Clindamycin adverse effects

Adverse effects are generally mild and include dryness, erythema, and itching.18 Although rare and seen most often with oral therapy, pseudomembranous colitis can occur with the use of topical clindamycin.19 As with any antibacterial agent, the possibility of resistance exists with the use of topical erythromycin. However, co-administration of erythromycin and benzoyl peroxide has been shown to decrease the incidence of resistance, as well as to improve symptoms of mild to moderate inflammatory acne.20... 

Clindamycin can be administered orally with a high bioavailability. Also formulations for intravenous administration exist. Protein binding is about 90%. It is distributed throughout the body except the CNS. It shows excellent penetration in bone and in empyema and abscesses. It is metabolized in the liver and excreted in the bile. The elimination half-life is about 3 h. Adverse effects include gastrointestinal distress, skin rashes and decreased liver function. Pseudomembranous colitis is relatively frequently seen due to resistance of Clostridium difficile. 

Common adverse effects are diarrhea, nausea, and skin rashes. Impaired liver function (with or without jaundice) and neutropenia sometimes occur. Severe diarrhea and enterocolitis have followed clindamycin administration. Administration of clindamycin is a risk factor for diarrhea and colitis due to Clostridium difficile. 

Adverse effects associated with lithium therapy include tremulousness, mental obtundation, cardiotoxicity, thyroid dysfunction, and leukocytosis (see Chapter 29 Antipsychotic Agents Lithium). Demeclocycline should be avoided in patients with liver disease (see Chapter 44 Chloramphenicol, Tetracyclines, Macrolides, Clindamycin, Streptogramins) and in children younger than 12 years. 

Common adverse effects are diarrhea, nausea, and skin rashes. Impaired liver function (with or without jaundice) and neutropenia sometimes occur. Severe diarrhea and enterocolitis have followed clindamycin administration. Antibiotic-associated colitis that has followed administration of clindamycin and other drugs is caused by toxigenic C difficile. This potentially fatal complication must be recognized promptly and treated with metronidazole, 500 mg orally or intravenously three times a day (the preferred therapy), or vancomycin, 125 mg orally four times a day (less desirable given the increasing prevalence of vancomycin-resistant enterococci). Relapse may occur. 

Doxycycline is commonly used for moderate to severe acne vulgaris. It is more effective and produces less resistance than tetracycline. The initial dose is 100 or 200 mg daily, followed by 50 mg daily as a maintenance dose after improvement is seen. Doxycycline maybe given with food, but it is more effective when taken 30 minutes before meals. / Minocycline is also commonly used for moderate to severe acne vulgaris. It is more effective than tetracycline. It is dosed similar to doxycycline (100 mg/day or 50 mg twice daily) and on an indefinite basis in selected patients. Minocycline has the most reported adverse effects of the tetracyclines, some of which may be serious. Trimethoprim-sulfamethoxazole (or trimethoprim alone) is a second-line oral agent that may be used for patients who do not tolerate tetracyclines and erythromycin or in cases of resistance to these antibiotics. The adult dose is usually 800 mg sulfamethoxazole and 160 mg trimethoprim twice daily. Clindamycin use is limited by diarrhea and the risk of pseudomembranous colitis. 

The most serious adverse effect is antibiotic-associated (pseudomembranous) colitis (see p. 210) usually due to opportunistic infection of the bowel with Clostridium difficile which produces an entero-toxin clindamycin should be stopped if any diarrhoea occurs. 

In a prospective, open, randomized trial clindamycin (600 mg tds) and quinine (650 mg tds) were compared with atovaquone (750 mg bd) plus azithromycin (500 mg on day 1 followed by 250 mg/day) in 58 patients with non-life-threatening babesiosis (3). Bacterial response was complete 3 months after the end of treatment. Adverse effects were reported by 72% of those who received clindamycin and quinine compared with 15% of those who received atovaquone and azithromycin. The most common adverse effects with clindamycin and quinine were tinnitus (39%), diarrhea (33%), and impaired hearing (28%) the symptoms had resolved in 73% of the patients assigned to clindamycin/quinine 3 months after the start of therapy and in 100% after 6 months. 

The direct toxicity of the lincosamides is relatively low (SED-7, 389) (6). The adverse effects of clindamycin may be well below 1%. In a tertiary care center, adverse reactions to chndamycin were reported in 0.47% of 3896 courses, and in half of these events an effect of other medications could not be excluded (7). However, chnda-mycin has not been given in as high doses as hncomycin. 

Pyrimethamine 50 mg/day has been nsed in combination with clindamycin for the treatment of Toxoplasma encephalitis in AIDS. Adverse effects were common (rash, diarrhea, nansea), bnt the incidence of hematological reactions was lower than with the combination of snlfadiazine and pyrimethamine (SEDA-16, 309). 

What are the common adverse effects associated with metronidazole and clindamycin ... 

The most notable adverse effect associated with clindamycin is antibiotic-associated colitis secondary to toxigenic Clostridium difficile. This organism usually overgrows in the Gl tract in the presence of antibiotics due to the inhibition of normal Gl flora. Ironically, the drug of choice for the treatment of antibiotic-associated colitis is metronidazole. Clindamycin also can cause diarrhea that is not related to C. difficile. 

The macrolides (e.g., erythromycin, clarithromycin, and azithromycin) are translocation inhibitors. Their spectrums of activity, clinical uses, biodisposition, and adverse effects are considered. Clindamycin is not a macrolide but shares many of their properties. 

Although their effectiveness is similar to the tetracyclines, the use of erythromycin and clindamycin is often limited due to their potential adverse outcomes. Erythromycin has treatment failure due to resistance and a high incidence of gastrointestinal intolerance, while clindamycin causes diarrhea and carries a risk of developing pseudomembranous colitis with long-term use.3,8... 

Lincomycin. Lincomycin (Lincocin, Lincorex) is similar in mechanism of action, clinical indications, and adverse side effects to clindamycin (see previously in this section). 

In 233 women with bacterial vaginosis, a 3-day regimen of clindamycin (intravaginal ovules, 100 mg/day) was as effective as a 7-day regimen of oral metronidazole (500 mg bd) and better tolerated (4). Treatment-related adverse events were reported more often with metronidazole, and systemic symptoms, such as nausea and taste disturbance, accounted for most of the difference between the groups. 

Units/30 d cum dose Caution [C, ] w/ neurologic Dz Contra Hypersensitivity to components, Infxn at inj site Disp Inj SE Anaphylaxis, erytliema muldforme, dysphagia, dyspnea, syncope, HA, NAG Interactions T Effects W7 aminoglycosides, clindamycin, lincomycin, MgS04, neuromuscular blockei S, quinidine EMS Generally, adverse events (anaphylaxis, CV effects) occur w/in a wk of Botox inj, may cause inj site pain there have been reports of paralysis cUstant to primary inj site OD Muscle paralysis and weakness, OD effects may have a delayed onset... 

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