Analysis of Spontaneous Reports of Hypoglycemia and Hyperglycemia associated with marketed systemic fluoroquinolones made to the Canadian adverse drug reaction monitoring program

Hypoglycemia, an adverse effect that may develop rapidly and progress to cause potentially serious consequences over a short period of time, is difficult to monitor in both outpatients and inpatients, and may be associated with serious central nervous system sequelae. Four recently published cases of severe acute hypoglycemia with gatifloxacin stimulated a review of the published literature and spontaneous adverse drug reaction reports made in Canada on fluoroquinolone-induced hypoglycemia or hyperglycemia. A search of the English literature for published reports of hypoglycemia associated with ciprofloxacin, gatifloxacin, levofloxacin, and moxifloxacin revealed 2 published case reports of hypoglycemia attributed to the potential drug–drug interaction of an oral hypoglycemic agent with ciprofloxacin; 4 such reports with gatifloxacin; and no reports with either levofloxacin or moxifloxacin. All spontaneously reported adverse drug reactions made to the Canadian Adverse Drug Reaction Monitoring Program (CADRMP) listed under the Metabolic and Nutritional Disorders category for the 3 marketed respiratory fluoroquinolones (gatifloxacin, levofloxacin, and moxifloxacin) were then obtained. Altogether, 25 (93%) of 27 reports in this category were due to either hypoglycemia or hyperglycemia with gatifloxacin; 4 (11%) of 35 reports, with levofloxacin; and 1 (10%) of 10 reports, with moxifloxacin. The number of case reports for hypoglycemia (x2 = 24; p < 0.001), hyperglycemia (x2 = 8; p < 0.05), and total (hypoglycemia, hyperglycemia, and both hypoglycemia and hyperglycemia) (x2 = 46; p < 0.001) was significantly higher for gatifloxacin than for either levofloxacin or moxifloxacin. The CADRMP reports for hypoglycemia or hyperglycemia with the respiratory fluoroquinolones may have identified a safety signal for gatifloxacin. A systematic analysis to determine causality, risk factors, and incidence of hypoglycemia or hyperglycemia may be warranted

Randomized controlled trial of chlorhexidine gluconate for washing, intranasal mupirocin, and rifampin and doxycycline versus no treatment for the eradication of methicillin-resistant staphylococcus aureus colonization

Background. Eradication of methicillin-resistant Staphylococcus aureus (MRSA) carriage may reduce the risk of MRSA infection and prevent transmission of the organism to other patients. Methods. To determine the efficacy of decolonization therapy, patients colonized with MRSA were randomized (3 : 1 allocation) to receive treatment (2% chlorhexidine gluconate washes and 2% mupirocin ointment intranasally, with oral rifampin and doxycycline for 7 days), or no treatment. Follow-up samples for MRSA culture were obtained from the nares, perineum, skin lesions, and catheter exit sites monthly for up to 8 months. The primary outcome measure was detection of MRSA at 3 months of follow-up. Univariate and multivariable analyses were performed to identify variables associated with treatment failure. Results. Of 146 patients enrolled in the study, 112 patients (87 treated; 25 not treated) were followed up for at least 3 months. At 3 months of follow-up, 64 (74%) of those treated had culture results negative for MRSA, compared with 8 (32%) of those not treated (P = .0001). This difference remained significant at 8 months of follow-up, at which time, 54% of those treated had culture results negative for MRSA (χ2 = 64.4; P < .0001, by log-rank test). The results of the multivariable analysis indicated that having a mupirocin-resistant isolate at baseline was associated with treatment failure (relative risk, 9.4; 95% confidence interval, 2.8–31.9; P = .0003), whereas decolonization therapy was protective (relative risk, 0.1; 95% confidence interval, 0.04–0.4; P = .0002). Mupirocin resistance emerged in only 5% of follow-up isolates. Conclusions. Treatment with topical mupirocin, chlorhexidine gluconate washes, oral rifampin, and doxycycline for 7 days was safe and effective in eradicating MRSA colonization in hospitalized patients for at least 3 months

Quinolone hyperglycemia and hypoglycemia

Authors response to Kanj

Cost-effectiveness analysis of six strategies for cardiovascular surgery prophylaxis in patients labeled penicillin allergic

The cost-effectiveness of different approaches to antimicrobial prophylaxis for cardiovascular surgery patients labeled penicillin allergic was studied. A decision-analytic model was used to examine the cost-effectiveness of six strategies for antimicrobial prophylaxis in cardiovascular surgery patients at a tertiary care hospital. The strategies consisted of (1) giving vancomycin to all patients labeled penicillin allergic, (2) giving cefazolin to all patients labeled penicillin allergic, (3) giving vancomycin to all patients with a history suggesting an immunoglobulin E (IgE)-mediated reaction to penicillin and cefazolin to patients without such a history, (4) administering a penicillin skin test to patients with a history suggesting an IgE-mediated reaction to penicillin and giving vancomycin to patients with positive results and cefazolin to all others, (5) skin testing all patients labeled penicillin allergic and giving vancomycin to those with positive results and cefazolin to those with negative results, regardless of history, and (6) skin testing all patients and giving vancomycin to those with positive results or a history suggesting an IgE-mediated reaction to penicillin and cefazolin to all others. Giving cefazolin to all patients labeled penicillin allergic was the least expensive strategy but was associated with the highest rate of both anaphylactic and non-life-threatening serious reactions. Selective use of vancomycin in patients with a history suggesting an IgE-mediated reaction to penicillin was associated with an added cost and a slightly lower rate of anaphylaxis. Although skin-testing strategies may decrease both non-life-threatening and anaphylactic reactions, the incremental cost was high. When vancomycin was given to all patients labeled penicillin allergic, the incremental cost was very high. A decision-analytic model indicated that selective use of vancomycin is more cost-effective than indiscriminate use of vancomycin for surgical prophylaxis in cardiovascular surgery patients labeled penicillin allergic

Ambulatory treatment of febrile neutropenia (FN): A Canadian survey of current practice

Oral presentatio

Glucose homeostasis abnormalities and gatifloxacin

Correspondanc

Feasibility of outpatient treatment of febrile neutropenia at a Canadian tertiary care centre

Oral presentatio

Transmission of methicillin-resistant Staphylococcus aureus (MRSA) to household contacts

No abstract availabl