常用氟喹诺酮类药物合理使用情况及血糖异常风险评估
Evaluation of the appropriate use of commonly prescribed fluoroquinolones and the risk of dysglycemia.
作者信息
Kabbara Wissam K, Ramadan Wijdan H, Rahbany Peggy, Al-Natour Souhaila
机构信息
Department of Pharmacy Practice, School of Pharmacy, Lebanese American University, Byblos, Lebanon.
Children's National Medical Center, Washington, DC, USA.
出版信息
Ther Clin Risk Manag. 2015 Apr 22;11:639-47. doi: 10.2147/TCRM.S81280. eCollection 2015.
BACKGROUND
Fluoroquinolones are among the most widely prescribed antibiotics. However, concerns about increasing resistant microorganisms and the risk of dysglycemia associated with the use of these agents have emerged.
OBJECTIVE
The primary objective of the study was to evaluate the appropriate use of commonly prescribed fluoroquinolones, including appropriate indication, dose, dose adjustment in renal impairment, and duration of treatment. The secondary objective was to investigate the dysglycemic effect of fluoroquinolone use (hypoglycemia and/or hyperglycemia) in diabetic and nondiabetic patients.
METHODS
A prospective observational study at a teaching hospital in Lebanon was conducted over a 6-month period. A total of 118 patients receiving broad-spectrum fluoroquinolones (levofloxacin, ciprofloxacin, and moxifloxacin) were identified. Patients were mainly recruited from internal medicine floors and intensive care units.
RESULTS
The final percentage for the appropriate indication, dose, and duration of fluoroquinolone therapy was 93.2%, 74.6%, and 57.6%, respectively. A total of 57.1% of the patients did not receive the appropriate dose adjustment according to their level of renal impairment. In addition, dysglycemia occurred in both diabetic and nondiabetic patients. Dysglycemia was more frequently encountered with ciprofloxacin (50.0%), followed by levofloxacin (42.4%) and moxifloxacin (7.6%). Hyperglycemia was more common than hypoglycemia in all groups. The highest incidence of hyperglycemia occurred with levofloxacin (70.0%), followed by ciprofloxacin (39.0%) and moxifloxacin (33.3%). In contrast, hypoglycemia did not occur in the ciprofloxacin group, but it was more common with moxifloxacin (11.1%) and levofloxacin (6.0%).
CONCLUSION
The major clinical interventions for the future will adjust the dose and duration of therapy with commonly prescribed fluoroquinolones. The incidence of hypoglycemia was less common than hyperglycemia.
背景
氟喹诺酮类药物是处方最广泛的抗生素之一。然而，对耐药微生物增加以及使用这些药物相关的血糖异常风险的担忧已经出现。
目的
该研究的主要目的是评估常用氟喹诺酮类药物的合理使用情况，包括适应证、剂量、肾功能损害时的剂量调整以及治疗疗程。次要目的是调查氟喹诺酮类药物使用对糖尿病和非糖尿病患者的血糖影响（低血糖和/或高血糖）。
方法
在黎巴嫩一家教学医院进行了为期6个月的前瞻性观察研究。共确定了118例接受广谱氟喹诺酮类药物（左氧氟沙星、环丙沙星和莫西沙星）治疗的患者。患者主要来自内科病房和重症监护病房。
结果
氟喹诺酮类药物治疗的适应证、剂量和疗程的最终合适率分别为93.2%、74.6%和57.6%。共有57.1%的患者未根据肾功能损害程度进行适当的剂量调整。此外，糖尿病和非糖尿病患者均出现了血糖异常。环丙沙星导致血糖异常的情况更常见（50.0%），其次是左氧氟沙星（42.4%）和莫西沙星（7.6%）。在所有组中，高血糖比低血糖更常见。左氧氟沙星导致高血糖的发生率最高（70.0%），其次是环丙沙星（39.0%）和莫西沙星（33.3%）。相比之下，环丙沙星组未发生低血糖，但莫西沙星（11.1%）和左氧氟沙星（6.0%）导致低血糖的情况更常见。
结论
未来主要的临床干预措施将是调整常用氟喹诺酮类药物的治疗剂量和疗程。低血糖的发生率低于高血糖。
Zotero 插件