From the Guidelines
The rare but serious side effect of topical clindamycin is pseudomembranous colitis (also called Clostridioides difficile-associated diarrhea or C. diff infection). Although this condition is more commonly associated with oral or intravenous clindamycin, it can occur with topical formulations as well due to systemic absorption of the antibiotic through the skin. Pseudomembranous colitis develops when clindamycin disrupts the normal gut flora, allowing overgrowth of C. difficile bacteria, which produce toxins that damage the intestinal lining. Patients should discontinue topical clindamycin and seek immediate medical attention if they develop severe, persistent, or bloody diarrhea during or after treatment. This side effect can occur during treatment or even weeks after discontinuation. The risk is higher in elderly patients, those with a history of gastrointestinal disease, and patients with compromised immune systems. While this side effect is rare with topical application, healthcare providers should still inform patients about this possibility when prescribing topical clindamycin, as supported by the guidelines of care for the management of acne vulgaris 1 and the update of the WSES guidelines for management of Clostridioides (Clostridium) difficile infection in surgical patients 1.
Some key points to consider when prescribing topical clindamycin include:
- The risk of pseudomembranous colitis is increased with antibiotic exposure, including topical clindamycin 1
- Patients should be informed about the possibility of pseudomembranous colitis and seek medical attention if they develop severe diarrhea during or after treatment
- The risk of pseudomembranous colitis is higher in certain patient populations, such as the elderly and those with a history of gastrointestinal disease
- Topical clindamycin is generally well-tolerated, but patients should be monitored for adverse effects, including dermatitis, folliculitis, and photosensitivity reaction 1
In terms of management, patients with pseudomembranous colitis should discontinue topical clindamycin and receive prompt medical attention. The treatment of pseudomembranous colitis typically involves the use of antibiotics, such as vancomycin or fidaxomicin, and supportive care, including fluid and electrolyte replacement. In severe cases, hospitalization may be necessary to manage complications, such as dehydration, electrolyte imbalances, and bowel perforation.
From the FDA Drug Label
Orally and parenterally administered clindamycin has been associated with severe colitis which may result in patient death... Diarrhea, bloody diarrhea, and colitis (including pseudomembranous colitis) have been reported with the use of topical and systemic clindamycin Cases of diarrhea, bloody diarrhea and colitis (including pseudomembranous colitis) have been reported as adverse reactions in patients treated with oral and parenteral formulations of clindamycin and rarely with topical clindamycin
The rare but serious side effect of topical clindamycin is pseudomembranous colitis.
- This condition is characterized by severe persistent diarrhea and severe abdominal cramps, and may be associated with the passage of blood and mucus.
- It may occur up to several weeks after cessation of therapy with clindamycin 2, 2.
From the Research
Rare but Serious Side Effects of Topical Clindamycin
- The rare but serious side effect of topical clindamycin is pseudomembranous colitis, as evidenced by several studies 3, 4, 5, 6, 7.
Characteristics of Pseudomembranous Colitis
- Pseudomembranous colitis is characterized by abdominal cramping, diarrhea, and the presence of a toxin produced by Clostridium difficile in the stool 3, 4, 5.
- The condition can be severe and potentially life-threatening, with complications such as toxic megacolon and acute peritonitis 6.
Association with Clindamycin
- Clindamycin has been associated with pseudomembranous colitis, even when used topically 3.
- The exact mechanism of this association is unknown, but it is thought to be related to the alteration of the enteric flora, allowing Clostridium difficile to proliferate and produce toxins 6.