Anti-infectives and the risk of severe hypoglycemia in users of glipizide or glyburide
Abstract
The objective of this study was to evaluate whether orally administered anti‐infectives increase the risk of severe hypoglycemia in users of glipizide or glyburide. We performed two case–control studies and two case–crossover studies using US Medicaid data. All the anti‐infectives examined were associated with an elevated risk of severe hypoglycemia. Using cephalexin as the reference category, in glipizide users, statistically significant associations were found with co‐trimoxazole (odds ratio (OR) = 3.14; 95% confidence interval (CI): 1.83–5.37); clarithromycin (OR = 2.90; 95% CI: 1.69–4.98); fluconazole (OR = 2.53; 95% CI: 1.23–5.23); and levofloxacin (OR = 2.09; 95% CI: 1.35–3.25). In glyburide users, with cephalexin as the reference, statistically significant associations were found with clarithromycin (OR = 5.02; 95% CI: 3.35–7.54); levofloxacin (OR = 2.83; 95% CI: 1.73–4.62); co‐trimoxazole (OR = 2.68; 95% CI: 1.59–4.52); fluconazole (OR = 2.20; 95% CI: 1.04–4.68); and ciprofloxacin (OR = 2.08; 95% CI: 1.23–3.52). In conclusion, exposure to all studied anti‐infective agents were associated with subsequent severe hypoglycemia. Using cephalexin as the reference, drug–drug interactions were evident with ciprofloxacin (in glyburide users only), clarithromycin, co‐trimoxazole, fluconazole, and levofloxacin.
How strong is the evidence?
Evidence Hub reads this as a case-control, done in people. Its evidence level is 4 of 5 (Low · observational). Observational designs can show an association but not prove cause.
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