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Previous Volume 354:1352-1361 March 30, 2006 Number 13 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Supplementary Material Editorial by Gurwitz, J. H. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background Gatifloxacin has been associated with both hypoglycemia and hyperglycemia. We examined dysglycemia-related health outcomes associated with various antibiotics in a population of approximately 1.4 million Ontario, Canada, residents 66 years of age or older.

Methods We conducted two population-based, nested case–control studies. In the first, case patients were persons treated in the hospital for hypoglycemia after outpatient treatment with a macrolide, a second-generation cephalosporin, or a respiratory fluoroquinolone (gatifloxacin, levofloxacin, moxifloxacin, or ciprofloxacin). In the second, case patients were persons who received hospital care for hyperglycemia. For each case patient, we identified up to five controls matched according to age, sex, the presence or absence of diabetes, and the timing of antibiotic therapy.

Results Between April 2002 and March 2004, we identified 788 patients treated for hypoglycemia within 30 days after antibiotic therapy. As compared with macrolide antibiotics, gatifloxacin was associated with an increased risk of hypoglycemia (adjusted odds ratio, 4.3; 95 percent confidence interval, 2.9 to 6.3). Levofloxacin was also associated with a slightly increased risk (adjusted odds ratio, 1.5; 95 percent confidence interval, 1.2 to 2.0), but no such risk was seen with moxifloxacin, ciprofloxacin, or cephalosporins. We then identified 470 patients treated for hyperglycemia within 30 days after antibiotic therapy. As compared with macrolides, gatifloxacin was associated with a considerably increased risk of hyperglycemia (adjusted odds ratio, 16.7; 95 percent confidence interval, 10.4 to 26.8), but no risk was noted with the other antibiotics. Risks were similar in the two studies regardless of the presence or absence of diabetes.

Conclusions As compared with the use of other broad-spectrum oral antibiotics, including other fluoroquinolones, the use of gatifloxacin among outpatients is associated with an increased risk of in-hospital treatment for both hypoglycemia and hyperglycemia.

Source Information

From the Institute for Clinical Evaluative Sciences (L.Y.P.-W., D.N.J., A.K., B.R.S., T.A.S., M.M.M.); the Centre for Research on Inner City Health, Department of Family and Community Medicine, St. Michael's Hospital (L.Y.P.-W.); the Department of Medicine and the Clinical Epidemiology Unit, Sunnybrook and Women's College Health Sciences Centre (D.N.J., B.R.S.); the Departments of Pediatrics (D.N.J.), Medicine (D.N.J., B.R.S.), Health Policy, Management, and Evaluation (D.N.J., T.A.S., M.M.M.), Pharmacy (L.D., M.M.M.), and Microbiology (D.E.L.), University of Toronto; the Department of Pharmacy, Toronto East General Hospital (C.S.); the Department of Pharmacy, Mount Sinai Hospital (L.D.); and the Department of Microbiology, University Health Network–Mount Sinai Hospital (D.E.L.) — all in Toronto.

This article was published at www.nejm.org on March 1, 2006.

Address reprint requests to Dr. Juurlink at Sunnybrook and Women's College Health Sciences Centre, 2075 Bayview Ave., G Wing 106, Toronto, ON M4N 3M5, Canada, or at dnj{at}ices.on.ca.

Full Text of this Article

Related Letters:

Gatifloxacin and Dysglycemia in Older Adults
Ittner K. P., Yadav V., Deopujari K., Park-Wyllie L. Y., Shah B. R., Juurlink D. N.
Extract | Full Text | PDF  
N Engl J Med 2006; 354:2725-2726, Jun 22, 2006. Correspondence

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