From the FDA Drug Label
Clindamycin is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Clindamycin is also indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci, and staphylococci Its use should be reserved for penicillin-allergic patients or other patients for whom, in the judgment of the physician, a penicillin is inappropriate. Because of the risk of colitis, as described in the BOXED WARNING, before selecting clindamycin, the physician should consider the nature of the infection and the suitability of less toxic alternatives (e.g., erythromycin) Bacteriologic studies should be performed to determine the causative organisms and their susceptibility to clindamycin To reduce the development of drug-resistant bacteria and maintain the effectiveness of clindamycin hydrochloride and other antibacterial drugs, clindamycin hydrochloride should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria
For a patient with phlebitis who is allergic to Bactrim and amoxicillin, clindamycin may be considered as an alternative antibiotic option, given its indication for serious skin and soft tissue infections, including those caused by staphylococci and streptococci 1. However, it is crucial to perform bacteriologic studies to determine the causative organisms and their susceptibility to clindamycin before initiating treatment. Additionally, the physician should consider the nature of the infection and the suitability of less toxic alternatives.
- Key considerations:
- Patient's allergy to Bactrim and amoxicillin
- Clindamycin's indication for serious skin and soft tissue infections
- Need for bacteriologic studies to determine susceptibility
- Potential risk of colitis associated with clindamycin use
From the Research
For a patient with phlebitis who is allergic to both Bactrim (sulfamethoxazole-trimethoprim) and amoxicillin, I would recommend clindamycin as the primary antibiotic choice, as supported by 2, which highlights its importance in treating less serious methicillin-susceptible S. aureus (MSSA) infections, particularly in patients with penicillin hypersensitivity. The typical dosage is 300-450 mg orally every 6-8 hours for 7-10 days, depending on severity. Alternatively, doxycycline 100 mg twice daily for 7-10 days could be used, considering its bacteriostatic activity against clindamycin resistance-inducible strains of CA-MRSA, as noted in 3. If the phlebitis is severe or associated with systemic symptoms, consider intravenous vancomycin, particularly if MRSA is suspected, given its effectiveness against serious MRSA infections, as discussed in 4 and 5. Before starting treatment, it's essential to determine if the phlebitis is infectious or purely inflammatory, as non-infectious phlebitis may not require antibiotics at all. The choice between these options should be guided by local resistance patterns, the patient's renal and hepatic function, and any other medications they're taking, taking into account the potential for cross-reactivity with cephalosporins in patients allergic to penicillin, as explored in 6. These recommendations target the most common causative organisms in infectious phlebitis, primarily Staphylococcus aureus and streptococci, while avoiding beta-lactams and sulfonamides due to the patient's allergies.