A Retrospective, Comparative Evaluation of Dysglycemias in Hospitalized Patients Receiving Gatifloxacin, Levofloxacin, Ciprofloxacin, or Ceftriaxone

Abstract

In the 17,108 patients receiving a fluoroquinolone or ceftriaxone, the rate of dysglycemia was greater in those receiving levofloxacin or gatifloxacin than in those receiving ceftriaxone. However, no difference was noted in the rate of glucose abnormalities with levofloxacin versus gatifloxacin. Clinicians should be aware of dysglycemic events that may occur in patients receiving fluoroquinolones, especially in those with diabetes mellitus or those receiving sulfonylureas.

The insulinotropic effect of fluoroquinolones

“…Hypoglycemias are rare, however, they are potentially life-threatening and have led to a number of fatalities [2]. While some of the hypoglycemic episodes have to be attributed to an interaction with sulfonylurea antidiabetic drugs [3][4][5], it is generally accepted that fluoroquinolones by themselves can induce hypoglycemias and concomitant sulfonylurea therapy is an independent risk factor [6].…”

The effect of levofloxacin and moxifloxacin on cardiovascular functions of rats with streptozotocin-induced diabetes

“…hyperglycaemia and hypoglycaemia associated with gatifloxacin and levofloxacin use respectively). 8,[18][19][20] Since levofloxacin and moxifloxacin are widely prescribed, the effect of these drugs on vascular function is becoming increasingly important, especially in diabetes, a disease which is strongly connected to cardiovascular complications. Therefore, the present study focused on the effect of these antibiotics on the cardiovascular function of STZ-diabetic rats, an animal model of type I diabetes.…”

“…hyperglycaemia with gatifloxacin use in the elderly patients). [7][8][9] Therefore, these fluoroquinolones (except moxifloxacin) were removed from the market.…”

Glycemic Control and Critical Illness

“…In addition, the effect of reduced GFR on enhancing risk for drug-induced hyperglycemia and, to a lesser extent, hypoglycemia, particularly with antibiotics such as gatifloxacin, should be recognized. 39,40 Similar adjustments may be required when calcineurin inhibitors and steroids are used in delayed graft function after renal transplants. 41 When dialysis is instituted, further adjustments in insulin dosing and more frequent glucose monitoring may be required.…”