Published online Mar 22, 2023. doi: 10.5497/wjp.v12.i2.12
Peer-review started: November 25, 2022
First decision: January 31, 2023
Revised: February 13, 2023
Accepted: March 9, 2023
Article in press: March 9, 2023
Published online: March 22, 2023
Processing time: 115 Days and 12.9 Hours
Fluoroquinolones are a class of broad-spectrum antimicrobials used for various bacterial infections. Frequent use of fluoroquinolones has been questioned due to severe associated adverse effects, including dysglycemia (hypoglycemia or hyperglycemia) due to an alternation in glucose metabolism. Recent clinical trials showed the association of poor clinical outcomes with hypoglycemia in critically ill patients without diabetes. Many predisposing factors worsen fluoroquinolone-induced hypoglycemia, including diabetes, concomitant medication use like sulfonylureas or insulin, renal disease, and the elderly.
We report a case of recurrent hypoglycemia after ciprofloxacin initiation for a 71-year-old, non-diabetic, critically ill patient despite the presence of total parenteral nutrition and nasogastric tube feeding. The adverse drug reaction probability (Naranjo) scale was completed with a probable adverse drug reaction. The hypoglycemia resolved entirely after ciprofloxacin discontinuation.
Although ciprofloxacin-induced hypoglycemia is rare, special consideration is needed for the elderly due to their higher susceptibility to adverse side effects.
Core Tip: Fluoroquinolones are a class of broad-spectrum antimicrobials used to treat various bacterial infections. Frequent use has been doubted due to associated adverse severe effects, including hypoglycemia or hyperglycemia due to an alternation in glucose metabolism. Recent clinical trials showed the association of poor clinical outcomes with hypoglycemia in critically ill patients without diabetes, emphasizing the harm of severe hypoglycemia. Ciprofloxacin has demonstrated the lowest incidence in the class in the diabetic population. We report a case of recurrent ciprofloxacin-induced hypoglycemia for non-diabetic critically ill patient despite total parenteral nutrition and nasogastric tube feeding. The hypoglycemia resolved successfully after ciprofloxacin discontinuation.