to have severe blood sugar swings than those who took antibiotics in the other classes. The level of risk varied according to the specific fluoroquinolone, according to the study, which was published in the journal Clinical Infectious Diseases.

The incidence of hyperglycemia (high blood sugar) per 1,000 people was 6.9 for people taking moxifloxacin, 3.9 for levofloxacin and 4.0 for ciprofloxacin. The incidence of hypoglycemia (low blood sugar) was 10 per 1,000 for moxifloxacin, 9.3 for levofloxacin and 7.9 for ciprofloxacin.

The incidence of hyperglycemia per 1,000 people was 1.6 for those taking the macrolide class of antibiotics and 2.1 for those on cephalosporins. The incidence of hypoglycemia per 1,000 people was 3.7 for macrolides and 3.2 for cephalosporins.

“Our results identified moxifloxacin as the drug associated with the highest risk of hypoglycemia, followed by levofloxacin and ciprofloxacin,” wrote Dr. Mei-Shu Lai, at National Taiwan University, and colleagues.

They said doctors should consider other antibiotics if they have concerns that patients might experience severe blood sugar swings.

“The study … does not prove a causal connection between particular fluoroquinolones and blood sugar dysregulation,” Ochner said. But he believes that it provides evidence that people with diabetes may be at special risk from moxifloxacin in particular.

“If moxifloxacin is to be prescribed to diabetic patients, there should be some additional expected benefit that justifies the increase in incurred risk,” Ochner said.

But another expert said there could be other explanations for why people on fluoroquinolones had more blood sugar fluctuations.

“It is hard to draw conclusions that fluoroquinolones themselves are the culprit, as all of these patients had infections, and infection can lead to hypo- or hyperglycemia in persons with diabetes,” said Dr. Alyson Myers, an endocrinologist at North Shore University Hospital in Manhasset, N.Y.

“In addition, those in the fluoroquinolone group were more likely to have chronic kidney disease or steroid use – the former can increase rates of hypoglycemia and the latter can increase rates of hyperglycemia,” Myers said. “Another confounding factor would be the type of diabetes treatments that patients were receiving, as sulfonylureas and insulin are both associated with greater risks of hypoglycemia than other diabetes medications.”

Source: Drugs.com

Risk of Severe Dysglycemia Among Diabetic Patients Receiving Levofloxacin, Ciprofloxacin, or Moxifloxacin in Taiwan.

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Background. Observational studies and fatal case reports raise concern about the safety of severe dysglycemia associated with fluoroquinolone use. The objective of this study was to assess the risk of severe dysglycemia among diabetic patients who received different fluoroquinolones.

Methods. In a population-based inception cohort study of diabetic patients covering the period from January 2006 to November 2007, outpatient new users of levofloxacin, ciprofloxacin, moxifloxacin, cephalosporins, and macrolides orally were identified. Study events were defined as emergency department visits or hospitalization for dysglycemia within 30 days following the initiation of antibiotic therapy. Results were analyzed with adjusted multinomial propensity score.

Results. A total of 78 433 diabetic patients receiving the antibiotics of interest were included in the study. The absolute risk of hyperglycemia per 1000 persons was 6.9 for moxifloxacin and 1.6 for macrolides. In contrast, the risk of hypoglycemia was 10.0 for moxifloxacin and 3.7 for macrolides. The adjusted odds ratios (AORs) and 95% confidence intervals (CIs) of levofloxacin, ciprofloxacin, and moxifloxacin compared with macrolides were 1.75 (1.12–2.73), 1.87 (1.20–2.93), and 2.48 (1.50–4.12), respectively, for hyperglycemia and 1.79 (1.33–2.42), 1.46 (1.07–2.00), and 2.13 (1.44–3.14), respectively, for hypoglycemia. Patients taking moxifloxacin faced a significantly higher risk of hypoglycemia than those receiving ciprofloxacin. A significant increase in the risk of hypoglycemia was also observed among patients receiving moxifloxacin concomitantly with insulin (AOR, 2.28; 95% CI, 1.22–4.24).

Conclusions. Diabetics using oral fluoroquinolones faced greater risk of severe dysglycemia. The risk of hypoglycemia varied according to the type of fluoroquinolone administered, and was most commonly associated with moxifloxacin.

Source: cid.oxfordjournals.org


Fluoroquinolones Up Risk for Severe Dysglycemia in Diabetes.

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A new nationwide cohort study has shown that patients with diabetes who use oral fluoroquinolone antibiotics are at greater risk for severe dysglycemia than those using other antibiotics.

