Clindamycin, adverse reaction

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. 

The most prominent adverse reaction of the lincosamides is diarrhea, which varies from mildly loose bowel movements to life-threatening pseudomembranous colitis (see monograph on Beta-lactam antibiotics). Almost all antimicrobial drugs have been associated with severe diarrhea and colitis however, lincomycin and clindamycin have been particularly incriminated. The incidence of clindamycin-induced diarrhea in hospital is 23%. Diarrhea resolves promptly after withdrawal in most cases. It seems to be dose-related and may result from a direct action on the intestinal mucosa. Severe colitis due to C. difficile is not dose-related and occurs in 0.01-10% of recipients. Clustering of cases in time and place suggests the possibility of cross-infection. Even low doses of clindamycin, in some cases after topical administration, can cause marked alterations in several intestinal functions related to bowel flora (23). There was reduced susceptibility of C. difficile to clindamycin in 80% of French isolates in 1997 (24). Lincomycin was among the antibiotics that were most often associated with the development of antibiotic-associated diarrhea in a Turkish study of 154 patients other associated antibiotics were azithromycin and ampicillin (25). 

Lammintausta K, Tokola R, Kalimo K. Cutaneous adverse reactions to clindamycin results of skin tests and oral exposure. Br J Dermatol 2002 146(4) 643-8. 

Fisher AA (1983) Adverse reactions to topical clindamycin, erythromycin and tetracycline. Cutis 32 415, 419, 424, 428... 

Verify the patient s allergy history and the type of reaction experienced. Attempt to discern between true allergy and adverse event. (3-Lactam-allergic patients may receive clindamycin, vancomycin, or other antimicrobials. Crossreactivity between penicillin allergy and cephalosporins is low but cephalosporins should be avoided in patients with a history of anaphylaxis to penicillins. 

Caumes E, Boequet H, Guermonprez G, Rogeaux O, Bricaire F, Katlama C, Gentilini M. Adverse cutaneous reactions to pyrimethamine/sulfadiazine and pyrimetha-mine/clindamycin in patients with AIDS and toxoplasmic encephalitis. Clin Infect Dis 1995 21(3) 656-8. 

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). 

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