Oral fluoroquinolones associated with increased dysglycemia risk in diabetics

Diabetic patients taking oral fluoroquinolones could have a higher risk for severe dysglycemia, according to a recent study.

Researchers performed a population-based inception cohort study of diabetic outpatients in Taiwan from January 2006 to November 2007 who were new users of oral levofloxacin, ciprofloxacin, moxifloxacin, cephalosporins and macrolides. The main outcome measures were emergency department visits or hospitalization for dysglycemia 30 days after antibiotic therapy was initiated. The study results were published online Aug. 14 by Clinical Infectious Diseases.

The study included 78,433 diabetic patients who were taking a fluoroquinolone, 12,564 taking ciprofloxacin, 4,221 taking moxifloxacin, 11,766 taking levofloxacin, 20,317 taking cephalosporins, and 29,565 taking macrolides. Two hundred fifteen hyperglycemic events and 425 hypoglycemic events occurred during the study period. Those taking moxifloxacin had an absolute risk of 6.9 per 1,000 persons for hyperglycemia and 10.0 per 1,000 persons for hypoglycemia; for those taking macrolides, the risks were 1.6 and 3.7 per 1,000 persons, respectively. Adjusted odds ratios for hyperglycemia with levofloxacin, ciprofloxacin and moxifloxacin compared to macrolides were 1.75, 1.87, and 2.48, while adjusted odds ratios for hypoglycemia were 1.79, 1.46, and 2.13, respectively. Hypoglycemia risk was significantly higher with moxifloxacin than with ciprofloxacin, as well as with moxifloxacin and concomitant insulin.

The authors noted that data on rare events were obtained from an electronic database and might therefore be incomplete. Among other limitations, they also pointed out that reverse causality could have been present, since severe infection can cause dysglycemia. However, they concluded that based on their results, diabetic patients taking fluoroquinolones, especially moxifloxacin, could potentially be at higher risk for severe dysglycemia. “Clinicians should consider these risks when treating patients with diabetes and prescribe fluoroquinolones cautiously,” the authors wrote.