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Clindamycin as an anti-staphylococcal agent--indications and limitations
Abstract:
In a general survey it is stated that for single Staphylococcus aureus infections, clindamycin is not considered to be a first-line drug. Its chief indication is penicillin allergy. Penetration and accumulation of clindamycin within leukocytes demonstrated in vitro may be of value in the treatment of S. aureus diseases resulting in large abscesses. An insidious risk of the development of Clostridium difficile diarrhoea limits the use of clindamycin in ambulatory long-term treatment of diabetic osteitis and chronic osteomyelitis. Such patients must therefore be carefully checked during clindamycin therapy. In staphylococcal endocarditis treated with clindamycin, relapses and development of resistance have been reported. Mixed staphylococcal and anaerobic infections in skin, subcutaneous tissue, the diabetic foot, bone and joints are primary indications for clindamycin. S. epidermidis infections, especially septicemia and endocarditis, are not suitable for clindamycin therapy due to a high rate of resistance.
Insights
Clindamycin is not a first-line treatment for Staphylococcus aureus infections but is useful for mixed anaerobic and staphylococcal infections. Careful monitoring is needed due to risks like Clostridium difficile diarrhea and resistance development.
Area of Science:
- Infectious Diseases
- Pharmacology
- Microbiology
Background:
- Clindamycin is not a primary choice for single Staphylococcus aureus infections.
- Its use is primarily indicated for patients with penicillin allergies.
- Leukocyte penetration by clindamycin suggests potential in treating abscesses caused by S. aureus.
Purpose of the Study:
- To evaluate the efficacy and limitations of clindamycin in treating various Staphylococcus aureus and mixed bacterial infections.
- To identify specific indications and contraindications for clindamycin therapy.
Main Methods:
- General survey and in vitro studies assessing clindamycin's properties.
- Review of clinical outcomes in patients treated with clindamycin for staphylococcal and mixed infections.
Main Results:
- Clindamycin is effective for mixed staphylococcal and anaerobic infections in skin, soft tissue, diabetic foot, bone, and joint infections.
- High rates of resistance limit clindamycin's utility in Staphylococcus epidermidis infections, including septicemia and endocarditis.
- Potential risks include Clostridium difficile-associated diarrhea, necessitating careful patient monitoring during long-term treatment for conditions like diabetic osteitis and chronic osteomyelitis.
- Relapses and resistance development have been observed in staphylococcal endocarditis treated with clindamycin.
Conclusions:
- Clindamycin has specific indications, particularly in mixed infections and for penicillin-allergic patients.
- Its use requires caution due to potential side effects and the risk of resistance, especially in certain S. aureus and S. epidermidis infections.