Clindamycin diarrhea with

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... 

Diarrhea If significant diarrhea occurs during therapy with lincomycin or clindamycin, discontinue therapy. 

Elderly Older patients with associated severe illness may not tolerate diarrhea well. Pregnancy Category B (clindamycin). 

Nausea vomiting diarrhea (clindamycin 3.4% to 30%) pseudomembranous colitis (clindamycin 0.01% to 10% 3 to 4 times more frequent with oral administration) neutropenia (sometimes transient) leukopenia agranulocytosis thrombocytopenic purpura skin rashes, urticaria, erythema multiforme anaphylaxis jaundice liver function test abnormalities (serum transaminase elevations). 

Clindamycin shows in vitro activity against Pro-pionibacterium acnes and topically applied clindamycin is effective for the treatment of acne. Approximately 10% of an applied dose is absorbed. In spite of this absorption pseudo-membranous colitis with bloody diarrhea is seldom seen. 

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. 

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. 

Clindamycin has in vitro activity against Propionibacterium acnes this has been postulated as the mechanism of its beneficial effect in acne therapy. Approximately 10% of an applied dose is absorbed, and rare cases of bloody diarrhea and pseudomembranous colitis have been reported following topical application. The hydroalcoholic vehicle may cause drying and irritation of the skin, with complaints of burning and stinging. The water-based gel and lotion formulations are well tolerated and less likely to cause irritation. Allergic contact dermatitis is uncommon. Clindamycin is also available in a fixed-combination topical gel with benzoyl peroxide (BenzaClin). 

Clindamycin Solutions of clindamycin salts are incompatible with alkaline doses or other drugs that are unstable at low pH. Clindamycin phosphate is not compatible with some rubber packing materials. pH-dependent degradation was reported with clindamycin, and phosphate salt was found to be most stable. Therapy with clindamycin should be stopped if diarrhea or colitis are found. The patient should be treated with other antibiotics. Clindamycin potentiates the actions of neuromuscular-blocking agents, opioids, and the antagonistic action of parasympathomimetics. 

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. 

In a retrospective cohort study of patients hospitalized in a Canadian teaching hospital during January 2003 to June 2004 there were 7421 episodes of care in 5619 patients, who were observed until they developed Clostridium difficile-s s,ocmt d diarrhea, or died, or for 60 days after discharge (107). Fluoroquinolones were the antibiotics that were most strongly associated with Clostridium di aJe-associated diarrhea (adjusted hazard ratio = 3.44 95% Cl = 2.65, 4.47). Almost one-quarter of all in-patients received quinolones, for which the population-attributable fraction of Clostridium difficile-as,s,odsAed diarrhea was 36%. All three generations of cephalosporins, macrolides, clindamycin, and intravenous beta-lactam/beta-lactamase inhibitors were intermediate-risk antibiotics, with similar hazard ratios (1.56-1.89). 

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 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). 

In a one-year retrospective study at a tertiary hospital in Spain, 17% of 148 episodes of diarrhea associated with C. difficile developed after therapy with clindamycin (26). The possible association of toxin-positive C. difficile-induced colitis and the use of clindamycin phosphate vaginal cream for bacterial vaginosis has been reported in a 25-year-old white woman postpartum (27). 

In a prospective study patients treated with antibiotics, including clindamycin, for 3 days had a significantly lower frequency of antibiotic-associated diarrhea than those treated for longer periods (28). 

Restricting the use of clindamycin has been successful in terminating outbreaks of C. difficile diarrhea associated with its use (29). Between 1989 and 1992, outbreaks of diarrhea due to a clindamycin-resistant strain of C. difficile occurred in different parts of the USA. Resistance was mediated by the ermB gene. The use of chndamycin was a specific risk factor for diarrhea due to this strain (30). 

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). 

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. 

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 ... 

B Antibiotic-associated diarrhea due to C difficile can occur with any antibiotic, but particularly with clindamycin. With the administration of antibiotics, normal Gl flora is inhibited, which allows C. difficile to overgrow. Metronidazole is the treatment of choice for C. difficile infections. Although oral vancomycin also has activity against C. difficile, it is typically used as second-line treatment... 

Agents in this group, especially clindamycin and lincomycin, are associated with bacterial overgrowth in the colon. Serious and potentially fatal diarrhea may occur in humans, rabbits, ruminants and horses. Foals appear to be less susceptible to erythromycin-induced diarrhea than adult horses and the ethylsuccinate formulation seems to be the least likely to induce diarrhea. 

Topical clindamycin inhibits P. acnes and provides comedolytic as well as anti-inflammatory activity. It is available in gel, lotion, solution, and disposable pad formulations, and is usually applied twice daily. Combination with BPO increases efficacy. Though rare, diarrhea and pseudomembranous colitis may occur secondary to topical clindamycin. ... 

The reported incidence of diarrhea associated with the administration of clindamycin ranges from 2 to 20%. A number of patients (variously reported as 0.01 to 10%) have developed pseudomembranous colitis caused by the toxin from the organism C. difficile. This colitis is characterized by abdominal pain, diarrhea, fever, and mucus and blood in the stools. Proctoscopic examination reveals white-to-yellow... 

Although many infections with gram-positive cocci respond to clindamycin, the high incidence of diarrhea and the occurrence of pseudomembranous colitis limit its use to infections where it is clearly superior to other agents. Clindamycin is particularly valuable for anaerobic infections, especially those due to B. fragiUs. Clindamycin is not predictably useful for the treatment of bacterial brain abscesses metronidazole, in combination with penicillin or a third-generation cephalosporin, is preferred. 

The safety of continuous intravenous infusion of clindamycin has been evaluated retrospectively in 70 patients with bone and joint infections who were treated with a median daily dose of 2400 mg for a median of 40 days [67 ]. Three developed moderate adverse events an allergic rash, diarrhea not related to Clostridium difficile, and a cytolytic hepatitis, all of which resolved on drag withdrawal. Continuous intravenous infusion of clindamycin may be suitable for parenteral treatment in out-patients. 

Trimethoprim-sulfamethoxazole (TMP-SMX) (20 mg/kg/day of trimethoprim) is the treatment of choice for P. carinii pneumonia (PCP). Oral therapy with TMP-SMX is reserved for children with mild PCP who do not have malabsorption or diarrhea. Intravenous pentamidine (4 mg/kg/day, given once a day) can be given to children with PCP who are intolerant of TMP-SMX or who have not responded after 5 days of TMP-SMX therapy. Other treatment regimens that may be considered for patients who are intolerant of or fail TMP-SMX and pentimidine are (1) atovaquone (40 mg/kg/ day, in two divided doses) for mild/moderate PCP only (2) dapsone with trimethoprim (3) trimetrexate with leucovorin and (4) clindamycin and primaquine. These alternate treatments have limited experience in pediatric patients. 

---