And although the risk was low — hyperglycemia or hypoglycemia related to fluoroquinolones occurred in fewer than 1 in 100 patients studied in the trial in 78,000 diabetics — doctors should still exercise caution, say Hsu-Wen Chou, MS, from the National Taiwan University, Taipei, and colleagues in their paper published onlineAugust 15 in Clinical Infectious Diseases.

The risks also appear to vary according to the type of fluoroquinolone antibiotic used, and 1 in particular, moxifloxacin (Avelox, Bayer), appears to most increase the likelihood of hypoglycemia, an effect that is heightened among patients receiving concomitant insulin or sulfonylurea treatment, coauthor Wang Jiun-Ling, MD, from I-Shou University and E-Da Hospital, Kaohsiung, Taiwan, told Medscape Medical News.

“Clinicians should consider hypoglycemic risks when treating diabetic patients with infection and prescribe fluoroquinolones cautiously,” said Dr. Wang. “If patients have a higher risk of hypoglycemia or develop hyper- or hypoglycemia during fluoroquinolone use, another class of antibiotic — such as beta-lactam or macrolide — should be considered.”

And patients should also be made aware of the risks, he added. “Those with diabetes who need to take fluoroquinolones should better understand the signs and symptoms of hypoglycemia and check blood glucose where necessary.”

Those With Renal Disease Also at Greater Risk

Dr. Chou and colleagues explain in their paper that fluoroquinolones, used to treat urinary-tract infections and community-acquired pneumonia among other things, are being increasingly prescribed because of their broad spectrum of action. But this greater use has spawned concerns regarding rare but severe adverse effects, which include tendon rupture, QT-interval prolongation, and dysglycemia.

In fact, one fluoroquinolone antibiotic, gatifloxacin (Tequin, Bristol-Myers Squibb), was already withdrawn from the US market in 2006 due to the risk for severe dysglycemia. However, there are insufficient data describing the likelihood of dysglycemia with other fluoroquinolones, they say.

Using the claims database for Taiwan’s national insurance program, the researchers analyzed data from 78,433 outpatients with mostly type 2 diabetes who had received a new prescription for an antibiotic from January 2006 to November 2007.

The antibiotics were divided into 3 classes: fluoroquinolones (levofloxacin, ciprofloxacin, or moxifloxacin); second-generation cephalosporins (cefuroxime, cefaclor, or cefprozil); or macrolides (clarithromycin or azithromycin).

A “study event” was defined as an emergency-department visit or hospitalization for dysglycemia among these patients within 30 days of the start of their antibiotic therapy.

Diabetic patients using oral fluoroquinolones faced greater risk for severe dysglycemia than those using antibiotics in other classes.

After multinomial propensity score adjustment, the odds ratio for hyperglycemia was 1.75 for levofloxacin, 1.87 for ciprofloxacin, and 2.48 for moxifloxacin compared with use of macrolides.

For hypoglycemia, the adjusted odds ratios (AORs) were 1.79, 1.46, and 2.13 for the same drugs, respectively, compared with macrolides.

This adverse effect was also more likely to occur in patients who suffered from comorbid kidney disease as well as those who were concomitantly treated with insulin or sulfonylureas, the researchers note.

“Our results showed a class effect regarding increased risk of severe dysglycemia among diabetic patients administered fluoroquinolones in Taiwan. Hypoglycemic risk varied according to the specifics of each drug and was most commonly associated with moxifloxacin. Clinicians should consider these risks when treating patients with diabetes and prescribe fluoroquinolones cautiously,” they conclude.

Sourrce: Medscape.com

 

 

Source: http://www.sciencedirect.com

 

Fluoroquinolones Linked to Dysglycemia in Patients with Diabetes.

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Fluoroquinolones are associated with increased risk for both hyperglycemia and hypoglycemia among patients with diabetes, compared with other antibiotics, according to a study in Clinical Infectious Diseases.

Researchers in Taiwan used national insurance claims data to identify roughly 78,000 outpatients with diabetes who received a new prescription for an oral antibiotic.

Within 30 days of starting the antibiotic, patients taking moxifloxacin, levofloxacin, or ciprofloxacin had 1.75 to 2.48 times the risk for hyperglycemia-related emergency department visits or hospitalizations, relative to patients taking macrolides. Risks were similarly elevated for episodes of hypoglycemia. Moxifloxacin was associated with the highest risk for dysglycemia.

The authors conclude: “Clinicians should consider these risks when treating patients with diabetes and prescribe fluoroquinolones cautiously.”

Source: Clinical Infectious Diseases article