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warnings
WARNINGS: Orally and parenterally administered clindamycin has been associated with severe colitis which may end fatally. Use of the topical formulation results in absorption of the antibiotic from the skin surface. Diarrhea, bloody diarrhea, and colitis (including pseudomembranous colitis) have been reported with the use of topical and systemic clindamycin. Symptoms can occur after a few days, weeks or months following initiation of clindamycin therapy. They have also been observed to begin up to several weeks after cessation of therapy with clindamycin. Studies indicate a toxin(s) produced by Clostridium difficile is one primary cause of antibiotic-associated colitis. The colitis is usually characterized by severe persistent diarrhea and severe abdominal cramps and may be associated with the passage of blood and mucus. Endoscopic examination may reveal pseudomembranous colitis. When significant diarrhea occurs, the drug should be discontinued. Large bowel endoscopy should be considered in cases of severe diarrhea. Antiperistaltic agents such as opiates and diphenoxylate with atropine may prolong and/or worsen the condition. Vancomycin has been found to be effective in the treatment of antibiotic-associated pseudomembranous colitis produced by Clostridium difficile . The usual adult dosage is 500 mg to 2 grams of vancomycin orally per day in three to four divided doses administered for 7 to 10 days. Mild cases of colitis may respond to discontinuance of clindamycin. Moderate to severe cases should be managed promptly with fluid, electrolyte, and protein supplementation as indicated. Cholestyramine and colestipol resins have been shown to bind the toxin in vitro . If both a resin and vancomycin are to be administered concurrently, it may be advisable to separate the time of administration of each drug. Systemic corticoids and corticoid retention enemas may help relieve the colitis. Other causes of colitis should also be considered. A careful inquiry should be made concerning previous sensitivities to drugs and other allergens.
ADVERSE REACTIONS: Skin dryness is the most common adverse reaction seen with the solution. Clindamycin has been associated with severe colitis which may end fatally (see WARNINGS ). Cases of diarrhea, bloody diarrhea and colitis (including pseudomembranous colitis) have been reported as adverse reactions in patients treated with topical formulations of clindamycin. Other effects which have been reported in association with the use of topical formulations of clindamycin include: Abdominal pain Irritation Contact dermatitis Oily Skin Gastrointestinal disturbances Sensitization Gram-negative folliculitis Stinging of the eye