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Severe pseudomembranous colitis after lincomycin and clindamycin
Abstract:
Four cases of severe pseudomembranous colitis following the use of lincomycin and clindamycin are described; 2 required emergency total colectomy and 2 died. Cases of such gravity after the use of these drugs have not been previously reported. On hundred and fifty-six orthopaedic cases where clindamycin and lincomycin were used postoperatively are reviewed; 34 had diarrhoea (22 per cent), and 3 of the severe cases occurred in this group. The diagnosis of pseudomembranous colitis may be difficult as the latent period from initiation of drug therapy to commencement of diarrhoea may be as much as 18 days, and that from cessation of drug therapy may be as much as 11 days. The value of early sigmoidoscopy in cases of diarrhoea of obscure aetiology is emphasized, and the characteristic sigmoidoscopic and histological appearances of pseudomembranous colitis are described. As these drugs may produce a lethal condition it is suggested that they should be used with appropriate discretion, especially in the elderly female who appears to be most at risk.
Insights
Severe pseudomembranous colitis can occur after lincomycin and clindamycin use, with some cases being fatal. Early diagnosis via sigmoidoscopy is crucial for prompt treatment of this serious gastrointestinal condition.
Area of Science:
- Gastroenterology
- Infectious Diseases
- Pharmacology
Background:
- Lincomycin and clindamycin are antibiotics sometimes used postoperatively.
- Severe adverse events, including fatal outcomes, have been associated with these drugs.
Observation:
- Four severe cases of pseudomembranous colitis were reported following lincomycin or clindamycin use.
- In a review of 156 orthopedic patients, 22% experienced diarrhea, with 3 severe cases occurring in this group.
Findings:
- The diagnosis of pseudomembranous colitis can be challenging due to a significant latent period after drug initiation or cessation.
- Early sigmoidoscopy is valuable for diagnosing diarrhea of unknown origin, revealing characteristic pseudomembranous colitis findings.
Implications:
- Lincomycin and clindamycin should be used with caution, particularly in elderly females, due to their potential to cause lethal conditions.
- Prompt diagnosis and intervention are critical for managing pseudomembranous colitis and improving patient outcomes.