From the FDA Drug Label
Clindamycin is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria. Its use should be reserved for penicillin-allergic patients or other patients for whom, in the judgment of the physician, a penicillin is inappropriate. intra-abdominal infections such as peritonitis and intra-abdominal abscess (typically resulting from anaerobic organisms resident in the normal gastrointestinal tract);
Clindamycin is appropriate for treatment of diverticulitis in patients allergic to penicillin.
- It is effective against anaerobic bacteria, which are often involved in diverticulitis.
- The drug label indicates its use for intra-abdominal infections, which includes diverticulitis. 1
From the Research
For patients with diverticulitis who are allergic to both penicillin and metronidazole, fluoroquinolones (such as ciprofloxacin or levofloxacin) combined with clindamycin are appropriate antibiotic alternatives. The most recent and highest quality study, 2, suggests that amoxicillin-clavulanate may be a suitable option for treating diverticulitis, but for patients allergic to penicillin, fluoroquinolones combined with clindamycin are a viable alternative. For outpatient treatment, ciprofloxacin 500-750 mg orally twice daily plus clindamycin 300-450 mg orally four times daily for 7-10 days is a common regimen. For hospitalized patients with more severe infection, intravenous options include levofloxacin 750 mg daily plus clindamycin 600-900 mg every 8 hours. These combinations provide coverage against both gram-negative aerobic bacteria and anaerobic organisms commonly involved in diverticulitis. The fluoroquinolone targets gram-negative bacteria while clindamycin covers anaerobes that would normally be treated with metronidazole. It's essential to note that fluoroquinolones carry black box warnings for certain adverse effects, so clinical judgment regarding risks versus benefits is necessary, as highlighted in 3. Consultation with an infectious disease specialist may be beneficial in cases of severe allergies or complicated infections to tailor the antibiotic regimen appropriately.
Some key points to consider when selecting an antibiotic regimen for patients with diverticulitis who are allergic to penicillin and metronidazole include:
- The use of fluoroquinolones combined with clindamycin as a suitable alternative, as mentioned in the example answer
- The importance of considering the risks and benefits of fluoroquinolone use, as highlighted in 2 and 3
- The need for clinical judgment and potentially consultation with an infectious disease specialist in cases of severe allergies or complicated infections
- The fact that the evidence on antibiotic treatment for uncomplicated acute diverticulitis is still limited, as noted in 4, and more trials are needed to obtain more precise effect estimates.
However, based on the most recent and highest quality study, 2, fluoroquinolones combined with clindamycin are a reasonable choice for patients with diverticulitis who are allergic to penicillin and metronidazole.