Use of Clindamycin in Pediatric Infections

Marcia L. Buck, Pharm.D., FCCP

Disclosures

Pediatr Pharm. 2008;14(2) 

In This Article

Adverse Effects

Clindamycin is generally well tolerated. Common adverse effects reported with its use include anorexia, abdominal pain, nausea, vomiting, and diarrhea. Hypersensitivity reactions, including rash and urticaria, have been reported, as well as rare cases of erythema multiforme, Stevens-Johnson syndrome, and anaphylactoid reactions. Clindamycin should be used with caution in patients with an underlying gastrointestinal disease or infection and in patients with atopy.[1,2,3]

Rapid IV administration of clindamycin has been associated with hypotension, arrhythmias, and cardiac arrest. Other rare adverse effects associated with clindamycin include: esophagitis, jaundice and abnormal hepatic transaminases, azotemia, oliguria, proteinuria, transient leukopenia and eosinophilia, thrombocytopenia, agranulocytosis, and polyarthritis.[2,3] Many of these rare adverse effects have been identified through case reports and a direct causal relationship with clindamycin has not been established.

As with other antibiotics, clindamycin use results in substantial changes in bowel microflora, and may result in the development of Clostridium difficile associated diarrhea (CDAD). Clindamycin, cephalosporins, ampicillin, and amoxicillin are the agents most frequently linked with CDAD. Because of the risk for severe colitis and reports of fatalities in patients with CDAD, prolonged systemic use of clindamycin should be reserved for severe infections when there are no alternative agents.[2,3]

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