Hypoglycemia from Quinolones
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þ Emails from Mercy, December 2002:

Mike Turturro writes:

Over the past few months, there have been several reports of patients at
Mercy developing hypoglycemia after receiving gatifloxacin (Tequin).  Many
of these patients received their first dose of this antibiotic in the DEM
and were most patients affected were over age 60, on oral hypoglycemic
agents and with some degree of renal insufficiency.  This issue has been
discussed at the Pharmacy and Therapeutics Committee, and will be discussed in
the Quality Management Committee.

Hypoglycemia associated with fluoroquinoline use has been well described,
but may be underreported or under appreciated.  The mechanism seems to be
stimulation of insulin release in patients who have some insulin reserve.
It is unclear whether certain fluoroquinolones are more likely to induce
this phenomenon than others.

I recommend caution in using this drug and consideration of alternative
antibiotics in older type 2 diabetic patients, particularly those with renal
insufficiency.  Also, please note that internal surveillance data has NOT
shown a significant problem with pneumococcal resistance to penicillin and
cephalosporin antibiotics at Mercy.

And Bob Frank replied:

THere was also a landmark case report from 1999 in Annals of EM by
Roberge/Kaplan/Frank (not listed in order of importance, obviously) that
also documented this problem w/ cipro and glucophage.  Also fulfilled my
residency graduation requirement for scholarly work.

[Roberge RJ, Kaplan R, Frank R, Fore C.: Glyburide-ciprofloxacin interaction
with resistant hypoglycemia. Ann Emerg Med 2000 Aug;36(2):160-3.]