Clindamycin allergy

Clindamycin allergy has recently been described in an acne patient, who used a 1 % clindamycin hydrochloride alcohol solution for 2 weeks before face itching occurred (CosKEY 1978 b). Many patients receiving topical acne antimicrobial therapy develop dermatitis it is not clear how much represents irritation rather than allergy. 

Broad-spectrum antibiotic cefotaxime or ceftriaxone (clindamycin for cephalosporin allergy) vancomycin for staphylococcal and resistant pneumococcal organisms... 

Broad intravenous antibiotic coverage for the encapsulated organisms can include ceftriaxone or cefotaxime. For patients with true cephalosporin allergy, clindamycin may be used. If staphylococcal infection is suspected owing to previous history or the patient appears acutely ill, vancomycin should be initiated. Macrolide antibiotics, such as erythromycin and azithromycin, may be initiated if Mycoplasma pneumonia is suspected. While the patient is receiving broad-spectrum antibiotics, their regular use of penicillin for prophylaxis can be suspended. Fever should be controlled with acetaminophen or ibuprofen. Because of the risk of dehydration during infection with fever, increased fluid may be needed.6,27... 

As such, patients with penicillin allergies should be treated with a first-generation cephalosporin (if non-type I allergy), a macrolide/azalide, or clindamycin. Recurrent infections caused by reinfection, poor adherence to therapy, or true penicillin failure can be treated with amoxicillin-clavulanate, clindamycin, or penicillin G benzathine.45... 

In uncomplicated cases, prompt oral antibiotic therapy with amoxicillin or a first-generation cephalosporin halts the progression of lymphangitis. Clindamycin may be used if the patient has a significant (1-lactam allergy. Intravenous antibiotics (penicillinase-stable penicillins, first-generation cephalosporins,... 

The most effective agent for the treatment (and prophylaxis) of human and animal bite-wound infections is amoxicillin-clavulanate. Alternatives for patients with significant penicillin allergies include either a fluoroquinolone or TMP-SMX in combination with clindamycin. Doxycycline also may be prescribed. The durations of prophylaxis and treatment generally are 3 to 5 and 10 to 14 days, respectively.3... 

Cefazolin or cefuroxime are appropriate for prophylaxis in cardiothoracic and vascular surgeries. In the case of 3-lactam allergy, vancomycin or clindamycin are advised. Debate exists on the duration of antimicrobial prophylaxis. The National Surgical Infection Prevention Project cites data that extending prophylaxis beyond 24 hours does not decrease SSI rates and may increase bacterial resistance.1 American Society of Health-System Pharmacists guidelines from 1999 allow for the continuation of prophylaxis for up to 72 hours.22 Duration of therapy should be based on patient factors and risk of development of an SSI. SSIs are rare after cardiothoracic operations, but the potentially devastating consequences lead some clinicians to support longer periods of prophylaxis. 

The goal of antimicrobial prophylaxis in dental procedures is to prevent endocarditis. According to American Heart Association guidelines, at-risk individuals should receive 2 g of amoxicillin 1 hour prior to the procedure.23 Patients with a (5-lactam allergy may receive clindamycin 600 mg 1 hour prior to the procedure. Interested readers should refer to the American Heart Association guidelines for a complete discussion on risk stratification and recommendations. 

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. 

Serious infections should be treated intravenously with a penicillinase-resistant penicillin (nafcillin) or first-generation cephalosporin (cefazolin). Patients with penicillin allergies should be treated with vancomycin or clindamycin. 

Hypersensitivity reactions Use with caution in patients with a history of asthma or significant allergies. Refer to Management of Acute Hypersensitivity Reactions. Renal function impairment Cautiously give clindamycin to patients with severe renal or hepatic disease accompanied by severe metabolic aberrations. Use of... 

Contraindications Historyof antibacterial-associated colitis, regional enteritis, orul-cerative colitis hypersensitivity to clindamycin or lincomycin known allergy to tartra-zine dye... 

Mazur N, Greenberger PA, Regalado J. Clindamycin hypersensitivity appears to be rare. Ann Allergy Asthma Immunol 1999 82(5) 443-5. 

Case Conclusion Because the etiology of intra-abdominal infections is most often polymicrobial (gram-negative and anaerobic bacteria) and the patient has an allergy to penicillin, FD can be treated empirically with tobramycin and metronidazole or clindamycin. This regimen provides adequate empiric coverage of the most noteworthy pathogens associated with intra-abdominal infections. 

MB is a 39-year-old man who is diagnosed with cellulitis. Since he has an allergy to penicillins (urticarial rash), he is prescribed clindamycin for 10 days. Nine days into therapy he develops diarrhea. A stool culture detects C difTidk toxin. What is the best treatment for MB s diarrhea ... 

In peniciUin-aUergic patients, oral or parenteral clindamycin may be used. Alternatively, a first-generation cephalosporin, such as cefazohn (1-2 g intravenously every 8 hours), may be used cautiously for patients who have not experienced immediate or anaphylactic penicitlin reactions and are negative for a penicillin skin test. In mild cases in which an oral cephalosporin can be nsed, ce-fadroxU 500 mg twice daily or cephalexin 250-500 mg four times daily is recommended. Other oral cephalosporins, such as cefaclor, cefprozil, and cefpodoxime proxetil, are also effective in the treatment of ceUnhtis bnt are considerably more expensive. In severe cases in which cephalosporins cannot be used because of documented methicihin-resistant staphylococci or severe /3-lactam allergies, vancomycin shonld be administered. 

Hemagglutinating antibodies to both lincomycin and clindamycin have been found in the serum of a patient with anaphylactic shock following oral administration of clindamycin (Lochmann et al. 1977). In the absence of other satisfactory methods, this assay seems to be useful in establishing the diagnosis of an allergic reaction to the lincomycins. The measured antibodies, however, may not be of importance in the genesis of the observed allergy. 

The lincomycins, ie. lincomycin and its semisynthetic analogue clindamycin (7-chlorohncomycin), used to be fairly popular antibiotics as alternative drugs for penicillin, especially in known or presumed cases of penicillin allergy or resistance to this antibiotic. Since it has been observed that oral or parenteral administration of both lincomycin and clindamycin may cause fulminating diarrhoea as a sequel to pseudomembranous colitis, their popularity has considerably decreased. 

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