LaPlante Kerry L, Mersfelder Tracey L, Ward Kristina E, Quilliam Brian J
Department of Pharmacy Practice, College of Pharmacy, University of Rhode Island, Providence, Rhode Island, USA.
Pharmacotherapy. 2008 Jan;28(1):82-9. doi: 10.1592/phco.28.1.82.
To assess the prevalence of dysglycemia (hypoglycemia or hyperglycemia) associated with oral levofloxacin and gatifloxacin therapy in an outpatient setting, and to determine the characteristics of patients who developed dysglycemia while receiving either fluoroquinolone.
Retrospective medical record review.
Outpatient clinic of a Veterans Affairs teaching hospital.
A total of 1573 patients who received oral levofloxacin (343 patients), gatifloxacin (589 patients), or azithromycin (as a control, 641 patients) between June 1, 2004, and May 31, 2006.
Dysglycemia occurred in 33 patients: 13 (2.2%), 9 (2.6%), and 11 (1.7%), respectively, of those in the gatifloxacin, levofloxacin, and azithromycin groups. Of 13 patients who experienced a hyperglycemic event, 11 (84.6%) had diabetes mellitus. After adjustment for confounding factors, neither levofloxacin nor gatifloxacin were associated with increased odds of developing a dysglycemic event compared with azithromycin. Multivariate analysis demonstrated that lack of downward dosage adjustment based on creatinine clearance (odds ratio [OR] 10.3, 95% confidence interval [CI] 3.8-27.6), presence of diabetes (OR 17.1, 95% CI 3.1-94.9), or treatment with insulin (OR 5.3, 95% CI 1.8-15.7) or sulfonylureas (OR 3.6, 95% CI 1.3-10.4) independently increased dysglycemia risk. Obesity (body mass index > or = 30 kg/m(2)) was independently protective (OR 0.22, 95% CI 0.09-0.55) against dysglycemic events.
Levofloxacin and gatifloxacin were not significantly associated with increased dysglycemic events compared with azithromycin. Lack of downward fluoroquinolone dosage adjustment for renal function, presence of diabetes, and treatment with insulin or sulfonylureas each independently increased the risk of dysglycemia. Obesity was independently protective against dysglycemia. More data are needed on the contributing effects of diabetes, fluoroquinolone dosage, and concomitant drug therapy so that an appropriate risk-management strategy can be developed.
评估门诊环境中口服左氧氟沙星和加替沙星治疗相关的血糖异常（低血糖或高血糖）患病率，并确定接受任一氟喹诺酮类药物治疗时发生血糖异常的患者特征。
回顾性病历审查。
一家退伍军人事务教学医院的门诊诊所。
2004年6月1日至2006年5月31日期间共1573例接受口服左氧氟沙星（343例）、加替沙星（589例）或阿奇霉素（作为对照，641例）治疗的患者。
33例患者发生血糖异常：加替沙星组、左氧氟沙星组和阿奇霉素组分别有13例（2.2%）、9例（2.6%）和11例（1.7%）。在13例发生高血糖事件的患者中，11例（84.6%）患有糖尿病。在对混杂因素进行调整后，与阿奇霉素相比，左氧氟沙星和加替沙星均未增加发生血糖异常事件的几率。多因素分析表明，未根据肌酐清除率进行剂量下调（比值比[OR]10.3，95%置信区间[CI]3.8 - 27.6）、患有糖尿病（OR 17.1，95%CI 3.1 - 94.9）、接受胰岛素治疗（OR 5.3，95%CI 1.8 - 15.7）或磺脲类药物治疗（OR 3.6，95%CI 1.3 - 10.4）均独立增加血糖异常风险。肥胖（体重指数≥30 kg/m²）对血糖异常事件具有独立保护作用（OR 0.22，95%CI 0.09 - 0.55）。
与阿奇霉素相比，左氧氟沙星和加替沙星与血糖异常事件增加无显著相关性。未根据肾功能下调氟喹诺酮类药物剂量、患有糖尿病以及接受胰岛素或磺脲类药物治疗均各自独立增加血糖异常风险。肥胖对血糖异常具有独立保护作用。需要更多关于糖尿病、氟喹诺酮类药物剂量和联合药物治疗的影响的数据，以便制定适当的风险管理策略。
