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Clindamycin: A Trojan Horse?

Clindamycin: A Trojan Horse? Abstract Clindamycin is a widely used antibiotic with a spectrum that includes Gram-positive bacteria, with the exception of enterococci, and Gram-negative anaerobes. Toxicities include clindamycin colitis, a pseudomembranous colitis that can be fatal. The colitis usually is related to dosage and duration of therapy, but can occur after ingestion of only several capsules. Once diarrhea develops in a patient taking clindamycin, the drug should be stopped and diagnostic measures to define colitis initiated. If colitis is present, it should be managed aggressively, probably with corticosteroids and with intensive supportive measures. References 1. Feigin R, Keeney RE, Nusrala J, et al: Efficacy of clindamycin therapy for otitis media . Arch Otolaryngol 98:27-31, 1973.Crossref 2. Pugliese WM, Mesches DN, Weinsum J, et al: Double blind study: Cleocin palmitate and erythromycin pediatric in otitis media in children . Curr Ther Res 14:31-34, 1972. 3. Takasu T, Baba S, Mamiya T, et al: Laboratory and clinical studies on clindamycin-2-palmitate in otorhinolaryngologic field . Jap J Antibiot 26:339-403, 1973.Crossref 4. Iwasawa T: Basic and clinical evaluation on clindamycin palmitate in otorhinolaryngological field infections . Jap J Antibiot 26:394-399, 1973.Crossref 5. Hunninghake DB, Banovetz JD: Systemic drugs , in Paparella MM, Shumrick DA (eds): Otolaryngology. Philadelphia, WB Saunders Co, 1973, pp 467-484. 6. Frederick J, Braude AL: Anaerobic infection of the paranasal sinuses . N Engl J Med 290:135-137, 1974.Crossref 7. Chronic sinusitis, editorial . Lancet 1:442, 1974. 8. Magerlein BJ, Birkenmeyer RD, Kagan F: Chemical modification of lincomycin . Antimicrob Agents Chemother , 1967, pp 727-736. 9. Geddes AM, Bridgwater FAJ, Williams DN, et al: Clinical and bacteriologic studies with clindamycin . Br Med J 2:703-704, 1970.Crossref 10. McGehee RF Jr, Smith CB, Wilcox C, et al: Comparative studies of antibacterial activity in vitro and absorption and excretion of lincomycin and clindamycin . Am J Med Sci 256:279-292, 1968.Crossref 11. Martin WJ, Gardner M, Washington JA: In vitro susceptibility of anaerobic bacteria isolated from clinical specimens . Antimicrob Agents Chemother 1:148-158, 1972.Crossref 12. Wagner JG, Novak E, Patel NC, et al: Absorption, excretion and half life of clindamycin in normal adult males . Am J Med Sci 256:25-37, 1968.Crossref 13. Stiver HG, Roland AR: Clinical and laboratory experience with clindamycin . Antimicrob Agents Chemother , 1971, pp 481-485. 14. Sanders E: Lincomycin: Fact, fancy, and future . Med Clin North Am 54:1295-1303, 1970. 