Antimicrobials with Special Precautions in Diabetes

Paul Auwaerter, M.D.

DEFINITION

  • Certain antibiotics may produce undesired changes in glycemic control when used in persons with diabetes.
  • No apparent interactions are described between antibiotics and insulins.
  • Serum concentrations of hypoglycemic agents may change due to inhibition or induction of oxidative metabolism (i.e. cytochrome P450 system) including: meglitinides (repaglinide, nateglinide), sulfonylureas (glyburide, glimepiride, glipizide), and glitizones (pioglitazone, rosiglitazone).
  • Specific cytochrome P450 substrates: repaglinide (2C8, 3A4); nateglinide (2C9>3A4); glyburide and glipizide (2C9); pioglitazone (3A4>2C8); rosiglitazone (2C8> 2C9).
  • Limited number of potential drug-drug interactions observed with metformin.

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