Can A New Molecular Test Enhance MRSA Detection?

By Brian McCurdy, Associate Editor

Following reports that gatifloxacin (Tequin) may not be safe for use in patients with diabetes, the drug’s manufacturer, Bristol-Myers Squibb, has revised the drug’s prescribing information. Accordingly, gatifloxacin is now contraindicated in diabetic patients due to serious reports of hypoglycemia and hyperglycemia. Tequin is a newer generation quinolone with an FDA indication for uncomplicated skin and skin structure infections.
A recent study in Clinical Infectious Diseases documented the rates of glucose homeostasis abnormality (GHA) adverse event reports (AERs) of gatifloxacin as compared to fellow quinolones levofloxacin, ciprofloxacin and moxifloxacin. All four drugs were responsible for a total of 568 GHA AERs in the United States between 1997 and 2003, according to the study. Of those 568 adverse events, researchers note gatifloxacin was responsible for 453, or 80 percent, including 17 fatal GHA AERs. As the study notes, patients who had GHA AERs were more likely older and being treated for diabetes. Researchers recommended that practitioners use alternatives to gatifloxacin in patients with diabetes.
Gatifloxacin’s effect on glucose homeostasis may not be limited to patients with diabetes. A case study in the Annals of Pharmacotherapy examined a non-diabetic patient with progressive renal dysfunction, who was treated for severe hyperglycemia. On day nine of a 10-day course of gatifloxacin 200 mg/day, doctors discovered her blood glucose was 1121 mg/dL, and accordingly discontinued her gatifloxacin regimen, notes the case study.

Sifting Through Alternative Antibiotics For Diabetic Foot Infections
What alternatives to gatifloxacin are feasible for diabetic patients with lower extremity infections? Mark Kosinski, DPM, cites levofloxacin (Levaquin, Ortho-McNeil) and moxifloxacin (Avelox, Schering-Plough). While both have been reported to cause GHA AERs, Dr. Kosinski says these are “rare,” a finding supported by the Clinical Infectious Diseases study.
Dr. Kosinski describes levofloxacin as “the workhorse drug of its class,” with an FDA indication for uncomplicated and complicated skin and skin structure infections. Levofloxacin has better activity than ciprofloxacin against Staphylococcus aureus, according to Dr. Kosinski, a Professor in the Department of Medicine at the New York College of Podiatric Medicine. Moxifloxacin recently received an indication for complicated skin and skin structure infections and has good activity against anaerobes such as B. fragilis, unlike levofloxacin, says Dr. Kosinski, a member of the Infectious Diseases Society of America.
“Quinolones are running the risk of becoming an overused class of antibiotic with an increasing incidence of resistance being reported,” says Dr. Kosinski, adding that gatifloxacin is not the first quinolone to be associated with an unacceptably high rate of side effects. He says temafloxacin, grepafloxacin and trovafloxacin have been withdrawn or restricted because of adverse events.

DPMs Gain Access To Medication Histories Provided By Pharmacies
By Brian McCurdy, Associate Editor

Physicians and their patients may gain easier access to medication histories, thanks to an emerging program by a company that provides electronic prescribing services.
The plan by SureScripts is to garner patients’ medication histories from pharmacies. The company will also collaborate with doctors to make these medication histories available to patients. Doctors will be able to access a view of the patient’s medication history across all prescribers and SureScripts notes that physicians will get a complete view of current and past medications.

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