Clindal/Clindal Injection Warnings

Clindal should only be used in the treatment of serious infections. In considering the use of the product, the practitioner should bear in mind the type of infection and the potential hazard of diarrhea which may develop, since cases of colitis have been reported during or even 2-3 weeks following the administration of clindamycin.
Studies indicate a toxin(s) produced by clostridia (especially Clostridium difficile) is the principal direct cause of antibiotic-associated colitis. These also indicate that this toxigenic clostridium is usually sensitive in vitro to vancomycin. When vancomycin 125-500 mg are administered orally 4 times a day for 7-10 days, there is a rapid observed disappearance of the toxin from fecal samples and a coincident clinical recovery from diarrhea. When the patient is receiving cholestyramine in addition to vancomycin, consideration should be given to separating the times of administration.
Colitis is a disease which has a clinical spectrum from mild, watery diarrhea to severe, persistent diarrhea, leucocytosis, fever, severe abdominal cramps, which may be associated with the passage of blood and mucous. If allowed to progress, it may produce peritonitis, shock and toxic megacolon. This may be fatal.
The appearance of marked diarrhea should be regarded as an indication that the product should be discontinued immediately. The disease is likely to follow a more severe course in older patients who are debilitated. Diagnosis is usually made by the recognition of the clinical symptoms, but can be substantiated by endoscopic demonstration of pseudomembranous colitis. The presence of the disease may be further confirmed by culture of the stool for Clostridium difficile on selective media and assay of the stool specimen for the toxin(s) of C. difficile.