title: A retrospective, comparative evaluation of dysglycemias in hospitalized patients receiving gatifloxacin, levofloxacin, ciprofloxacin, or ceftriaxone.
abstract: OBJECTIVE
  To compare rates of blood glucose abnormalities in hospitalized patients receiving fluoroquinolones or ceftriaxone, and to describe the characteristics of patients who develop blood glucose abnormalities while receiving these agents.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  Two community-based hospitals in the Houston, Texas, region.
  
  
  METHODS
  Seventeen thousand one hundred eight patients who received fluoroquinolones or ceftriaxone; of those, 101 received levofloxacin, gatifloxacin, or ceftriaxone and also had serum glucose concentrations above 200 or below 50 mg/dl within 72 hours of receiving the drug.
  
  
  RESULTS
  Baseline demographics of patients with glucose abnormalities while receiving gatifloxacin, levofloxacin, or ceftriaxone were similar. Mean +/- SD patient age, weight, and estimated creatinine clearance were 67 +/- 17 years, 79 +/- 21 kg, and 52 +/- 32 ml/minute, respectively. Dysglycemia rates relative to treatment were as follows: gatifloxacin 76 (1.01%) of 7540 patients, levofloxacin 11 (0.93%) of 1179, ceftriaxone 14 (0.18%) of 7844, ciprofloxacin 0 (0%) of 545, and any fluoroquinolone 87 (0.94%) of 9264. Dysglycemia was more likely to occur in patients receiving any fluoroquinolone than in those receiving ceftriaxone (relative risk [RR] 3.32, 95% confidence interval (CI) 2.31-4.78, p < 0.05). The rate of dysglycemia did not differ with gatifloxacin and levofloxacin (RR 1.07, 95% CI 0.62-1.86, p = 0.8). Of the 101 patients with dysglycemias, hypoglycemia occurred in nine (9%) and hyperglycemia in 92 (91%). In a multivariate analysis of patients receiving fluoroquinolones, only concomitant sulfonylurea therapy was identified as an independent risk factor for development of hypoglycemia compared with patients who experienced hyperglycemia.
  
  
  CONCLUSIONS
  In the 17,108 patients receiving a fluoroquinolone or ceftriaxone, the rate of dysglycemia was greater in those receiving levofloxacin or gatifloxacin than in those receiving ceftriaxone. However, no difference was noted in the rate of glucose abnormalities with levofloxacin versus gatifloxacin. Clinicians should be aware of dysglycemic events that may occur in patients receiving fluoroquinolones, especially in those with diabetes mellitus or those receiving sulfonylureas.
authors.affiliation: Division of Infectious Diseases, Department of Internal Medicine, University of Texas Health Science Center at Houston, Houston, Texas 77030, USA. john.mohr@uth.tmc.edu
authors.forename: John F
authors.initials: JF
authors.lastname: Mohr
authors.forename: Peggy S
authors.initials: PS
authors.lastname: McKinnon
authors.forename: Patti J
authors.initials: PJ
authors.lastname: Peymann
authors.forename: Irene
authors.initials: I
authors.lastname: Kenton
authors.forename: Edward
authors.initials: E
authors.lastname: Septimus
authors.forename: Pablo C
authors.initials: PC
authors.lastname: Okhuysen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000890:Anti-Infective Agents / Q000009:adverse effects*; D001786:Blood Glucose / Q000032:analysis; D002443:Ceftriaxone / Q000009:adverse effects*; D002939:Ciprofloxacin / Q000009:adverse effects*; D005260:Female; D024841:Fluoroquinolones / Q000009:adverse effects*; D000077734:Gatifloxacin; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced*; D007003:Hypoglycemia / Q000139:chemically induced*; D064704:Levofloxacin; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000009:adverse effects*; D011358:Product Surveillance, Postmarketing; D012189:Retrospective Studies
chemical_list: D000890:Anti-Infective Agents; D001786:Blood Glucose; D024841:Fluoroquinolones; D002939:Ciprofloxacin; D064704:Levofloxacin; D002443:Ceftriaxone; D015242:Ofloxacin; D000077734:Gatifloxacin