Pseudomembranous colitis caused by topical clindamycin phosphate

Parry, M. F.

doi:10.1001/archderm.122.5.583

Cited by 14 publications

(4 citation statements)

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“…In addition to the usual local adverse events of erythema, desquamation, dryness and burning, topical clindamycin therapy has also been associated with two published cases of pseudomembranous or Clostridium difficile colitis [96,97] . There has also been one case report of diarrhea, confirmed by dechallenge and rechallenge, which was not mediated by C. difficile [98] .…”

Section: Adverse Eventsmentioning

confidence: 99%

Topical clindamycin in the management of acne vulgaris

Guay

2007

Expert Opinion on Pharmacotherapy

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A small cadre of antimicrobials are commonly used and regarded as effective and safe, as systemic and topical treatments of acne vulgaris. These include oral tetracycline, doxycycline, minocycline and topical clindamycin and erythromycin. Topical antimicrobials work via both antimicrobial and non-antimicrobial mechanisms: the former due to suppression of the growth of propionibacterial species (especially Propionibacterium acnes and P. granulosum). Clindamycin appears to be superior in efficacy compared with erythromycin and tetracycline. However, the emergence and spread of resistance among propionibacteria to both erythromycin and clindamycin calls into question their long-term viability as topical anti-acne therapies. Only through judicious use of combination topical therapies (e.g., topical retinoid, benzoyl peroxide or azelaic acid plus clindamycin or erythromycin) and the practice of effective infection control (i.e., handwashing between seeing patients in the clinic) can both clindamycin's and erythromycin's widespread utility be preserved in this disorder.

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Section: Adverse Eventsmentioning

confidence: 99%

Topical clindamycin in the management of acne vulgaris

Guay

2007

Expert Opinion on Pharmacotherapy

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“…The high frequency of involvement of parenteral cephalosporins may be related to the fact that most of these undergo significant biliary elimination. Topical administration of certain antibiotics, such as clindamycin, has been reported as a possible cause of pseudomembranous colitis (Parry & Rha 1986). …”

Section: Implicated Antibioticsmentioning

confidence: 99%

The Clinical Significance of Antibiotic-Associated Pseudomembranous Colitis in the 1990s

1991

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Antibiotic-associated pseudomembranous colitis is an uncommon but potentially serious adverse reaction, resulting in acute diarrhoea and characterised by colonic pseudomembranes. A direct relationship between the disease, recent antibiotic therapy and proliferation of Clostridium difficile in the colonic lumen was established in the late 1970s. It is thought that antibiotic therapy may alter the enteric flora, enabling C. difficile to proliferate and produce toxins with cytopathic (toxin B or cytotoxin) and hypersecretory (toxin A or enterotoxin) effects on the mucosa. Apart from clindamycin, the first antibiotic recognised to be clearly associated with pseudomembranous colitis, the antimicrobial agents most commonly responsible are cephalosporins and ampicillin (or amoxicillin). However, virtually all antibiotics except parenterally administered aminoglycosides can cause the disease. Vancomycin and metronidazole, 2 drugs used to treat antibiotic-associated pseudomembranous colitis, have also been reported to be responsible for the complication when used parenterally. Pseudomembranous colitis may develop after perioperative prophylactic antibiotic therapy with cephalosporins. Antibiotic-associated pseudomembranous colitis is most frequent in elderly and debilitated patients and in intensive care units. Nosocomial acquisition of C. difficile has been documented. Therefore it has been recommended that enteric isolation precautions should be taken with patients with this disease. The clinical symptoms include watery diarrhoea, abdominal cramping, and frequently fever, leucocytosis and hypoalbuminaemia. Toxic megacolon and acute peritonitis secondary to perforation of the colon are the most serious complications. The pseudomembranes are usually seen during endoscopic procedures, sigmoidoscopy or, if possible, colonoscopy; the most useful microbiological tests for confirmation of the diagnosis include cycloserine cefoxitin fructose agar (CCFA) stool cultures and stool toxin assays on tissues or by immunological techniques. However, cultures and toxin tests may be positive in patients without pseudomembranous colitis or C. difficile-associated diarrhoea. Mild cases may respond to discontinuation of the drug responsible, but therapy with an anticlostridial antibiotic is often necessary: a 10-day course of oral vancomycin, metronidazole or bacitracin should be given. Relapses are seen in 5 to 50% of patients treated. Antibiotic treatment should avoid sporulation leading to other relapses. 'Biotherapy' (lactobacilli, Saccharomyces) has also been proposed.

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“…[30] A most important side effect of topical antibiotics is the development of bacterial resistance and cross resistance; therefore, it should not be used as monotherapy.…”

Section: Introductionmentioning

confidence: 99%

Acne vulgaris treatment : The Current Scenario

Rathi¹

2011

Indian J Dermatol

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Acne Vulgaris is one of the most common skin disorders which dermatologists have to treat. It mainly affect adolescent, though may present at any age. In recent years, due to better understanding of the pathogenesis of acne, new therapeutic modalities and various permutation and combinations have been designed. In topical agents; benzoyl peroxide, antibiotics, retinoids, etc are the mainstay of treatment; can be given in combinations. While systemic therapy includes oral antibiotics, hormonal therapy, and isotretinoin, depending upon the need of patients it has to be selected. Physical treatment in the form of lesion removal, photo-therapy is also helpful in few of them. Since various old and new topical and systemic agents are available to treat acne, it sometime confuse treating dermatologist. To overcome this, panel of physicians and researchers worked together as a global alliance and task force to improve outcomes in acne treatment. They have tried to give consensus recommendation for the treatment of acne. Successful management of acne needs careful selection of anti-acne agents according to clinical presentation and individual patient needs.

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Pseudomembranous colitis caused by topical clindamycin phosphate

Cited by 14 publications

References 0 publications

Topical clindamycin in the management of acne vulgaris

Topical clindamycin in the management of acne vulgaris

The Clinical Significance of Antibiotic-Associated Pseudomembranous Colitis in the 1990s

Acne vulgaris treatment : The Current Scenario

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