Gatifloxacin-Induced Hyperglycemia: A Review of 4 Cases and the Literature

Gatifloxacin, a broad-spectrum fluoroquinolone, has recently been voluntarily withdrawn by Bristol-Myers Squibb from the market secondary to dysglycemic events associated with this agent. Risk factors for this adverse event include diabetes and those who are elderly (65 years of age or older), have renal insufficiency, or take glucose altering medications. The mechanism for this adverse reaction is not fully understood. However, it is theorized that there is an association between accumulation of gatifloxacin (particularly in elderly patients or those with renal insufficiency) and dysglycemic events with gatifloxacin. A review of the literature found 13 reported cases of hyperglycemia induced by gatifloxacin and 2 clinical trials evaluating gatifloxacin's association with hyperglycemia. Similarly to other reported cases, the authors' 4 outpatients were initiated on gatifloxacin therapy and subsequently had developed hyperglycemia during gatifloxacin therapy. Prior to the multiple observations of dysglycemias associated with gatifloxacin, this medication was widely used and thought to have an excellent safety profile. Hence, clinicians should be vigilant and exercise caution with newly approved medications.