Clindamycin


Clindamycin is a semi-synthetic derivative of lincomycin active against most gram-positive and anaerobic bacteria.
 
Clindamycin together with pyrimethamine has been used as alternative treatment for toxoplasmic encephalitis in AIDS patients.
 
Incidence
Up to 10% of patients treated develop rashes at the end of the first week, or during the second week of therapy.
 
58% of patients treated with pyrimethamine/clindamycin have cutaneous reactions after an averageof 13 days.
 
Clinical manifestations
General: anaphylactic shock.
 
Respiratory: bronchospasm.
 
Cutaneous: contact dermatitis (very rare), pruritus, maculopapular eruptions, lip or palpebral edema, Stevens-Johnson syndrome, leukocytoclastic angeitis.
 
Diagnostic methods
Cutaneous testing
 
Skin prick-tests (150 mg/ ml): negative.
 
Intradermal skin-tests: negative.
 
Patch-tests (clindamycin phosphate 1% pet. or aq.): positive in patients with contact dermatitis.
 
No specific IgE found.
 
Detection of hemagglutinating antibodies which specificity has been confirmed by inhibition of hemagglutination.
 
Mechanisms
Residual impurities from the manufacturing process.
 
Management
Desensitization (orally, in AIDS patients with toxoplasmic encephalitis).
  • Day 1: 20 mg, 20 mg, 20 mg
  • Day 2: 40 mg, 40 mg, 40 mg
  • Day 3: 80 mg, 80 mg; 80 mg
  • Day 4: 150 mg, 150 mg, 150 mg
  • Day 5: 300 mg, 300 mg, 300 mg
  • Day 6: 600 mg, 600 mg, 600 mg
  • Day 7: 600 mg, 600 mg, 600 mg, 600 mg
Discontinuation of the treatment 9% to 14% due to adverse effects.

References

  1. Garcia R, Galindo P.A, Feo F, Gomez E, Fernandez F, "Delayed allergic reactions to amoxycillin and clindamycin", Contact. Dermatitis, 1996 ; 35 (2): 116-7
  2. Caumes E, Bocquet H, Guermonprez G, Rogeaux O, Bricaire F, Katlama C, Gentilini M, "Adverse cutaneous reactions to pyrimethamine/sulfadiazine and pyrimethamine/clindamycin in patients with AIDS and toxoplasmic encephalitis", Clin. Infect. Dis., 1995 ; 21 (3): 656-8
  3. Marcos C, Sopena B, Luna I, Gonzalez R, de la Fuente J, Martinez-Vazquez C, "Clindamycin desensitization in an AIDS patient", AIDS, 1995 ; 9 (10): 1201-2
  4. Vidal C, Iglesias A, Saez A, Rodriguez M, "Hypersensitivity to clindamycin", D. I. C. P, 1991 ; 25 (3): 317

As in all diagnostic testing, the diagnosis is made by the physican based on both test results and the patient history.