Possible Gatifloxacin-Induced Hyperglycemia

Donaldson, Amy R.; Vandiver, Jeremy R; Finch, Christopher K.

doi:10.1345/aph.1d360

Cited by 29 publications

(18 citation statements)

References 6 publications

(13 reference statements)

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“…1,2) However, after clinical introduction in 1999, many serious glycemic abnormalities associated with use of GFLX were reported. [3][4][5][6][7][8] Most of these adverse reactions were observed in diabetic patients, and GFLX is now contraindicated for diabetic patients in Japan and the United States. 6,8) It is known that glycemic control is influenced by a number of drugs.…”

mentioning

confidence: 99%

Gatifloxacin Induces Augmented Insulin Release and Intracellular Insulin Depletion of Pancreatic Islet Cells

Tomita

Onishi

Sato

et al. 2007

Biological & Pharmaceutical Bulletin

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Many hypoglycemic and hyperglycemic episodes associated with clinical use of gatifloxacin (GFLX), a novel fluoroquinolone antimicrobial agent, have been reported in recent years. Some have reported hypoglycemia induced by fluoroquinolones, indicating that these agents may stimulate insulin secretion from pancreatic islet cells. In this study, we investigated the effect of GFLX on insulin homeostasis in islet cells using the insulin secreting cell line, HIT-T15. After 1 h incubation with over 100 m mM of GFLX, insulin secretion from the cells was significantly augmented. However, the augmentation of insulin release induced by GFLX subsequently reached a plateau. Coincidentally, cellular insulin was decreased by 120 h incubation, and reactivity to re-stimulation by sulfonylurea was suppressed. The GFLX insulin depletion effect was stronger than the effects produced by such other fluoroquinolones as levofloxacin and ciprofloxacin. This study suggests that GFLX should induce insulin oversecretion from pancreatic islet cells in the short-term, and decrease insulin productivity or increase insulin disintegration in the long-term. These results are consistent with the clinical results of GFLX finding that hypoglycemic episodes were seen after a first single administration, and most hyperglycemic episodes were seen more than 2 d after the start of administration.

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mentioning

confidence: 99%

Gatifloxacin Induces Augmented Insulin Release and Intracellular Insulin Depletion of Pancreatic Islet Cells

Tomita

Onishi

Sato

et al. 2007

Biological & Pharmaceutical Bulletin

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“…Neither hyperglycemia, nor hypoglycemia, 15,16 which is considered to develop by an increase of insulin release, was observed.…”

Section: Discussionmentioning

confidence: 90%

Clinical effect of gatifloxacin, 200mg daily, on bacterial community-acquired pneumonia in the elderly

Okimoto

Kibayashi

Mimura

et al. 2005

Journal of Infection and Chemotherapy

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“…Antibiotics, especially fluoroquinolones (gatifloxacin, levofloxacin, etc), have been reported to cause abnormalities in blood glucose homeostasis, such as hypoglycemia and hyperglycemia [2][3][4][5]8]. In vitro studies showed that some fluoroquinolones can block ATP-sensitive potassium channels of pancreatic β-cells and stimulate insulin secretion, leading to hypoglycemia [9,10].…”

Section: Discussionmentioning

confidence: 99%

“…Antibiotics, especially the fluoroquinolones, have been reported to be associated with alterations in glycemic control among patients with diabetes as well as those without diabetes [2][3][4][5]. However, cephem or macrolide antibiotics have rarely, if ever, been reported to induce hyperglycemia.…”

Section: Introductionmentioning

confidence: 99%

Possible Cefcapene Pivoxil- or Clarithromycin-Induced Severe Hyperglycemia in a Patient With Type 2 Diabetes: A Case Report

Miyoshi¹

2013

J Med Cases

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There are various reasons for the deterioration of glycemic control observed in patients with diabetes, one of which is drug-induced hyperglycemia. Antibiotics, especially the fluoroquinolones, have been reported to be associated with glucose disturbances. However, induction of hyperglycemia by cephem or macrolide antibiotics has rarely, if ever, been reported. Here, we report the case of possible antibiotics-induced severe hyperglycemia in a patient with type 2 diabetes. A 67-year-old Japanese diabetic man, who was not using oral hypoglycemic agents or insulin but whose condition was controlled with diet and exercise, presented at an otolaryngology clinic with nasal discharge and rhinorrhea. His glycosylated hemoglobin (HbA1c) level had been stable at 6.6-7.2% for several years. He was diagnosed with acute sinusitis and given an oral cephem antibiotic, cefcapene pivoxil, for 1 week. His otolaryngeal symptoms were slight and disappeared soon. Thereafter, therapy was switched to a macrolide antibiotic, clarithromycin, for 3 weeks. Twenty-five days after the initiation of antibiotic therapy, severe hyperglycemia was pointed out; his random serum glucose and HbA1c levels were 29.4 mmol/L and 10.6%, respectively. The patient required insulin and oral hypoglycemic agent therapy. The Naranjo probability scale suggests that the relationship between the administration of cefcapene pivoxil or clarithromycin and the patient's severe hyperglycemia might be possible. To the best of our knowledge, there has been no previous report of a deterioration in glycemic control in a patient with diabetes administered a cephem (cefcapene pivoxil) or macrolide (clarithromycin) antibiotic. Considering the global prescription of cephem and macrolide antibiotics, awareness of the fact that some patients are at high risk for impaired glucose tolerance is important when prescribing antibiotics. Further studies are warranted to determine the incidence rate of hyperglycemia among patients with diabetes who are administered cephem and macrolide antibiotics.

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Possible Gatifloxacin-Induced Hyperglycemia

Abstract: The temporal relationship between gatifloxacin administration and the patient's hyperglycemia suggests an iatrogenic cause. Based on our experience and the product labeling, clinicians should be more aware of the blood glucose-altering effects of gatifloxacin.

Cited by 29 publications

References 6 publications

Gatifloxacin Induces Augmented Insulin Release and Intracellular Insulin Depletion of Pancreatic Islet Cells

Gatifloxacin Induces Augmented Insulin Release and Intracellular Insulin Depletion of Pancreatic Islet Cells

Clinical effect of gatifloxacin, 200mg daily, on bacterial community-acquired pneumonia in the elderly

Possible Cefcapene Pivoxil- or Clarithromycin-Induced Severe Hyperglycemia in a Patient With Type 2 Diabetes: A Case Report

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