Fatal colitis in a hemophilic patient with inhibitor

A severe colitis developed in a hemophilic patient following an antibiotic regimen which included clindamycin. A surgical procedure, total hip replacement, had been complicated by the appearance of a powerful factor VIII inhibitor and a Bacteroides fragilis infection. The resulting bleeding diathesis was successfully managed with the use of an "activated prothrombin complex"; however, the occurrence of colitis following intravenous clindamycin therapy proved to be fatal. Clindamycin, like the related antibiotic lincomycin, appears to have significant intestinal toxicity and should be restricted to the treatment of life-threatening proven Bacteroides infections.