Diarrhoea clindamycin

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. 

Colitis may result from various gut infections, especially amoebic colitis. Clindamycin, vancon cin or metronidazole may be used in treatment. The diarrhoea of colitis states may be treated with normal ANTIDIARRHOEALS, e.g. the opioids codeine, morphine, diphenoxylate and loperamide. The colic may respond to ANTISPASMODICS, e.g. the anticholinergics atropine, hyoscine, dicyclomine, propantheline. Meheverine is a direct-acting antispasmodic effective in some types of gut colic. 

Kaolin-pectin can markedly reduce the absorption of lincomycin. This can be avoided by giving the lincomycin two hours after the kaolin. The rate but not the extent of clindamycin absorption is altered by kaolin-pectin. However, note that diarrhoea is often an indication that these antibacterials should be withdrawn. 

However, note that marked diarrhoea is an indication that lincomycin or clindamycin should be stopped immediately. This is because it may be a sign of pseudomembranous colitis, which can be fatal. 

In a meta-analysis of the effectiveness of clindamycin plus quinine for the treatment of falciparum malaria, two patients reported watery diarrhoea secondary to C. difficile [87 ]. 

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. 

The clinical presentation of colitis associated with lincomycin or clindamycin therapy may vary from mild diarrhoea to severe persistent disease. Apparently, the diarrhoea and colitis due to the lincomycins do not constitute a uniform clinical entity. 

Orthopaedic hospital patients often need lincomycin or clindamycin therapy an analysis of 1158 of these patients treated with antibiotics revealed 58 cases of diarrhoea, many of them in association with lincomycin, as well as several cases during treatment with other antibiotics such as the penicillins and tetracyclines. Since in this study there were only 3 documented cases of lincomycin-associated colitis, the conclusion was drawn that continued use of lincomycin or clindamycin appears to be fully justified by the low incidence of colitis (49 -, 50 ). In another study there have been 3 severe cases out of 144 patients receiving lincomycins as a prophylactic measure for total hip replacements. It is concluded in this study that as these drugs may produce a lethal condition, they should be used with appropriate discretion, especially in the elderly female who appears to be most at risk (48 ). 

Lincomycin 4.280) from Streptomyces lincolnensisy and its derivative clindamycin (4,28b)y are given orally for resistant strains of Gram-positive cocci, and also for intestinal anaerobes, such as Bacteroides which builds up in postoperative blind-loops. It inhibits peptidyl transferase on the SoS ribosomal subunit, much as chloramphenicol does (Smithers, Bennett, and Struck, 1969). The principal side-effects are diarrhoea, and even colitis. 

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