Hsu-Wen Chou, from the National Taiwan University in Taipei, and colleagues identified outpatient new users of oral levofloxacin, ciprofloxacin, moxifloxacin, cephalosporin, and macrolides from a population-based inception cohort study of patients with diabetes (for the period January 2006–November 2007). Emergency department visits or hospitalization for dysglycemia within 30 days of initiation of antibiotic therapy were considered study events.
The researchers included 78,433 patients with diabetes receiving the antibiotics of interest. For moxifloxacin and macrolides the absolute risk of hyperglycemia per 1,000 persons was 6.9 and 1.6, respectively, whereas the risk of hypoglycemia was 10 and 3.7, respectively. Compared with macrolides, the adjusted odds ratios for levofloxacin, ciprofloxacin, and moxifloxacin were 1.75, 1.87, and 2.48, respectively, for hyperglycemia; and 1.79, 1.46, and 2.13, respectively, for hypoglycemia. The risk of hypoglycemia was significantly increased for patients taking moxifloxacin vs. ciprofloxacin. There was a significant increase in the risk of hypoglycemia seen among patients receiving moxifloxacin concomitantly with insulin (adjusted odds ratio, 2.28).
“Our results showed a class effect regarding increased risk of severe dysglycemia among diabetic patients administered fluoroquinolones in Taiwan,” the authors write. “Clinicians should consider these risks when treating patients with diabetes and prescribe fluoroquinolones cautiously.”