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Gastrointestinal side effects of clindamycin and ampicillin therapy
Abstract:
Hospitalized patients who received clindamycin or ampicillin were evaluated for gastrointestinal side effects for a period of up to six weeks after therapy was discontinued. Of 104 patients receiving clindamycin therapy, 31 (29.8%) developed diarrhea, and two (1.9%) developed pseudomembranous colitis (PMC). Of 138 patients receiving ampicillin, 24 (17.3%) developed diarrhea, and one (0.7%) developed PMC. Diarrhea persisting for three days or more was noted in 13 (12.5%) of the patients receiving clindamycin and in seven (5.1%) of those receiving ampicillin. The tendency to develop diarrhea was positively correlated with serious illness, abdominal or pelvic sepsis, and total dosage of clindamycin. Examination of stools from a patient with PMC that was associated with clindamycin therapy showed a decrease in the number of anaerobic bacteria from the numbers found in stool cultures of normal controls. Those patients who did not develop diarrhea also had fewer anaerobic bacteria and coliform organisms. Lymphocytes from the patient with PMC were hyporeactive to phytohemagglutinin and hyperreactive to clindamycin.
Insights
Clindamycin and ampicillin can cause gastrointestinal issues like diarrhea and pseudomembranous colitis (PMC). Clindamycin was associated with a higher incidence of these side effects, particularly in seriously ill patients.
Area of Science:
- Infectious Diseases
- Gastroenterology
- Pharmacology
Background:
- Antibiotic-associated diarrhea (AAD) and pseudomembranous colitis (PMC) are significant clinical concerns.
- Clindamycin and ampicillin are commonly prescribed antibiotics with potential gastrointestinal side effects.
Purpose of the Study:
- To compare the incidence of gastrointestinal side effects, specifically diarrhea and PMC, between hospitalized patients receiving clindamycin and ampicillin.
- To identify factors associated with the development of these side effects.
Main Methods:
- A cohort of hospitalized patients receiving either clindamycin or ampicillin was prospectively evaluated for gastrointestinal side effects up to six weeks post-therapy.
- Incidence rates of diarrhea and PMC were recorded and compared between the two antibiotic groups.
- Stool analysis and lymphocyte reactivity were examined in a patient with PMC.
Main Results:
- Clindamycin therapy was associated with a higher incidence of diarrhea (29.8%) and PMC (1.9%) compared to ampicillin (17.3% diarrhea, 0.7% PMC).
- Prolonged diarrhea (≥3 days) was also more frequent with clindamycin (12.5%) than ampicillin (5.1%).
- Factors correlating with diarrhea included serious illness, sepsis, and higher clindamycin dosage. Stool analysis revealed altered anaerobic bacteria and coliforms in patients with diarrhea and PMC.
Conclusions:
- Clindamycin appears to carry a higher risk of gastrointestinal side effects, including diarrhea and PMC, than ampicillin in hospitalized patients.
- The development of these side effects may be linked to the severity of illness, specific infections, antibiotic dosage, and alterations in gut microbiota.
- Further research into the mechanisms of antibiotic-induced gut dysbiosis and host immune response is warranted.