-- Robert Preidt
THURSDAY, Aug. 15 (HealthDay News) -- Diabetes patients who take
a certain class of antibiotics are more likely to have severe blood
sugar fluctuations than those who take other types of the drugs, a
new study finds.
The increased risk was low but doctors should consider it when
prescribing the class of antibiotics, known as fluoroquinolones, to
people with diabetes, the researchers said. This class of
antibiotics, which includes drugs such as Cipro (ciprofloxacin),
Levaquin (levofloxacin) and Avelox (moxifloxacin), is commonly used
to treat conditions such as urinary tract infections and
One expert said the study should serve as a wake-up call for
"Given a number of alternatives, physicians may consider prescribing alternate antibiotics ... in the place of fluoroquinolones (particularly moxifloxacin) to patients with diabetes," said Dr. Christopher Ochner, assistant professor of pediatrics and adolescent medicine at the Icahn School of Medicine at Mount Sinai, in New York City. "In general, this study demonstrates that closer attention needs to be paid to particular drug-condition interactions."
The study included about 78,000 people with diabetes in Taiwan.
The researchers looked at the patients' use of three classes of
antibiotics: fluoroquinolones; second-generation cephalosporins
(cefuroxime, cefaclor, or cefprozil); or macrolides (clarithromycin
The investigators also looked for any emergency-room visits or
hospitalizations for severe blood sugar swings among the patients
in the 30 days after they started taking the antibiotics.
The results showed that patients who took fluoroquinolones were
more likely to have severe blood sugar swings than those who took
antibiotics in the other classes. The level of risk varied
according to the specific fluoroquinolone, according to the study,
which was published in the journal
Clinical Infectious Diseases.
The incidence of hyperglycemia (high blood sugar) per 1,000
people was 6.9 for people taking moxifloxacin, 3.9 for levofloxacin
and 4.0 for ciprofloxacin. The incidence of hypoglycemia (low blood
sugar) was 10 per 1,000 for moxifloxacin, 9.3 for levofloxacin and
7.9 for ciprofloxacin.
The incidence of hyperglycemia per 1,000 people was 1.6 for
those taking the macrolide class of antibiotics and 2.1 for those
on cephalosporins. The incidence of hypoglycemia per 1,000 people
was 3.7 for macrolides and 3.2 for cephalosporins.
"Our results identified moxifloxacin as the drug associated with the highest risk of hypoglycemia, followed by levofloxacin and ciprofloxacin," wrote Dr. Mei-Shu Lai, at National Taiwan University, and colleagues.
They said doctors should consider other antibiotics if they have
concerns that patients might experience severe blood sugar
"The study ... does not prove a causal connection between particular fluoroquinolones and blood sugar dysregulation," Ochner said. But he believes that it provides evidence that people with diabetes may be at special risk from moxifloxacin in particular.
"If moxifloxacin is to be prescribed to diabetic patients, there should be some additional expected benefit that justifies the increase in incurred risk," Ochner said.
But another expert said there could be other explanations for
why people on fluoroquinolones had more blood sugar
"It is hard to draw conclusions that fluoroquinolones themselves are the culprit, as all of these patients had infections, and infection can lead to hypo- or hyperglycemia in persons with diabetes," said Dr. Alyson Myers, an endocrinologist at North Shore University Hospital in Manhasset, N.Y.
"In addition, those in the fluoroquinolone group were more likely to have chronic kidney disease or steroid use -- the former can increase rates of hypoglycemia and the latter can increase rates of hyperglycemia," Myers said. "Another confounding factor would be the type of diabetes treatments that patients were receiving, as sulfonylureas and insulin are both associated with greater risks of hypoglycemia than other diabetes medications."
The U.S. National Institute of Diabetes and Digestive and Kidney
Diseases has more about
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