15. Straw RN, Hook JB, Williamson HE, et al: Neuromuscular blocking properties of lincomycin . J Pharmaceut Sci 54:1814, 1965.Crossref 16. Tully TE, Feinberg SB: A reappearance of antibiotic induced pseudomembranous enterocolitis . Radiology 110:563-567, 1974.Crossref 17. Cohen LE, McNeill CJ, Wells RF: Clindamycin-associated colitis . JAMA 223:1379-1380, 1973.Crossref 18. Kaplan K, Weinstein L: Lincomycin . Med Clin North Am 15:131-139, 1968. 19. Manashil GB, Kern JA: Nonspecific colitis following oral lincomycin therapy . Am J Gastroenterol 60:394-399, 1973. 20. Temperley JM: Lincomycin, clindamycin and colitis . Lancet 1:221, 1974. 21. Wells RF, Cohen LE, McNeill CJ: Clindamycin and pseudomembranous colitis . Lancet 1:68, 1974. 22. Sisson JGP, Boulton-Jones JM, Peters DK: Clindamycin and pseudomembranous colitis . Lancet 1:172, 1974.Crossref 23. Stroehlein JR, Hoffman HN, Sedlock RE, et al: Lincomycin, clindamycin and colitis . Lancet 1:221, 1974.Crossref 24. Sneddon J: Lincomycin, clindamycin and colitis . Lancet 1:221, 1974. 25. Dyck WP, Viteri AL, Howard PH: Lincomycin, clindamycin and colitis . Lancet 1:272, 1974.Crossref 26. Stroehlein JR, Sedlock RE, Hoffman HN, et al: Clindamycin-associated colitis . Mayo Clin Proc 49:240-243, 1974. 27. Tedesco FJ, Stanley RJ, Alpers DH: Diagnostic features of clindamycin-associated pseudomembranous colitis . N Engl J Med 290:841-843, 1974.Crossref 28. Pittman FE, Pittman JC, Humphrey CD: Lincomycin and pseudomembranous colitis . Lancet 1:451, 1974.Crossref 29. Shimkin PM, Link RJ: Pseudomembranous colitis: A consideration in the barium enema differential diagnosis of acute generalized ulcerative colitis . Br J Radiol 46:437-439, 1973.Crossref 30. Wilkinson SP: Clindamycin and colitis . Lancet 1:415, 1974.Crossref 31. LeFrock JL, Klainer AS, Omar M, et al: The spectrum of clindamycin-lincomycin colitis , abstracted, in Fourteenth Interscience Conference on Antimicrobial Agents and Chemotherapy . Washington, DC, American Society for Microbiology, 1974. 32. Tedesco FJ, Halford MD, Alpers DH: Clindamycin-associated pseudomembranous colitis: A prospective study . Gastroenterology 66:788, 1974. 33. Omar M, Chen S, Anderson WE: Nonspecific colitis following oral clindamycin and lincomycin therapy . Gastroenterology 66:755, 1974. 34. Hirschfield JS: Clindamycin associated proctocolitis . Gastroenterology 66:844, 1974. 35. Kelly PC: Clindamycin vs. penicillin in pneumococcal pneumonia , abstracted, in Fourteenth Interscience Conference on Antimicrobial Agents and Chemotherapy . Washington, DC, American Society for Microbiology, 1974. 36. Hubbard WN Jr: Clindamycin and pseudomembranous colitis . Lancet 1:172, 1974. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Archives of Otolaryngology American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1975 American Medical Association. All Rights Reserved.
ISSN
0003-9977
DOI
10.1001/archotol.1975.00780330031008
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Abstract

