Gatifloxacin and Dysglycemia
Park-Wyllie LY, Juurlink DN, Kopp A, et al. Outpatient gatifloxacin therapy and dysglycemia in older adults. N Engl J Med. 2006 Mar;354(13):1352-1361.
Fluoroquinolones are the most commonly prescribed antibiotics in the United States. Side effects associated with some fluoroquinolones (temafloxacin, grepafloxacin, sparfloxacin, and trovafloxacin) have prompted their restriction or withdrawal. Until now, dysglycemia had been associated with gatifloxacin only in small studies or case reports.
This study sought to examine, by a nested case control design, the association between gatifloxacin and dysglycemia that required hospital care. The researchers reviewed all prescription records from the Ontario (Canada) Drug Benefit database, which houses complete prescription drug sales for all patients older than age 65 (1.4 million residents). They linked this with a national Canadian database of those same patients’ emergency room visits and hospital admissions. Cases were patients who received hospital care for hypoglycemia (or hyperglycemia) within 30 days of filling an antibiotic prescription (macrolide, cephalosporin, or fluoroquinolone). Controls were patients who had not received hospital care after an antibiotic prescription in the same time period. They were matched by age, gender, whether or not they had been diagnosed as having diabetes, diabetic drug use, and time of antibiotic prescription. Patients were excluded if they turned 65 within the year, had been hospitalized within 90 days, had subsequent hospitalizations for dysglycemia, or had more than one antibiotic in 30 days. Logistic regression was used to determine the odds ratio for the association between dysglycemia and recent antibiotic use. In multivariable analysis, they adjusted for liver disease, renal disease, alcohol use, hospitalizations, physician visits, diabetic and P-450 medications, socioeconomic status, and number of prescription drugs. They were also stratified by diabetes status.
The cases treated for hypoglycemia were four times more likely than controls to have been treated with gatifloxacin than with a macrolide (OR 4.3, CI 2.9-6.3). The association was slightly less with levofloxacin (OR 1.5, CI 1.2-2.0), and there was no association of hypoglycemia with moxifloxacin, ciprofloxacin, or cephalosporins. The cases treated for hyperglycemia were 17 times more likely than controls to have been treated with gatifloxacin than with a macrolide (OR 16.7, CI 10.4-26.8). There was no association of hyperglycemia with the other fluoroquinolones or cephalosporins. The analyses were similar when stratified by diabetes status. In total, 1.1% of all gatifloxacin treatments were associated with dysglycemia requiring hospital care within 30 days. As to what to do with gatifloxacin, as stated precisely in an accompanying editorial, “For every approved indication for gatifloxacin, there are safer, equally effective, and less costly alternatives.”
Physician Board Certification and Acute MI Quality Measures.
Chen J, Rathore SS, Wang Y, et al. Physician board certification and the care and outcomes of elderly patients with acute myocardial infarction. J Gen Intern Med. 2006 Mar;21(3):238-244.
Board certification may have implications for practicing physicians because there is evidence that both hiring organizations and patients prefer board-certified physicians over non-board certified physicians. However, it is unknown if such certification translates into better quality of patient care.
In this study researchers sought to examine the relationship between physician board certification and quality of care in patients with acute myocardial infarction (AMI). Medical records were abstracted from the Cooperative Cardiovascular Project, a cohort of Medicare beneficiaries hospitalized with AMI. Board certification was obtained from the American Medical Association (AMA) Physician Masterfile, which is reportedly 94% accurate. Quality of care measures included ASA and beta-blocker use at the time of admission and discharge. Researchers also evaluated 30-day and one-year mortality.