Certain Antibiotics Increase Hypoglycemia Risk in Patients on Sulfonylureas
the MPR take:
Certain antimicrobial agents can interact with sulfonylureas and increase the risk of hypoglycemia. A new study published in JAMA: Internal Medicine indicates that prescribing an interacting antimicrobial appears to be common among older patients taking sulfonylureas and is linked to substantial morbidity and increased healthcare costs. Compared with non-interacting antimicrobials, the following antibiotics were associated with higher rates of hypoglycemia in patients taking concomitant sulfonylureas: clarithromycin (odds ratio [OR]: 3.96), levofloxacin (OR: 2.60), sulfamethoxazole-trimethoprim (OR: 2.56), metronidazole (OR: 2.11), ciprofloxacin (OR: 1.62). The study data demonstrated that 13.2% of hypoglycemic events occurred when patients were taking one of these five interacting antibiotics; each prescription correlated with an additional Medicare cost of $30 for subsequent hypoglycemia. The authors conclude that more effort needs to be made to limit the use of interacting antibiotics in older diabetes patients taking sulfonylureas since the rates of hospitalization for hypoglycemic events are now higher than for hyperglycemic events.
Importance: Certain antimicrobial drugs interact with sulfonylureas to increase the risk of hypoglycemia. Design, Setting, and Participants: This was a retrospective cohort study of Texas Medicare claims from 2006–2009 for patients 66 years or older who were prescribed glipizide or glyburide and who also filled a prescription for one of the 16 antimicrobials most commonly prescribed for this population.
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