Avoid Antibiotics that Lower the Blood Glucose to a Dangererous Level in Diabetics!

Avoid Antibiotics that Lower the Blood Glucose to a Dangerous Level in Diabetics!

Dr Mohanta G.P

Professor,Annamalai university

chidambaram, T.N

            Diabetes continues to be a concern in our society and the health system as well. The annual number of deaths in India due to diabetes has increased more than two folds between 1990 and 2010. With increasing incidences, the world has given India the title “Diabetes capital of World”. Oral hypoglycaemic medicines are the choice for managing Type 2 diabetes if glycemic target are not achieved with modification of diet, maintenance of a healthy body weight and regular physical activity. 

            Hypoglycaemia is a commonly recognised adverse effect associated with insulin and sulphonyl urea medicines [glipizide or glyburide]. This develops suddenly with symptoms of nervousness, trembling, weakness, sweating, intense hunger, palpitation and disorientation; and in extreme case loss of consciousness. Elderly patients, patients who have diabetes for long time, have kidney damage, use more than one diabetes medicine, involved in extensive glycemic control activities, or have problems with memory are more likely to develop hypoglycaemia. Severe hypoglycaemia is also associated with increased risks of cardiovascular events like heart attacks and stroke, cognitive impairment, dementia and death.

            The recent research published in Journal of American Medical Association (JAMA) Internal Medicine showed that five antibiotics: ciprofloxacin, clarithromycin, levofloxacin, Metronidazole, and cotrimoxazole are associated with increased risk of severe hypoglycaemia in patients treated with sulphonyl urea.  The increased greatest risk is found to be with clarithromcin and least risk with the use of ciprofloxacin. The researchers concluded that the drug (Antibiotics)-drug (glipizide or glyburide) interaction is the cause of hypoglycaemia. Clarithromycin increases the drug level of sulphonyl urea; Levofloxacin increases the drug action and increases the drug level; Metronidazole interferes with drug metabolism; Cotrimoxazole interferes with drug metabolism; and ciprofloxacin enhances drug action. The problem of drug – drug interaction is more likely in our country            when the diabetic patients self medicate with antibiotics. Many times the use of these antibiotics is not necessary.  The patients need to be discouraged self medication especially with antibiotics in their own interest and in the interest of the community.

            The physicians and the pharmacists must realize that the avoidance of serious life threatening hypoglycaemia is the key component of successful diabetes management. If the diabetic patients, already with glipizide or glyburide, need antibiotic therapy, avoid using the antibiotics (antibiotics includes other antibacterial medicines too) described earlier. Alternative antibiotics are available. The patients should also be educated on the symptoms, danger and immediate management of hypoglycaemia.