Can clindamycin (antibiotic) cause a rash?

From the Guidelines

Clindamycin can cause skin rashes as a side effect in some patients, and if a rash develops, it is crucial to contact a healthcare provider immediately to assess the severity and determine the best course of action, which may include stopping the medication and switching to an alternative antibiotic, as recommended by the Infectious Diseases Society of America guidelines 1.

Causes and Symptoms of Clindamycin-Induced Rash

The rash may appear as red, itchy patches, hives, or in severe cases, might be part of a more serious reaction called Stevens-Johnson syndrome. Symptoms that warrant immediate medical attention include fever, swelling, difficulty breathing, or blistering.

• The exact mechanism of clindamycin-induced rash is not fully understood, but it is believed to be an immune-mediated response, with approximately 10% of patients experiencing some form of cutaneous reaction 1.
• People with previous allergic reactions to lincomycin or other antibiotics may be at higher risk of developing a rash while taking clindamycin.

Management of Clindamycin-Induced Rash

If a rash develops, the healthcare provider may recommend:

• Antihistamines like diphenhydramine (Benadryl) 25-50mg every 6 hours for mild reactions
• Topical corticosteroids for localized rashes
• Switching to an alternative antibiotic, such as those recommended by the Infectious Diseases Society of America guidelines for skin and soft tissue infections 1 It is essential to inform healthcare providers about any previous antibiotic allergies before starting new treatments to minimize the risk of adverse reactions.

Prevention and Monitoring

To prevent clindamycin-induced rash, it is crucial to:

• Monitor patients closely for signs of rash or other adverse reactions
• Adjust treatment regimens as needed to minimize the risk of rash development
• Consider alternative antibiotics for patients with a history of allergic reactions to clindamycin or other antibiotics, as recommended by the WHO Model List of Essential Medicines 1.

From the FDA Drug Label

The following reactions have been reported with the use of clindamycin. ... Hypersensitivity Reactions: Generalized mild to moderate morbilliform-like (maculopapular) skin rashes are the most frequently reported adverse reactions. Vesiculobullous rashes, as well as urticaria, have been observed during drug therapy Severe skin reactions such as Toxic Epidermal Necrolysis, some with fatal outcome, have been reported Skin and Mucous Membranes: Pruritus, vaginitis, angioedema and rare instances of exfoliative dermatitis have been reported

• Clindamycin can cause rash as a hypersensitivity reaction, with generalized mild to moderate morbilliform-like (maculopapular) skin rashes being the most frequently reported adverse reactions.
• Severe skin reactions, including Toxic Epidermal Necrolysis, have also been reported, some with fatal outcome 2.
• Other skin-related adverse reactions include vesiculobullous rashes, urticaria, pruritus, vaginitis, angioedema, and rare instances of exfoliative dermatitis 2.

From the Research

Clindamycin and Rash

• Clindamycin has been associated with various types of rashes, including maculopapular exanthems, drug rash with eosinophilia and systemic symptoms (DRESS), acute generalized exanthematous pustulosis (AGEP), acute febrile neutrophilic dermatosis, and symmetrical drug-related intertriginous and flexural exanthema (SDRIFE) 3.
• A case report described a patient who developed toxic epidermal necrolysis (TEN) after taking clindamycin, highlighting the importance of recognizing and managing this severe cutaneous reaction 4.
• Skin testing with clindamycin can carry some risk of adverse reactions, and a stepwise and individual diagnostic work-up is recommended 5.
• Clindamycin is rarely associated with precipitating Stevens-Johnson syndrome (SJS) or TEN, but it is essential to be aware of the potential risks and to monitor patients for any signs of cutaneous adverse reactions 4.

Types of Rashes Associated with Clindamycin

• Maculopapular exanthems: a common type of rash associated with clindamycin, characterized by a flat, red rash 3.
• DRESS: a severe rash characterized by fever, rash, and swollen lymph nodes, which can be life-threatening if not treated promptly 3.
• AGEP: a rare but severe rash characterized by numerous small, sterile pustules on the skin, often accompanied by fever and leukocytosis 3.
• TEN: a severe, life-threatening rash characterized by widespread skin blistering and detachment, often requiring hospitalization and intensive care 4.

Diagnosis and Management

• Skin testing with clindamycin can be used to diagnose hypersensitivity reactions, but it carries some risk of adverse reactions 5.
• A stepwise and individual diagnostic work-up is recommended, considering potential risk factors and testing in a specialized center with emergency equipment available 5.
• Prompt recognition and management of cutaneous adverse reactions, including SJS and TEN, are crucial to improve patient outcomes 4, 6, 7.