Hypoglycemia associated with pivalate-conjugated antibiotics in young children: A retrospective study using a medical and pharmacy claims database in Japan.

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.

• Authors: Yasuhisa Tatebe, Toshihiro Koyama, Naoko Mikami, Yoshihisa Kitamura, Toshiaki Sendo, Shiro Hinotsu
• Journal: Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy (J Infect Chemother) Vol. 26 Issue 1 Pg. 86-91 (Jan 2020) ISSN: 1437-7780 [Electronic] Netherlands
• PMID: 31401031 (Publication Type: Journal Article)
• Copyright: Copyright © 2019 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. Published by Elsevier Ltd. All rights reserved.

Chemical References

• Anti-Bacterial Agents
• Cephalosporins
• Pentanoic Acids
• cefcapene pivoxil hydrochloride
• pivalic acid

Topics

• Anti-Bacterial Agents (adverse effects, chemistry)
• Antimicrobial Stewardship
• Cephalosporins
• Child, Preschool
• Comorbidity
• Databases, Factual
• Female
• Humans
• Hypoglycemia (chemically induced, epidemiology)
• Infant
• Japan
• Male
• Pentanoic Acids (chemistry)
• Retrospective Studies