Off-label use of otic ciprofloxacin/dexamethasone led to hyperglycemia in infant: Case report

USA: A recent case report, published in the Annals of Otology, Rhinology & Laryngology, describes the case of hyperglycemia in a child with Type 1 diabetes following the off-label use of otic ciprofloxacin/dexamethasone drops in the nasal passage. The article also reviews previous reports of adverse endocrine effects from intranasal corticosteroids in pediatric patients.

Tom Ben-Dov, New York University School of Medicine, New York, NY, USA, and colleagues describe the clinical case and conducted a literature review of MEDLINE (PubMed) and EMBASE. 

The case in question is of a 9-month-old female with a history of Type 1 diabetes who underwent unilateral choanal atresia repair and was started on 1 week of ciprofloxacin 0.3%/dexamethasone 0.1% otic drops twice a day for choanal obstruction with granulation tissue. 

While the patient's airway patency improved, average daily blood glucose increases by 40 to 50 points were noted on the patient's continuous glucose monitor. The hyperglycemia resolved within 2 days after switching to mometasone furoate 0.05% spray. 

They also reviewed 21 pediatric otolaryngology cases of iatrogenic Cushing's syndrome associated with on- and off-label use of topical steroid suspensions in the airway. Patients ranged from 3 months to 16 years in age and used doses of 50 μg/day to 2 mg/day.

"To the best of our knowledge, this is the first reported pediatric case of increased blood glucose levels associated with intranasal steroid suspensions," the researcher's team wrote in their study. 

They suggest that when prescribing these medications for off-label use in infants and small children, particularly among patients with underlying endocrine disorders such as diabetes, counseling families on precise dose administration and potential endocrine disturbances is critical. 

Reference:

Ben-Dov T, Yang J, April MM. Off-Label Use of Ciprofloxacin/Dexamethasone Drops in the Pediatric Upper Airway: Case Presentation and Review of Adverse Effects. Annals of Otology, Rhinology & Laryngology. June 2022. doi:10.1177/00034894221104461