Prevalence of and Risk Factors for Dysglycemia in Patients Receiving Gatifloxacin and Levofloxacin in an Outpatient Setting

Abstract

Levofloxacin and gatifloxacin were not significantly associated with increased dysglycemic events compared with azithromycin. Lack of downward fluoroquinolone dosage adjustment for renal function, presence of diabetes, and treatment with insulin or sulfonylureas each independently increased the risk of dysglycemia. Obesity was independently protective against dysglycemia. More data are needed on the contributing effects of diabetes, fluoroquinolone dosage, and concomitant drug therapy so that an appropriate risk-management strategy can be developed.

Risk of hepatotoxicity associated with fluoroquinolones: A national case–control safety study

“…2014; 71: [37][38][39][40][41][42][43] F luoroquinolones have had a major impact on the treatment of moderate-to-severe infections since their introduction over 20 years ago. 1 They are used extensively worldwide in both community and nosocomial settings because of their broad-spectrum bactericidal activity, clinical utility, excellent oral bioavailability, and ease of dosing. 2 Further adding to their appeal is a favorable adverse-effect profile.…”

The insulinotropic effect of fluoroquinolones

“…While hyperglycemias may involve extrapancreatic effects [39], our observation that the fluoroquinolones at 100 µM were ineffective to stimulate insulin secretion in the presence of a basal glucose concentration leads to the provocative question why these compounds are hypoglycemic at all. Intriguingly, diabetes is a strong risk factor, independently of a sulfonylurea or insulin therapy [40] In conclusion, it seems that the K ATP channel-blocking effect is a necessary but not a sufficient condition for the hypoglycemic side effect of the fluoroquinolones. In particular, the prominent role of gatifloxacin is not sufficiently explained.…”

Evaluation of Initial and Steady-State Gatifloxacin Pharmacokinetics and Dose in Pulmonary Tuberculosis Patients by Using Monte Carlo Simulations

“…A single-dose crossover study in healthy volunteers showed a reduction in the elimination rate of gatifloxacin resulting in a 14% increase in the area under the concentration time curve to infinity (AUC 0 -ϱ ) when it was given together with rifampin, isoniazid, and pyrazinamide (8). Reports of dysglycemia related to the use of gatifloxacin in elderly patients with renal insufficiency (9,10,11,12) have raised concerns that pharmacokinetic interactions may lead to an increased risk of toxicity related to higher gatifloxacin exposure. On the other hand, in vitro and in vivo studies suggest a target ratio of Ն125 for the free drug area under the concentration versus time curve to MIC (fAUC/MIC) for maximal bactericidal effect and prevention of resistance to fluoroquinolones (13,14).…”