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There have also been reports of glucose disturbances with other fluoroquinolones; therefore, it may be prudent to use them with caution as well in patients who are prone to hypo- and hyperglycemic events, such as individuals with diabetes [ 12 , 15 , 20 , 22–26 ]. If dysglycemia was problematic with the other fluoroquinolones, one might suspect that there should be more reports with ciprofloxacin and levofloxacin, given that they were approved by the US Food and Drug Administration in 1987 and 1996, respectively. However, spontaneous reporting of adverse drug reactions tends to occur more frequently with newer medications, such as gatifloxacin [ 27 ]. Considering these factors, it is difficult to compare the incidence of dysglycemic events among the individual fluoroquinolones. The objective of the present study was to compare the risk of severe hypo- and hyperglycemia in a cohort of patients treated with gatifloxacin, ciprofloxacin, or levofloxacin or with a nonfluoroquinolone antibiotic, azithromycin.

Study design and sample selection . The institutional review boards at the Veterans Affairs (VA) Pittsburgh Healthcare System and the Edward Hines, Jr., VA Hospital/North Chicago VA Medical Center approved the study. VA outpatients with a prescription for gatifloxacin, levofloxacin, ciprofloxacin, or azithromycin from 1 October 2000 through 30 September 2005 were included. Data were examined using 2 general approaches, a descriptive surveillance method and a standard analytic method.

Study design and sample selection

Our surveillance approach estimated the rates of severe hypo- and hyperglycemia during the risk period of the drug (ie, within 15 days after the prescription date) by summing the number of unique patients with events in a calendar-year quarter and dividing by the number of unique patients filling an outpatient prescription for the drug in the quarter. This was repeated over time. This estimate is very simple, can be applied readily to the entire VA population, and can be used to visualize the pattern over time (figures 1 and 2 ). However, it is purely descriptive and does not take into account a variety of potential biases that may influence the patterns. A standard analytic approach using a retrospective inception (new users) cohort was employed to assess possible biases and characterize the potential association between fluoroquinolone use and dysglycemia.

Figure 1
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Rates of hypoglycemia, by quarter. Estimates of rates are shown over calendar-year quarters for azithromycin (×), ciprofloxacin (○), levofloxacin (□), and gatifloxacin (△).

Figure 1
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Rates of hypoglycemia, by quarter. Estimates of rates are shown over calendar-year quarters for azithromycin (×), ciprofloxacin (○), levofloxacin (□), and gatifloxacin (△).

Figure 2
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Rates of hyperglycemia, by quarter. Estimates of rates are shown over calendar-year quarters for azithromycin (×), ciprofloxacin (◯), levofloxacin (□), and gatifloxacin (▵).

Figure 2
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Rates of hyperglycemia, by quarter. Estimates of rates are shown over calendar-year quarters for azithromycin (×), ciprofloxacin (◯), levofloxacin (□), and gatifloxacin (▵).

In the analytic approach, patients were included only once during the study period. We excluded patients if they received one of the study antibiotics within 24 weeks before the index date (ie, the date of the first antibiotic prescription during the study period), to ensure that only patients receiving new prescriptions were subjects. We also excluded patients with a primary inpatient diagnosis of hyperglycemia or hypoglycemia within 90 days of the index date so as to study only new-onset dysglycemic events. Finally, patients who received a single dose of the study antibiotics, were changed to another study antibiotic during the risk period, or did not have an age recorded were excluded from the cohort.

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UPDATE: July 8, 9 AM: Re-entry hours for Basalt High School will be from 10:00 AM to 3:00 PM today. If your ID does not have your physical address, be sure to pick up a re-entry tag!

UPDATE: July 7, 6 pm: Starting tomorrow, some neighborhoods will be open for reentry. Estimated sequencing and timeframes are:

Starting tomorrow, some neighborhoods will be open for reentry.

8 a.m.El Jebel Trailer Park

2 p.m.Big Pinion and Little PinionShadow RockOriginal Road, Pine Ridge and Sagewood CourtHillcrest, SilveradoTwo Rivers for access to Hillcrest

Checkpoints will be in place for 24 hours following the opening. Residents will need to need to show either a reentry badge or photo ID with a physical address each time for security purposes.

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