Abstract

I read with great interest the letter by Bobba et al,¹ entitled “Hyperglycemia in an elderly diabetic patient: Drug-drug or drug-disease interaction?” in which an elderly patient experienced loss of glycemic control potentially due to the use of gatifloxacin, a newer fluoroquinolone antibacterial agent. The case report does emphasize the need for providers to consider potential drug-related causes or interactions when evaluating a patient with symptomatic alterations in glycemic control. A variety of pharmacologic agents have been linked to the development of abnormal glucose metabolism, diabetes mellitus, hypoglycemia and hyperglycemia. The case also highlights the need for providers to consider a number of patient-specific factors when dosing medications, such as age, body weight or body surface area, hepatic function, renal function, concomitant medications, and comorbid illness. The case report describes a recognized drug-drug interaction between a fluoroquinolone antibacterial agent and a sulfonylurea, associated with loss of glycemic control. In addition, one must consider the potential impact that an infectious process could have on the patient’s serum glucose levels or if the patient experienced a rapid decrease in renal function which could lead to increased serum gatifloxacin levels. Potential complications due to disregarding appropriate dosing guidelines is a common theme in the medical literature regarding reports of older adults experiencing drug-related morbidities.