Sulphonylurea Use in Diabetic Patients with Melioidosis: A Systematic Review

Salil Phadnis, Aishwarya Potdar, Ricardo Izurieta, Rahul Mhaskar 1,2,4University of South Florida Morsani College of Medicine, 12901 Bruce B Downs Blvd, Tampa, FL 33612. 3University of South Florida College of Public Health, 13201 Bruce B Downs Blvd, Tampa, FL 33612. DOI: https://doi.org/10.24321/2455.7048.201905 Introduction: Diabetes is a common comorbidity among patients with melioidosis. Melioidosis, is an infectious disease caused by Burkholderia pseudomallei. Current literature shows a conflicted view regarding the interactions between sulphonylurea medications and susceptibility and severity of B. pseudomallei infections. We conducted a systematic review to determine the effect of sulphonylurea medications on diabetic patients with melioidosis. Methods: We included randomized controlled trials, prospective and retrospective cohort studies that compared health outcomes among patients with diabetes and melioidosis who were taking sulphonylurea medication with those who were not. Our primary outcome was mortality, while secondary outcomes were development of complications such aswere hypotension, septicemia and respiratory distress. The methodological quality of included studies was investigated using the checklist by Downs and Black. Data were synthesized as risk ratios (RR) with 95% Confidence Intervals (CI) using random effects model. Results: We included three observational studies enrolling a total of 1,349 patients. We did not find evidence for a difference in mortality among patients suffering with melioidosis and diabetes receiving sulphonylurea medications compared with patients not receiving sulphonylurea medications (RR: 0.63 (95 % Cis 0.22-1.85) p=0.41). We also did not find any significant differences in hypotension (RR: 0.81 (95% Cis 0.25-2.62) p=0.73), respiratory distress (RR: 0.66 (95%Cis 0.34-1.29) p=0.23), or septicemia (RR: 0.80 (95% Cis 0.45-1.42) p=0.45) between the two groups. Conclusion: Given the high comorbidity rate of melioidosis and diabetes and the use of sulphonylureas as a first line treatment, we believe a far more thorough investigation of the effect of sulphonylurea medications on mortality and complications from melioidosis is warranted.