Antibiotics Linked to Lows in People Taking Certain Diabetes Drugs

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A new study from researchers at the University of Texas has linked certain antibiotics to hypoglycemia (low blood glucose) in older people taking sulfonylureas, a class of oral diabetes medicine prescribed to treat Type 2 diabetes. An estimated 26 million people in the United States have Type 2 diabetes.

To determine the risk of hypoglycemia in older people taking the diabetes medicines glipizide (brand name Glucotrol) or glyburide (DiaBeta, Glynase, PresTab, Micronase) along with one of 16 commonly prescribed antibiotics, the investigators looked at Texas Medicare claims covering the period from 2006 to 2009 for people at least 66 years old.

In those who had been prescribed one of the antibiotics included in the study, the rate of hypoglycemic episodes ranged from 0.17% to 1.44% in people taking glipizide and from 0.32% to 1.87% in people taking glyburide. The antibiotics ciprofloxacin (Cipro, Cipro XR, Proquin XR), clarithromycin (Biaxin, Biaxin XL), levofloxacin (Levaquin), metronidazole (Flagyl), and sulfamethoxazole-trimethoprim (Bactrim, Septra) were found to have a significant association with hypoglycemia.

Moxifloxacin (Avelox) and fluconazole (Diflucan), two antibiotics that previously appeared to be linked to hypoglycemia, were not found to have a significant association with lows in this study.

“Physicians should definitely avoid using those antibiotics in patients on sulfonylureas. In the great majority of cases, there are equally effective, noninteracting antibiotics available,” noted study author James S. Goodwin, MD, in an interview with Reuters Health. “In addition, antibiotics tend to be overprescribed in the community, so often the best choice is not to prescribe one. Some physicians may have the attitude of ‘well, it can’t hurt,’ when prescribing an antibiotic. Our study is an example of one of the many ways in which such drugs can hurt.”

Gerry Rayman, MD, FRCP, who was not involved with the research, added that if a hypoglycemia-associated antibiotic must be used in a person taking a sulfonylurea, that person should monitor his blood glucose levels more frequently.

For more information, read the article “Several antibiotics tied to hypoglycemia in patients on sulfonylureas” or see the study’s abstract in the journal JAMA Internal Medicine. And to learn more about preventing hypoglycemia, read the article “Take a Bite Out of Hypoglycemia: 10 Proven Strategies for Cutting Down on Low Blood Glucose,” by certified diabetes educator Gary Scheiner.

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