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. 2025 Jul 25.
doi: 10.1002/cpt.70016. Online ahead of print.

Risk of Infections with SGLT2 Inhibitors Versus DPP4 Inhibitors: A Population-Based Cohort Study Using Antibiotic Dispensing Data

Maria J Alfonso Arvez  1 , George S Q Tan  1 , Sam Wade  1 , Zanfina Ademi  1 , Jenni Ilomäki  1 , J Simon Bell  1
Affiliations

Risk of Infections with SGLT2 Inhibitors Versus DPP4 Inhibitors: A Population-Based Cohort Study Using Antibiotic Dispensing Data

Maria J Alfonso Arvez et al. Clin Pharmacol Ther. .

Abstract

This study compared the number and cumulative dose of antibiotic dispensings among new users of sodium-glucose cotransporter-2 (SGLT2) inhibitors and dipeptidyl peptidase-4 (DPP4) inhibitors following hospital discharge in individuals with type 2 diabetes. A retrospective cohort study was conducted using data from public and private hospitals in Victoria, Australia. Antibiotic dispensings were assessed over 12 months among new users of these medicines. Negative binomial regression with inverse probability of treatment weighting was applied to estimate weighted incidence rate ratios and confidence intervals for the total number of antibiotic dispensings and cumulative defined daily doses, stratified by antibiotic class. A total of 58.3% of SGLT2 inhibitor users (9,162 individuals) and 61.4% of DPP4 inhibitor users (16,589 individuals) received antibiotics. Initiators of SGLT2 inhibitors had a lower number of overall antibiotic dispensings compared with initiators of DPP4 inhibitors (weighted incidence rate ratio 0.88, 95% confidence interval 0.85 to 0.90), a pattern that was consistent across antibiotic classes. SGLT2 inhibitor initiators also had lower cumulative defined daily doses overall (weighted incidence rate ratio 0.89, 95% confidence interval 0.86 to 0.93), with significantly lower doses for penicillins, sulphonamides, and quinolones. These findings suggest that the initiation of SGLT2 inhibitors was associated with lower antibiotic use in terms of both the number of dispensings and cumulative dose, indicating potentially lower rates of infections among individuals with type 2 diabetes.

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