THE JOURNAL OF !:-\FECTIOUS DISEASES. VOL. 135. SUPPLE"fE:\T • MARCH 1977 by the University of Chicago. All rights reserved.

© 1977

Clinical Study of Gastrointestinal Complications Associated with Clindamycin Therapy From the Division of Allergy, Immunology and Infectious Diseases, Palo Alto Medical Research Foundation, Palo Alto; and the Department of Medicine, Division of Infectious Diseases, Stanford University School of Medicine, Stanford, California

John E. Swartzberg, Rosemary M. Maresca, and Jack S. Remington

study designed to determine the efficacy of this drug in treatment of nonbacterial disease, and when 12 other patients with pseudomembranous colitis were seen in a relatively brief period thereafter. We attempted to define the incidence of gastrointestinal side effects associated with clindamycin therapy. No similar attempt had been published" and soon after we embarked on our study, physicians began to recognize the morbidity and mortality associated with pseudomembranous colitis. Although the incidence of diarrhea and pseudomembranous colitis associated with clindamycin is not known" estimates of incidence of diarrhea have ranged from 4% [2] to 20CJ'o [3] and those of pseudomembranous colitis from 38 C) Vomiting

No. of patients (%) 35 34 29 28 25 23 12

(53.0) (51.5) (43.9) (42.4) (37.9) (34.8) (18.2)

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inpatients at Stanford University Medical Center and the Palo Alto Veterans Administration Hospital and outpatients at the Palo Alto Medical Clinic and the Kaiser Permanente Hospital in Santa Clara who were receiving clindamycin were included. All patients were asked to complete a questionnaire which indicated their total dosage of c1indamycin; occurrence of nausea, emesis, anorexia, excessive flatus, fever, and weight loss; and use of other medications during therapy [5]. Information about age, sex, inpatient or outpatient status, type of service for inpatients, underlying disease (s), reason (s) for clindamycin therapy, route of administration, amount of clindamycin administered, duration of therapy, and concurrently administered medications was obtained from the patients' medical records. Any patient with signs or symptoms related to the gastrointestinal tract was carefully questioned about changes in quality, frequency, and duration of bowel movements, and about their temporal relationship to the use of clindamycin. Patients were also asked if the dosage of clindamycin was altered or discontinued because of diarrhea or other gastrointestinal problems, or if they changed their life-style because of these difficulties. All inpatients were seen by one of us. Those patients with more stools than usual had a physical examination performed every 24-48 hr during hospitalization. Asymptomatic patients were examined twice weekly during hospitalization. Any subsequent follow-up was done by telephone. Questionnaires were completed by each patient at the conclusion of the follow-up study. Outpatients were mailed the questionnaires seven days after completing clindamycin therapy. Patients who did not return the questionnaire

523 (52.3)

GI Complications with Clindarnycin

S101

Table 3. Occurrence of diarrhea related to route of administration of clindamycin therapy.

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200

190 160

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150 140

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130

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220

158

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11.0

87

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