Hypoglycemia associated with pivalate-conjugated antibiotics in young children: A retrospective study using a medical and pharmacy claims database in Japan. Issue 1 (January 2020)

• Record Type: Journal Article
• Authors: Tatebe, Yasuhisa; Koyama, Toshihiro; Mikami, Naoko; Kitamura, Yoshihisa; Sendo, Toshiaki; Hinotsu, Shiro
• Is Part Of: Journal of infection and chemotherapy. Volume 26:Issue 1(2020:Jan.)
• Page Start: 86
• Page End: 91
• Publication Date: 2020-01
• Subjects: Pivalate-conjugated antibiotics -- Hypoglycemia -- Children -- Claims data -- Antimicrobial stewardship -- Oral antibiotics; Chemotherapy -- Periodicals; Infection -- Periodicals; Communicable diseases -- Chemotherapy -- Periodicals; 615.5805
• DOI: 10.1016/j.jiac.2019.07.013
• Languages: English
• ISSNs: 1341-321X

Abstract

Abstract: Introduction: Acute bacterial infectious diseases are major causes for outpatient visits for young children. Pivalate-conjugated antibiotics (PCAs) are frequently prescribed for these situations in Japan, while several literatures have shown a potential risk of hypoglycemia associated with PCAs. This study aimed to evaluate the incidence of PCA-induced hypoglycemia in children, compared with other oral beta-lactam antibiotics. Methods: This retrospective cohort study using a Japanese medical and pharmacy claims database was performed on children aged 1 month to 5 years old with at least once prescription of PCAs or other oral beta-lactam antibiotics from January 2011 to December 2013. Hypoglycemia was defined based on diagnostic codes or the prescription of 10% or 20% glucose injection. We examined the prevalence of hypoglycemic events and performed multivariate analysis to investigate the risk of hypoglycemia with PCAs compared with the control oral beta-lactam antibiotics. Results: We identified 179, 594 eligible patients in this population. In the PCA and control groups, there were 454, 153 and 417, 287 prescriptions and 3356 (0.74%, 95% confidence intervals [CI] 0.71–0.76) and 2605 (0.62%, 95% CI 0.60–0.65) hypoglycemic events, respectively. Multivariate analysis revealed that PCAs were associated with hypoglycemia (adjusted odds ratios [OR] 1.18, 95% CI 1.12–1.24), and even a shorter duration of PCAs prescribing (≤7 days) was significantly associated with hypoglycemia (adjusted OR 1.17, 95% CI 1.11–1.24). Conclusion: These results suggest that in young children PCA use, even for a short period, is a risk factor of hypoglycemia.