Side Effects of Clindamycin
Clindamycin can cause severe colitis, which may be fatal, with symptoms including diarrhea, bloody diarrhea, and pseudomembranous colitis being the most serious adverse effects. 1
Common Side Effects
Gastrointestinal Effects
- Severe colitis: The most serious adverse effect, including pseudomembranous colitis
- Diarrhea: Occurs in approximately 13.5-29.8% of patients 2, 3
- Abdominal pain
- Pseudomembranous colitis: Reported in 1.9-2.5% of patients 2, 3
Recent evidence shows that nearly 98% of patients experience some gastrointestinal side effects with oral clindamycin, with higher doses (600 mg) associated with more severe and prolonged symptoms compared to lower doses (300 mg) 4.
Dermatological Effects
- Dermatitis
- Folliculitis
- Photosensitivity reactions
- Pruritus (itching)
- Skin dryness
- Peeling
- Maculopapular exanthema: Can present with preferential involvement of striae distensae 5
Risk Factors for Increased Side Effects
Several factors are associated with increased risk of developing side effects, particularly gastrointestinal symptoms:
- Age: Older patients experience more severe side effects 3
- Route of administration: Parenteral administration may increase diarrhea risk 3
- Higher dosage: 600 mg doses cause more prolonged symptoms than 300 mg doses 4
- Serious underlying illness
- Abdominal or pelvic sepsis 2
Special Considerations
Contraindications
Clindamycin is contraindicated in patients with:
- History of hypersensitivity to clindamycin or lincomycin
- History of regional enteritis
- History of ulcerative colitis
- History of antibiotic-associated colitis 6
Drug Interactions
- Should not be used with erythromycin-containing products
- Can enhance the action of neuromuscular blocking agents
- Caution with concomitant topical medications 6
Monitoring and Management
When to Discontinue
- Promptly discontinue if diarrhea develops
- Provide fluid support for self-limited cases 3
Duration of Side Effects
- Diarrhea typically lasts 3-5 days (dose-dependent)
- Stomach pain may persist for 4-7 days (dose-dependent) 4
Clinical Pearls
- Early recognition is key: Monitor for diarrhea and discontinue promptly if it develops
- Dose matters: Lower doses (300 mg) cause fewer and less severe side effects than higher doses (600 mg)
- Almost all patients experience some side effects with oral clindamycin, so consider this when prescribing
- Reserve clindamycin for serious anaerobic infections when other antibiotics cannot be used 7
- Topical formulations have lower risk of systemic side effects but can still cause local irritation
The high incidence of gastrointestinal side effects with clindamycin warrants careful consideration before prescribing, especially when alternatives are available.