Abstract Clindamycin is a widely used antibiotic with a spectrum that includes Gram-positive bacteria, with the exception of enterococci, and Gram-negative anaerobes. Toxicities include clindamycin colitis, a pseudomembranous colitis that can be fatal. The colitis usually is related to dosage and duration of therapy, but can occur after ingestion of only several capsules. Once diarrhea develops in a patient taking clindamycin, the drug should be stopped and diagnostic measures to define colitis initiated. If colitis is present, it should be managed aggressively, probably with corticosteroids and with intensive supportive measures. References 1. Feigin R, Keeney RE, Nusrala J, et al: Efficacy of clindamycin therapy for otitis media . Arch Otolaryngol 98:27-31, 1973.Crossref 2. Pugliese WM, Mesches DN, Weinsum J, et al: Double blind study: Cleocin palmitate and erythromycin pediatric in otitis media in children . Curr Ther Res 14:31-34, 1972. 3. Takasu T, Baba S, Mamiya T, et al: Laboratory and clinical studies on clindamycin-2-palmitate in otorhinolaryngologic field . Jap J Antibiot 26:339-403, 1973.Crossref 4. Iwasawa T: Basic and clinical evaluation on clindamycin palmitate in otorhinolaryngological field infections . Jap J Antibiot 26:394-399, 1973.Crossref 5. Hunninghake DB, Banovetz JD: Systemic drugs , in Paparella MM, Shumrick DA (eds): Otolaryngology. Philadelphia, WB Saunders Co, 1973, pp 467-484. 6. Frederick J, Braude AL: Anaerobic infection of the paranasal sinuses . N Engl J Med 290:135-137, 1974.Crossref 7. Chronic sinusitis, editorial . Lancet 1:442, 1974. 8. Magerlein BJ, Birkenmeyer RD, Kagan F: Chemical modification of lincomycin . Antimicrob Agents Chemother , 1967, pp 727-736. 9. Geddes AM, Bridgwater FAJ, Williams DN, et al: Clinical and bacteriologic studies with clindamycin . Br Med J 2:703-704, 1970.Crossref 10. McGehee RF Jr, Smith CB, Wilcox C, et al: Comparative studies of antibacterial activity in vitro and absorption and excretion of lincomycin and clindamycin . Am J Med Sci 256:279-292, 1968.Crossref 11. Martin WJ, Gardner M, Washington JA: In vitro susceptibility of anaerobic bacteria isolated from clinical specimens . Antimicrob Agents Chemother 1:148-158, 1972.Crossref 12. Wagner JG, Novak E, Patel NC, et al: Absorption, excretion and half life of clindamycin in normal adult males . Am J Med Sci 256:25-37, 1968.Crossref 13. Stiver HG, Roland AR: Clinical and laboratory experience with clindamycin . Antimicrob Agents Chemother , 1971, pp 481-485. 14. Sanders E: Lincomycin: Fact, fancy, and future . Med Clin North Am 54:1295-1303, 1970. 15. Straw RN, Hook JB, Williamson HE, et al: Neuromuscular blocking properties of lincomycin . J Pharmaceut Sci 54:1814, 1965.Crossref 16. Tully TE, Feinberg SB: A reappearance of antibiotic induced pseudomembranous enterocolitis . Radiology 110:563-567, 1974.Crossref 17. Cohen LE, McNeill CJ, Wells RF: Clindamycin-associated colitis . JAMA 223:1379-1380, 1973.Crossref 18. Kaplan K, Weinstein L: Lincomycin . Med Clin North Am 15:131-139, 1968. 19. Manashil GB, Kern JA: Nonspecific colitis following oral lincomycin therapy . Am J Gastroenterol 60:394-399, 1973. 20. Temperley JM: Lincomycin, clindamycin and colitis . Lancet 1:221, 1974. 21. Wells RF, Cohen LE, McNeill CJ: Clindamycin and pseudomembranous colitis . Lancet 1:68, 1974. 22. Sisson JGP, Boulton-Jones JM, Peters DK: Clindamycin and pseudomembranous colitis . Lancet 1:172, 1974.Crossref 23. Stroehlein JR, Hoffman HN, Sedlock RE, et al: Lincomycin, clindamycin and colitis . Lancet 1:221, 1974.Crossref 24. Sneddon J: Lincomycin, clindamycin and colitis . Lancet 1:221, 1974. 25. Dyck WP, Viteri AL, Howard PH: Lincomycin, clindamycin and colitis . Lancet 1:272, 1974.Crossref 26. Stroehlein JR, Sedlock RE, Hoffman HN, et al: Clindamycin-associated colitis . Mayo Clin Proc 49:240-243, 1974. 27. Tedesco FJ, Stanley RJ, Alpers DH: Diagnostic features of clindamycin-associated pseudomembranous colitis . N Engl J Med 290:841-843, 1974.Crossref 28. Pittman FE, Pittman JC, Humphrey CD: Lincomycin and pseudomembranous colitis . Lancet 1:451, 1974.Crossref 29. Shimkin PM, Link RJ: Pseudomembranous colitis: A consideration in the barium enema differential diagnosis of acute generalized ulcerative colitis . Br J Radiol 46:437-439, 1973.Crossref 30. Wilkinson SP: Clindamycin and colitis . Lancet 1:415, 1974.Crossref 31. LeFrock JL, Klainer AS, Omar M, et al: The spectrum of clindamycin-lincomycin colitis , abstracted, in Fourteenth Interscience Conference on Antimicrobial Agents and Chemotherapy . Washington, DC, American Society for Microbiology, 1974. 32. Tedesco FJ, Halford MD, Alpers DH: Clindamycin-associated pseudomembranous colitis: A prospective study . Gastroenterology 66:788, 1974. 33. Omar M, Chen S, Anderson WE: Nonspecific colitis following oral clindamycin and lincomycin therapy . Gastroenterology 66:755, 1974. 34. Hirschfield JS: Clindamycin associated proctocolitis . Gastroenterology 66:844, 1974. 35. Kelly PC: Clindamycin vs. penicillin in pneumococcal pneumonia , abstracted, in Fourteenth Interscience Conference on Antimicrobial Agents and Chemotherapy . Washington, DC, American Society for Microbiology, 1974. 36. Hubbard WN Jr: Clindamycin and pseudomembranous colitis . Lancet 1:172, 1974.

Journal

Archives of OtolaryngologyAmerican Medical Association

Published: Apr 1, 1975

References