Effects of Gatifloxacin and Levofloxacin on Rates of Hypoglycemia and Hyperglycemia Among Elderly Hospitalized Patients

Abstract

Higher rates of both hypoglycemia and hyperglycemia were noted among elderly hospitalized patients who received gatifloxacin compared with those receiving levofloxacin, irrespective of dosing.

Severe Dysglycemia with the Fluoroquinolones: A Class Effect?

“…One contributing factor may be overexposure (eg, failure to adjust the dose in patients with renal insufficiency) [32]. The results of our study and of others [12,15,16,20,21], as well as this potentially common mechanism for hypoglycemia, suggest the need for caution when using certain fluoroquinolones, because the odds of hypo-and hyperglycemia appear to vary among the agents [33]. This is not unusual; differences in risk have been reported for other adverse effects with this class of antibiotics [34].…”

“…However, gatifloxacin-which had been used in the treatment of a variety of infections, including those involving the skin and the respiratory and genitourinary tracts [1,2]-was withdrawn from the market because of concerns about severe glucose disturbances. Although hypoglycemia and hyperglycemia were reported only rarely during clinical trials with gatifloxacin, severe dysglycemic events, typically in elderly patients and in patients with diabetes, were re-ported during the postmarketing period [3] and published in the medical literature [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21].…”

Patients With Long-QT Syndrome Caused by Impaired hERG -Encoded K v 11.1 Potassium Channel Have Exaggerated Endocrine Pancreatic and Incretin Function Associated With Reactive Hypoglycemia

“…Similarly, the widely used fluoroquinolone antibiotics that also block the K v 11.1 1 have been associated with hypoglycemia both in patients with and without diabetes mellitus, and with fatal hypoglycemia, as well, when used together with sulfonylurea. 1,38,39 Indeed, several widely used pharmaceutical agents are known to block the Kv11.1 channel, 1,27 and may, therefore, on the background of the present observations, also be suspected to increase the risk of reactive hypoglycemia.…”

Cardiovascular and metabolic safety profiles of the fluoroquinolones

“…Specifically, the RR of hypoglycemia with gatifloxacin was more than twofold higher than with levofloxacin, the molecule more frequently captured among case reports collected [9,19,25,[74][75][76]80]. In keeping with this, both descriptive and etiological surveys showed that levofloxacin users were more at risk of dysglycemia than those exposed to ciprofloxacin [9,19,25,[56][57][58][59][60][61][62][63][64][74][75][76]. Moreover, almost all case reports and series confirmed that predisposing factors, such as diabetes, kidney failure and use of antidiabetics (e.g., glyburide) were able to increase the risk of blood glucose disorders within a short time of onset.…”