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

Yasuhisa Tatebe, Toshihiro Koyama, Naoko Mikami, Yoshihisa Kitamura, Toshiaki Sendo, Shiro Hinotsu

Research output: Contribution to journalArticle

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.

Original languageEnglish
Pages (from-to)86-91
Number of pages6
JournalJournal of Infection and Chemotherapy
Volume26
Issue number1
DOIs
Publication statusPublished - Jan 2020

Fingerprint

Hypoglycemia
Japan
Retrospective Studies
Databases
Anti-Bacterial Agents
beta-Lactams
Confidence Intervals
Prescriptions
Hypoglycemic Agents
Multivariate Analysis
Odds Ratio
Communicable Diseases
Cohort Studies
Outpatients
Glucose
Control Groups
Injections

Keywords

  • Antimicrobial stewardship
  • Children
  • Claims data
  • Hypoglycemia
  • Oral antibiotics
  • Pivalate-conjugated antibiotics

ASJC Scopus subject areas

  • Microbiology (medical)
  • Pharmacology (medical)
  • Infectious Diseases

Cite this

Hypoglycemia associated with pivalate-conjugated antibiotics in young children : A retrospective study using a medical and pharmacy claims database in Japan. / Tatebe, Yasuhisa; Koyama, Toshihiro; Mikami, Naoko; Kitamura, Yoshihisa; Sendo, Toshiaki; Hinotsu, Shiro.

In: Journal of Infection and Chemotherapy, Vol. 26, No. 1, 01.2020, p. 86-91.

Research output: Contribution to journalArticle

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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.",
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AB - 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.

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