The Spectrum of Colitis Associated with Lincomycin and Clindamycin Therapy

Abstract

Ten cases of protracted diarrheal illness after the oral administration of lincomycin or clindamycin in standard dosages were observed in previously healthy subjects. An abrupt onset of diarrhea, crampy abdominal pain, fever, and leukocytosis was observed one to 12 days after discontinuation of the drug. Proctoscopic examination revealed erythematous friable mucosa covered with small raised, yellowish-white plaques that were sometimes confluent. Barium contrast studies of the colon demonstrated irregular shaggy mucosa, ulcerations, cobblestone appearance, and thumb printing. Rectal bipsy showed acute inflammation with pseudomembranes with focal or superficial ulcerations. All patients had a protracted course but recovered with supportive management. Follow-up barium enemas and proctoscopy were done on all patients and were normal. A history of diarrhea, fever, and mucosal changes seen on proctoscopy in a patient who has recently received one of these antibiotics should raise the possibility of colitis associated with clindamycin and lincomycin therapy.

Pseudomembranous colitis.

“…If one excludes proven infective lesions, such as staphylococcal colitis, it is possible that this is the case. The inflammatory 'non-diagnostic' biopsies described in the literature (Cohen et al, 1973;Scott et al, 1973;Le Frock et al, 1975) may well have had the pattern of variants of TI lesions. Such cases, when progressive, terminate in pseudomembranous colitis.…”

Clostridium difficile: clinical disease and diagnosis

“…Because of wide variations in the suspected etiology, no single factor was firmly established as the cause. The rate of incidence of antibioticassociated diarrhea and pseudomembranous colitis varied among different studies, and the diseases displayed multiple pathological entities ranging from severe and life-threatening to mild and self-limited (26, 158,165,213). Published concepts concerning the cause of antibiotic-associated diarrhea and pseudomembranous colitis ranged from a direct effect of the antibiotic or a metabolite of the antibiotic on the intestinal mucosa (213) to changes in the intestinal microflora or a localized Schwartzmann reaction (125,221).…”

Fibrin thrombi, a cause of clindamycin-associated colitis?

“…Several reports contain no mention of the condition of the capillaries (Le Frock et al, 1975;Price and Davies, 1975;Burbige and Milligan, 1975;Tedesco et al, 1974;. Furthermore, Tedesco and his associates who have a wide experience of clindamycin-associated colitis, specifically mention the absence of thrombosis in mucosal vessels in one of their large series (Sumner and Tedesco, 1975) but the use of a specific stain for fibrin is not apparent from their paper.…”