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TOPLINE:

Fluoroquinolones don't increase the risk for severe hypoglycemia compared with amoxicillin in older patients with diabetes treated with second-generation sulfonylureas, but caution is warranted in younger adults.

METHODOLOGY:

• The use of fluoroquinolones, a highly effective drug for the treatment of several bacterial infections, has raised safety concerns because of reports of various adverse effects, including hypoglycemia.
• Researchers assembled a cohort of patients with diabetes who initiated second-generation sulfonylureas (1998-2020) and assessed the 30-day risk for hypoglycemia in 143,417 patients who also initiated fluoroquinolones or amoxicillin.
• To assess the risk for severe hypoglycemia, fluoroquinolone users were matched up to 1:5 with amoxicillin users on number of previous sulfonylurea prescriptions, other antibiotic use in past month, and propensity scores.
• The 30-day risk for severe hypoglycemia (hospitalization or death because of hypoglycemia) associated with fluoroquinolone use was assessed and compared with that associated with amoxicillin use.
• In secondary analyses, the outcomes were further stratified by age, sex, and glycated hemoglobin levels.

TAKEAWAY:

• Overall, there was no statistically significant difference in the risk for severe hypoglycemia among those who initiated fluoroquinolones or amoxicillin while being on a second-generation sulfonylurea (hazard ratio [HR], 1.17; 95% CI, 0.91-1.50).
• Stratified by age, fluoroquinolone vs amoxicillin use was associated with an increased risk for severe hypoglycemia in patients aged < 65 years (HR, 2.90; 95% CI, 1.41-5.97) but not in those aged ≥ 65 years.

IN PRACTICE:

"While our study findings should provide some reassurance to physicians and patients on second-generation sulfonylureas regarding the hypoglycemic safety of fluoroquinolones in advanced age, these antibiotics should be prescribed with caution when it comes to younger sulfonylurea users," the authors wrote.

SOURCE:

Jenny Dimakos, MD, from the Department of Medicine, McGill University, Montreal, Quebec, Canada, led this study, which was published online in Diabetes, Obesity and Metabolism.

LIMITATIONS:

Because of the relatively low number of antibiotic exposures, the apparent increased risk for hypoglycemia in younger adults should be interpreted with caution. Also, patients could contribute multiple episodes of antibiotic use but only one hypoglycemia-related outcome.

DISCLOSURES:

This research was funded by a project grant from the Canadian Institutes of Health Research. Robert W. Platt declared receiving personal fees from several sources outside this work, including biotechnology and pharmaceutical companies.