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Fluoroquinolone antibiotics are associated with an increased risk of blood glucose swings in diabetic patients, researchers reported.

In a large cohort study, the fluoroquinolones were linked to a heightened risk of both hypo- and hyperglycemia, compared with other antibiotic classes, according to Mei-Shu Lai, MD, PhD, and colleagues at the National Taiwan University in Taipei.

The risks were low -- observed in fewer than one in 100 patients studied -- but clinicians should be cautious when treating diabetic patients with fluoroquinolones, Lai and colleagues reported

"Other antibiotics should be considered if dysglycemia is a concern," Lai and colleagues argued.

The fluoroquinolones have previously been associated with rare but severe adverse events, affecting the

But they are becoming more widely used, the researchers noted, to treat such things as urinary tract infections and community-acquired pneumonia.

Previous research has also linked fluoroquinolones and hyperglycemia or hypoglycemia. Indeed, one drug, gatifloxacin (Tequin), was pulled from the U.S. market because of the risk of blood sugar abnormalities.

To try to quantify the risks faced by diabetics, Lai and colleagues turned to the claims database for Taiwan's national insurance program, where they identified people with diabetes who were prescribed an antibiotic from one of three classes -- the fluoroquinolones, macrolides, and cephalosporins.

Over a 23-month study period, they identified 12,564 diabetic patients who were newly prescribed ciprofloxacin (Cipro), 4,221 users of moxifloxacin (Avelox), and 11,766 who were given levofloxacin (Levaquin).

They also found 20,317 users of cephalosporins and 29,565 users of macrolides.

Among those patients, hospital records showed that 215 patients had hyperglycemic events and 425 had hypoglycemic events that occurred within 30 days of the start of their prescriptions, Lai and colleagues reported.

The absolute risk of hyperglycemia for macrolides and cephalosporins, they reported, was 1.6 and 2.1 cases per 1,000 people, respectively. On the other hand, the rates per 1,000 people for moxifloxacin, levofloxacin, and ciprofloxacin were 6.9, 3.9, and 4.0, respectively.,

Absolute risks for hypoglycemia were higher -- 3.7 and 3.2 per 1,000 people for macrolides and cephalosporins, respectively, and 10.0 for moxifloxacin, 9.3 for levofloxacin, and 7.9 for ciprofloxacin.

Compared with the macrolides, which have not been associated with dysglycemia, the fluoroquinolones had significantly increased risks of both hypo- and hyperglycemia. Specifically:

• For hypoglycemia, the adjusted odds ratios for levofloxacin, ciprofloxacin, and moxifloxacin were 1.75, 1.87, and 2.48, respectively.
• For hyperglycemia, the respective adjusted odds ratios were 1.79, 1.46, and 2.13.

Within the class, moxifloxacin was associated with a significantly higher risk of hypoglycemia than ciprofloxacin, with an adjusted odds ratio of 1.62. The risk of hypoglycemia was also significantly higher among patients receiving moxifloxacin concomitantly with insulin, with an adjusted odds ratio of 2.28.

The researchers cautioned that the study was based on an electronic database, leading to "a degree of uncertainty" in diagnosis and a lack of laboratory data.

They also noted that severe infection itself can lead to blood sugar swings, suggesting a possibility of reverse causation, and not all possible confounding factors could be measured.

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