USA: The use of antibiotics, including fluoroquinolones, in many patients, is associated with hypoglycemia when they are also taking glucose-lowering medications (sulfonylureas or meglitinides), according to a recent study published in the journal Drug Safety.
The study further found that certain antibiotics (cefditoren, tigecycline, ertapenem, and clarithromycin) are associated with hypoglycemia even if not taken with sulfonylureas or meglitinide. According to the authors, the association between ertapenem and hypoglycemia has not been previously reported.
Fluoroquinolones, clarithromycin, linezolid, tigecycline, cefditoren, doxycycline, and trimethoprim-sulfamethoxazole are known to be associated with hypoglycemia, but few studies have considered concomitant glucose-lowering medications. Christopher R. Frei, The University of Texas at Austin, San Antonio, TX, USA, and colleagues evaluated the association between hypoglycemia and antibiotics using the US Food and Drug Administration Adverse Event Reporting System (FAERS) while accounting for concomitant glucose-lowering medications including sulfonylureas and meglitinides.
FAERS reports from 1 January 2004 to 31 December 2017 were included in the study. Reporting odds ratios (RORs) and corresponding 95% confidence intervals (CIs) for the association between antibiotics and hypoglycemia were calculated. An association was considered to be statistically significant when the lower limit of the 95% CI was > 1.0.
After applying the inclusion criteria, a total of 2,334,959 reports (including 18,466 hypoglycemia reports) were considered.
Key findings of the study include:
Statistically significant hypoglycemia RORs (95% CI) for antibiotics were: cefditoren 14.03 (8.93–22.03), tigecycline 3.32 (1.95–5.65), clarithromycin 2.41 (1.89–3.08), ertapenem 2.07 (1.14–3.75), moxifloxacin 2.06 (1.59–2.65), levofloxacin 1.66 (1.37–2.01), and linezolid 1.54 (1.07–2.20).
After adjusting for concomitant sulfonylureas and meglitinides, the following antibiotics were still significantly associated with hypoglycemia: cefditoren 14.25 (9.08–22.39), tigecycline 3.34 (1.96–5.68), ertapenem 1.93 (1.03–3.60), and clarithromycin 1.56 (1.15–2.11).
The study, "Hypoglycemia Associated with Antibiotics Alone and in Combination with Sulfonylureas and Meglitinides: An Epidemiologic Surveillance Study of the FDA Adverse Event Reporting System (FAERS)," is published in the Springer journal Drug Safety.
DOI: https://doi.org/10.1007/s40264-019-00901-7