Gatifloxacin-Associated Hypoglycemia

Objective: To report a case of prolonged hypoglycemia associated with glyburide and gatifloxacin use. Case Summary: An 82-year-old white woman with diabetes mellitus type 2 and chronic renal insufficiency developed postoperative pneumonia. She had previously been on long-term glyburide therapy. Protracted hypoglycemia after institution of gatifloxacin developed despite discontinuation of oral hypoglycemic therapy. After 2 days of intravenous dextrose, sustained normoglycemia was achieved. Discussion: Hypoglycemic reactions with glyburide and fluoroquinolone antibiotics have been reported, but not with gatifloxacin. Although drug administration error cannot be excluded, no documentation exists to support this. The onset of hypoglycemia soon after administration of gatifloxacin and reports of similar interactions favor the hypothesis that hypoglycemia was induced by a gatifloxacin–glyburide interaction. Conclusions: Fluoroquinolone-associated hypoglycemia has been documented, and an interaction of gatifloxacin and glyburide appears probable. Patients with diabetes should be monitored for the development of resistant hypoglycemia, especially if they are on concomitant oral hypoglycemic medications.