A 65-year-old woman with type 2 diabetes is started on canagliflozin. She returns after 3 weeks with dysuria and vulvar itching. Urine culture grows Candida species. The mechanism of increased genital infections with SGLT2 inhibitors is:
- A Immunosuppression due to drug-induced neutropenia
- B Increased glucose concentration in urine promoting microbial growth ✓
- C Direct cytotoxic effect on urothelial cells
- D Altered vaginal pH due to drug excretion
Correct answer: B. Increased glucose concentration in urine promoting microbial growth
Explanation
SGLT2 inhibitors block glucose reabsorption in the proximal tubule, causing glucosuria. The glucose in urine promotes bacterial and fungal growth, leading to increased genital and urinary tract infections. There is no neutropenia or direct urothelial toxicity. Vaginal pH change is not the primary mechanism.
Reference: Katzung's Basic and Clinical Pharmacology, 15th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
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