Clindamycin (Systemic)

Warning

Diarrhea and Colitis

• Clostridium difficile-associated diarrhea and colitis (CDAD; also known as antibiotic-associated diarrhea and colitis or pseudomembranous colitis) has been reported with nearly all anti-infectives, including clindamycin, and may range in severity from mild to life-threatening. Anti-infectives alter normal flora of the colon and may permit overgrowth of C. difficile.

• Because clindamycin has been associated with severe colitis (potentially fatal), it should be reserved for treatment of serious infections when less toxic anti-infectives are inappropriate. Do not use for nonbacterial infections. (See Uses.)

• C. difficile produces toxins A and B which contribute to development of CDAD. Hypertoxin-producing strains cause increased morbidity and mortality since they may be refractory to anti-infectives and may require colectomy. CDAD must be considered in all patients who present with diarrhea following anti-infective use. Careful medical history is necessary since CDAD has been reported to occur 2 months or longer after administration of anti-infectives.

• If CDAD is suspected or confirmed, ongoing anti-infective use not directed against C. difficile may need to be discontinued. Institute appropriate fluid and electrolyte management, protein supplementation, anti-infective treatment of C. difficile, and surgical evaluation as clinically indicated. (See Superinfection/Clostridium difficile-associated Diarrhea and Colitis [CDAD] under Cautions.)