Outpatient Gatifloxacin Therapy and Dysglycemia in Older Adults

Park-Wyllie, Laura; Juurlink, David N.; Kopp, Alexander; Shah, Baiju R.; Stukel, Thérèse A.; Stumpo, Carmine; Dresser, Linda; Low, Donald E.; Mamdani, Muhammad

doi:10.1056/nejmoa055191

Cited by 335 publications

(226 citation statements)

References 40 publications

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“…Both, hypoglycemic and hyperglycemic episodes occur during therapy [1,2]. Hypoglycemias are rare, however, they are potentially life-threatening and have led to a number of fatalities [2].…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“…While case reports of hypoglycemias exist for a number of fluoroquinolones, pharmacoepidemiologic evidence clearly documents an outstanding role of gatifloxacin as an inducer of hypoglycemias [1,2]. Since in one large trial the risk of other fluoroquinolones was found not to be different from that of other antibacterial drugs it has been supposed that the induction of glucose abnormalities is not a class effect of fluoroquinolones [1]. Also, the fluoroquinolones norfloxacin and levofloxacin were found to be only weakly effective as K ATP channel blockers [10,11], but nevertheless there are case reports linking these compounds to severe and even lethal hypogycemias [13,14], which 4 raises the question as to whether there are unidentified triggering factors.…”

Section: Introductionmentioning

confidence: 99%

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The insulinotropic effect of fluoroquinolones

Ghaly¹,

Gunda²,

Sahin³

et al. 2009

Biochemical Pharmacology

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

The insulinotropic effect of fluoroquinolones

Ghaly¹,

Gunda²,

Sahin³

et al. 2009

Biochemical Pharmacology

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“…Demographic and mortality data were obtained from the Ontario Health Insurance Plan Registered Persons Database, a registry of all Ontario residents with publically‐funded health insurance, and physicians’ services were identified using OHIP physician claims data. These databases were linked in an anonymous fashion using encrypted Ontario health card numbers, and are routinely used to study drug safety 27, 28, 29, 30, 31, 32.…”

Section: Methodsmentioning

confidence: 99%

A population‐based study of the drug interaction between clopidogrel and angiotensin converting enzyme inhibitors

Cressman

Macdonald

Fernandes

et al. 2015

Brit J Clinical Pharma

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AimsClopidogrel and angiotensin converting enzyme (ACE) inhibitors are commonly co‐prescribed drugs. Clopidogrel inhibits carboxylesterase 1 (CES1), the enzyme responsible for converting prodrug ACE inhibitors (such as ramipril and perindopril) to their active metabolites. The clinical implications of this potential drug interaction are unknown. The clinical consequences of the potential drug interaction between clopidogrel and prodrug ACE inhibitors were examined.MethodsWe conducted a nested case–control study of Ontarians aged 66 years and older treated with clopidogrel between September 1 2003 and March 31 2013 following acute myocardial infarction. Cases were subjects who died or were hospitalized for reinfarction or heart failure in the subsequent year, and each was matched with up to four controls. The primary outcome was a composite of reinfarction, heart failure or death. The primary analysis examined whether use of the prodrug ACE inhibitors ramipril or perindopril was more common among cases than use of lisinopril, an active ACE inhibitor.ResultsAmong 45 918 patients treated with clopidogrel following myocardial infarction, we identified 4203 cases and 14 964 controls. After adjustment, we found no association between the composite outcome and use of perindopril (adjusted odds ratio (aOR) 0.94, 95% confidence interval (CI) 0.76, 1.16) or ramipril (aOR 0.97, 95% CI 0.80, 1.18), relative to lisinopril. Secondary analyses of each element of the composite outcome yielded similar findings.ConclusionsFollowing myocardial infarction, use of clopidogrel with ACE inhibitors activated by CES1 is not associated with an increased risk of adverse cardiovascular outcomes relative to lisinopril. These findings suggest that the recently described drug interaction between clopidogrel and prodrug ACE inhibitors is of little clinical relevance.

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“…Among the fluoroquinolones, the antimycobacterial activity is highest for moxifloxacin followed by levofloxacin and then ofloxacin, as evidenced by animal studies [22]. Use of gatifloxacin is not advised because of the many serious side effects such as dysglycemia [23]. Ciprofloxacin has hardly any anti-TB activity and should not be considered here [14,24].…”

Section: What Regimen To Start?mentioning

confidence: 99%

Current therapies for the treatment of multidrug-resistant tuberculosis in children in India

Mukherjee

Lodha

Kabra

2017

Expert Opinion on Pharmacotherapy

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Introduction: Multidrug-resistant tuberculosis (MDR-TB) is a serious life threatening condition affecting children as well as adults worldwide. Timely diagnosis and effective treatment, both of which are complex in children, are the prerogatives for a favorable outcome.Areas covered: This review covers epidemiology, treatment regimen and duration, newer drugs and adverse events in children with MDR-TB. Special note has been made of epidemiology and principles of treatment followed in Indian children.Expert opinion: High index of suspicion is essential for diagnosing childhood MDR-TB. If there is high probability, a child can be diagnosed as presumptive MDR-TB and started on empiric treatment in consultation with experts. However, every effort should be made to confirm the diagnosis. Backbone of an effective MDR-TB regimen consists of four 2nd line anti-TB drugs plus pyrazinamide; duration being 18–24 months. The newer drugs delamanid and bedaquiline can be used in younger children if no other alternatives are available after consultation with experts. Wider availability of these drugs should be ensured for benefit to all concerned. More research is required for development of new and repurposed drugs to combat MDR-TB. Children need to be included in clinical trials for such life-saving drugs, so that nobody is denied the benefits.

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Outpatient Gatifloxacin Therapy and Dysglycemia in Older Adults

Abstract: As compared with the use of other broad-spectrum oral antibiotics, including other fluoroquinolones, the use of gatifloxacin among outpatients is associated with an increased risk of in-hospital treatment for both hypoglycemia and hyperglycemia.

Cited by 335 publications

References 40 publications

The insulinotropic effect of fluoroquinolones

The insulinotropic effect of fluoroquinolones

A population‐based study of the drug interaction between clopidogrel and angiotensin converting enzyme inhibitors

Current therapies for the treatment of multidrug-resistant tuberculosis in children in India

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