Comparative Study between Levofloxacin and Ciprofloxacin Regarding Their Risk on Dysglycemia and QT Interval Prolongation

Research Abstract

ABSTRACT Background Levofloxacin and ciprofloxacin are more commonly used among fluoroquinolone class and the question of cardiac safety and dysglycemia of this class has been raised. Objective To compare intravenous levofloxacin and ciprofloxacin regarding their risk on the corrected QT interval (QTc) prolongation and dysglycemia in diabetic and non-diabetic patients. Methods A randomized prospective study at Beni-Suef University Hospital was conducted on 200 adult patients over six months. The patients received intravenous levofloxacin (750 mg) once daily or ciprofloxacin (400 mg) twice daily. Electrocardiogram and fasting blood glucose were obtained from each patient before starting antibiotic, 24 hours, 72 hours after the first dose, and 72 hours after antibiotics cessation. Results The present study showed that levofloxacin administration produced a significant prolongation of QTc interval compared to the ciprofloxacin group after 72 hours of starting treatment in diabetic patients. The relative risk for QTc prolongation with levofloxacin was more than ciprofloxacin by about 4 and 1.5 times in diabetic and non-diabetic patients, respectively. Ciprofloxacin administration produced a significant elevation of Alanine transaminase (ALT), 24 hours after the first dose compared to baseline values in both diabetic and non-diabetic patients. Levofloxacin administration showed a significant elevation of ALT and Aspartate transaminase (AST), 72 hours after the first dose compared to baseline values in diabetic patients. On the other hand, ciprofloxacin administration revealed a significant decrease in Potassium (K) and Magnesium (Mg), 24 hours, 72 hours after the first dose compared to the baseline values in both diabetic and non-diabetic patients. Besides, levofloxacin administration revealed a significant decrease in Sodium (Na) and K, 72 hours after the first dose compared to the baseline values in diabetic patients while non-diabetic patients showed a significant decrease only in K. Levofloxacin administration produced significant hyperglycemia, 72 hours from starting antibiotics compared to ciprofloxacin in diabetic patients. In non-diabetic patients, levofloxacin administration produced significant hyperglycemia, 24 hours after the first dose and significant hypoglycemia, 72 hours after the first dose compared to ciprofloxacin. The relative risk for dysglycemia with levofloxacin was 2.28 and 1.39 times more than ciprofloxacin in diabetic and non-diabetic patients, respectively. Conclusion The current study showed that the risk for QTc prolongation was higher in levofloxacin than in ciprofloxacin in diabetic and non-diabetic patients. Additionally, levofloxacin was associated with a greater risk for hyperglycemia than ciprofloxacin in diabetic and non-diabetic. Furthermore, the risk for hypoglycemia was greater with levofloxacin than with ciprofloxacin in non-diabetic. Thus, the risk for QTc prolongation and dysglycemia may appear with ciprofloxacin and levofloxacin administration. Keywords Ciprofloxacin, Levofloxacin, QTc-prolongation, Dysglycemia, Diabetic and Non-diabetic

Research Keywords

Comparative Study between Levofloxacin and Ciprofloxacin Regarding Their Risk on Dysglycemia and QT Interval Prolongation