Yip Clifford, Lee Audrey J
Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Stockton, California, USA.
Clin Ther. 2006 Nov;28(11):1857-66. doi: 10.1016/j.clinthera.2006.11.014.
Gatifloxacin is a fluoroquinolone antibiotic that has been associated with severe hypoglycemic and hyperglycemic events.
The purpose of this report was to describe a new case of gatifloxacin-associated hyperglycemia in an elderly patient and to provide a summary of case reports.
A male patient, aged 86 years, was hospitalized with small bowel obstruction due to adhesions from a previous appendectomy. At the time of admission, the patient weighed 78.5 kg (ideal body weight, 73 kg), had a body mass index of 24.8 kg/m2, and had a calculated creatinine clearance of 45.6 mL/min. The patient's hospital medications were metoprolol, diltiazem, subcutaneous heparin, ranitidine, vancomycin, piperacillin/tazobactam, and aspirin. He also was treated with gatifloxacin 400 mg QD for suspected pneumonia during the hospital stay. After 4 days of the gatifloxacin regimen, the patient's mean blood glucose concentration increased from 133 mg/dL at the time of admission to 537 mg/dL. Although the patient exhibited signs of glycosuria (ie, urine glucose concentration >1000 mg/dL), he did not complain of symptoms of hyperglycemia, such as polyuria, polyphagia, or polydipsia. The hyperglycemia resolved after administration of gatifloxacin was discontinued and the patient had received regular insulin 15 U SC over 5 hours.
The exact mechanism by which gatifloxacin induces hyperglycemia is unknown, but it may be related to vacuolation of pancreatic beta-cells, leading to a decrease in insulin secretion. This case, along with the 15 other summarized cases, adds to the evidence for an association between gatifloxacin and hyperglycemia. These patients had other risk factors that may have contributed to the development of hyperglycemia, including age >65 years and renal impairment.
An elderly patient with no history of diabetes developed severe hyperglycemia after receiving doses of gatifloxacin 400 mg that had not been adjusted for age-related renal impairment. The hyperglycemia resolved after discontinuation of gatifloxacin.
加替沙星是一种氟喹诺酮类抗生素，与严重的低血糖和高血糖事件有关。
本报告旨在描述一例老年患者加替沙星相关性高血糖的新病例，并总结病例报告。
一名86岁男性患者因既往阑尾切除术后粘连导致小肠梗阻入院。入院时，患者体重78.5kg（理想体重73kg），体重指数为24.8kg/m²，计算得出的肌酐清除率为45.6mL/min。患者的住院用药包括美托洛尔、地尔硫卓、皮下注射肝素、雷尼替丁、万古霉素、哌拉西林/他唑巴坦和阿司匹林。住院期间，他还因疑似肺炎接受了每日400mg加替沙星治疗。加替沙星治疗4天后，患者的平均血糖浓度从入院时的133mg/dL升至537mg/dL。尽管患者出现了糖尿迹象（即尿糖浓度>1000mg/dL），但他并未主诉高血糖症状，如多尿、多食或多饮。停用加替沙星并在5小时内皮下注射15U常规胰岛素后，高血糖症状得到缓解。
加替沙星诱发高血糖的确切机制尚不清楚，但可能与胰腺β细胞空泡化有关，导致胰岛素分泌减少。该病例以及其他15例总结病例进一步证明了加替沙星与高血糖之间的关联。这些患者还有其他可能导致高血糖发生的危险因素，包括年龄>65岁和肾功能损害。
一名无糖尿病病史的老年患者在接受未根据年龄相关肾功能损害调整剂量的400mg加替沙星后发生了严重高血糖。停用加替沙星后高血糖症状得到缓解。
