Levofloxacin induced hypoglycemia in a non-diabetic patient.

Fluoroquinolones are generally regarded as safe antimicrobial agents with relatively few adverse effects or drug interactions. Because of their recognized safety profile and potent in vitro activity, fluoroquinolones have been widely used for the treatment of community- and hospital-acquired infections. Although uncommon, both hypoglycaemia and hyperglycaemia (dysglycaemia) appear to occur with all the fluoroquinolones. It is usually reported in conjunction with impaired creatinine clearance and elderly diabetics receiving concomitant treatment with antidiabetic agents (especially sulfonylureas) or insulin. The exact mechanism of this effect is unknown but is postulated to be a result of blockage of adenosine 5'-triphosphate-sensitive potassium channels in pancreatic cell membranes. Here we report a case of hypoglycaemia in a hospitalized non-diabetic elderly patient in whom this life-threatening adverse effect was related in a temporal fashion to the administration of intravenous levofloxacin meant to cover pulmonary infection in a setting of subacute small bowel obstruction and septicaemia. This case emphasizes the occurrence of profound and prolonged hypoglycaemia consequent upon levofloxacin use, an adverse reaction that has been described with almost all members of the quinolone family of antibiotics. Taking into consideration the frequency of fluoroquinolones use in the hospital and ambulatory setting, clinicians should be cognizant of this potential adverse effect in non-diabetic patients treated with levofloxacin, and they should look out for symptoms of hypoglycaemia and monitor blood glucose levels more frequently, especially early in the course of therapy.

An open-label, prospective study comparing efficacy, tolerability and cost of therapy of losartan with enalapril in stage 1 and stage 2 hypertension.

Background: Hypertension is a chronic disease which insidiously affects multiple systems in the body especially the cardiovascular and cerebrovascular systems. Also being a chronic disease the patient is required to take medications lifelong and this has financial implications. This study was attempted to evaluate drugs in two antihypertensive groups: Angiotensin II antagonist losartan v/s angiotensin converting enzyme inhibitor enalapril. Methods: A total of 100 patients as per the selection criteria were enrolled in the study and allocated randomly to either group A (losartan group) or group B (enalapril group). The study period was for 12 weeks, during which regular assessments were done - first on recruitment and then at 2nd week, 4th week, 8th week, and 12th week. The assessment parameters were diastolic, systolic pressures and pulse rate. Routine investigations were performed during the 1st visit and after 12 weeks of the study period. Results: There were no significant differences between the treatment groups with respect to baseline patient demographic data and clinical characteristics like systolic blood pressure, diastolic blood pressure and heart rate. The cost benefit ratio and less adverse effects (cough), can be appreciated in group A (losartan group). Conclusions: Losartan and enalapril were well tolerated after 12 weeks of treatment with notable tolerability advantages of losartan especially with respect to the respiratory system (cough). The cost of therapy for losartan group was almost half the cost of therapy for enalapril group and hence being cost effective. Thus, losartan could be preferred as a suitable alternative to enalapril as an antihypertensive agent.