title: Outpatient gatifloxacin therapy and dysglycemia in older adults.
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.
authors.affiliation: Institute for Clinical Evaluative Sciences, St. Michael's Hospital, Toronto.
authors.forename: Laura Y
authors.initials: LY
authors.lastname: Park-Wyllie
authors.forename: David N
authors.initials: DN
authors.lastname: Juurlink
authors.forename: Alexander
authors.initials: A
authors.lastname: Kopp
authors.forename: Baiju R
authors.initials: BR
authors.lastname: Shah
authors.forename: Therese A
authors.initials: TA
authors.lastname: Stukel
authors.forename: Carmine
authors.initials: C
authors.lastname: Stumpo
authors.forename: Linda
authors.initials: L
authors.lastname: Dresser
authors.forename: Donald E
authors.initials: DE
authors.lastname: Low
authors.forename: Muhammad M
authors.initials: MM
authors.lastname: Mamdani
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000009:adverse effects* / Q000627:therapeutic use; D016022:Case-Control Studies; D002511:Cephalosporins / Q000009:adverse effects; D048909:Diabetes Complications / Q000139:chemically induced; D005260:Female; D024841:Fluoroquinolones / Q000009:adverse effects* / Q000627:therapeutic use; D000077734:Gatifloxacin; D006760:Hospitalization; D006801:Humans; D006943:Hyperglycemia / Q000139:chemically induced* / Q000453:epidemiology; D007003:Hypoglycemia / Q000139:chemically induced* / Q000453:epidemiology; D064704:Levofloxacin; D018942:Macrolides / Q000009:adverse effects; D008297:Male; D015242:Ofloxacin / Q000009:adverse effects; D009864:Ontario / Q000453:epidemiology; D012306:Risk
chemical_list: D000900:Anti-Bacterial Agents; D002511:Cephalosporins; D024841:Fluoroquinolones; D018942:Macrolides; D064704:Levofloxacin; D015242:Ofloxacin; D000077734:Gatifloxacin