Abstract
Background and aim
Fluoroquinolones are antimicrobial agents with a broad spectrum of activity against gram-positive, gram-negative, and anaerobic organisms. They are widely used in surgical practice and are generally considered safe. Hypoglycemia because of use of levofloxacin is a rarely reported complication. This report of a case of a surgical patient highlights this potentially fatal complication.
Patient
An elderly, non-diabetic patient with renal impairment presented with a possible duodenal perforation. After successful surgery, the patient developed recurrent hypoglycemic episodes in the post-operative period after use of levofloxacin. Delay in recognition of the cause of hypoglycemia led to irreversible brain damage and death.
Results
The calculated Naranjo adverse drug reaction probability scale criteria suggest the possibility that these episodes were related to levofloxacin. The mechanism of hypoglycemia with levofloxacin relates to the potential inhibition of the KATP channel on the pancreatic beta cell by the drug.
Conclusion
The case report highlights the need to be aware of this potentially fatal complication of a drug commonly used in surgical practice.
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References
Rubinstein E (2001) History of quinolones and their side effects. Chemotherapy 47(Suppl 3:3–8):44–48
Ball P (2000) New antibiotics for community acquired lower respiratory tract infections: improved activity at a cost? Int J Antimicrob Agents 16:263–272
Friedrich LV, Dougherty R (2004) Fatal hypoglycemia associated with levofloxacin. Pharmacotherapy 24:1807–1812
Kanbay M, Aydogan T, Bozalan R, Isik A, Uz B, Kaya A, Akcay A (2006) A rare but serious side effect of levofloxacin: hypoglycemia in a geriatric patient. Diabetes Care 29:1716–1717
Lawrence KR, Adra M, Keir C (2006) Hypoglycemia-induced anoxic brain injury possibly associated with levofloxacin. J Infect 52:e177–e180
Wang S, Rizvi AA (2006) Levofloxacin-induced hypoglycemia in a nondiabetic patient. Am J Med Sci 331:334–335
Naranjo CA, Busto U, Sellers EM, Sandor P, Ruiz I, Roberts EA, Janecek E, Domecq C, Greenblatt DJ (1981) A method for estimating the probability of adverse drug reactions. Clin Pharmacol Ther 30:239–245
Baker SE, Hangii MC (2002) Possible gatifloxacin-induced hypoglycemia. Ann Pharmacother 36:1722–1726
Menzies DJ, Dorsainvil PA, Cunha BA, Johnson DH (2002) Severe and persistent hypoglycemia due to gatifloxacin interaction with oral hypoglycemic agents. Am J Med 113:232–234
LeBlanc M, Belanger C, Cossette P (2004) Severe and resistant hypoglycemia associated with concomitant gatifloxacin and glyburide therapy. Pharmacotherapy 24:926–931
Park-Wyllie LY, Juurlink DN, Kopp A, Shah BR, Stukel TA, Stumpo C, Dresser L, Low DE, Mamdani MM (2006) Outpatient gatifloxacin therapy and dysglycemia in older adults. N Engl J Med 354:1352–1361
Ishiwata Y, Itoga Y, Yasuhara M (2006) Effect of levofloxacin on serum glucose concentration in rats. Eur J Pharmacol 551:168–174
Tomita T, Onishi M, Sato E, Kimura Y, Kihira K (2007) Gatifloxacin induces augmented insulin release and intracellular insulin depletion of pancreatic islet cells. Biol Pharm Bull 30:644–647
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Singh, M., Jacob, J.J., Kapoor, R. et al. Fatal hypoglycemia with levofloxacin use in an elderly patient in the post-operative period. Langenbecks Arch Surg 393, 235–238 (2008). https://doi.org/10.1007/s00423-007-0268-0
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DOI: https://doi.org/10.1007/s00423-007-0268-0