Topical Clindamycin and C. difficile Infection Risk

Mechanism of Risk

Disruption of the normal gut microbiota is the primary mechanism by which antibiotics, including clindamycin, increase risk of C. difficile infection, and even limited systemic absorption of topical clindamycin can potentially disrupt intestinal microflora, creating conditions favorable for C. difficile proliferation and toxin production 1, 2, 3

Clindamycin (all formulations) has historically been considered one of the antibiotics posing the greatest risk for C. difficile infection, along with third-generation cephalosporins, penicillins, and fluoroquinolones, according to the Infectious Diseases Society of America 4, 5
A landmark study found that oral clindamycin administration resulted in diarrhea in a significant portion of patients and pseudomembranous colitis, which led to the identification of C. difficile as the causative agent 1

Patients with a history of antibiotic-associated colitis or inflammatory bowel disease may be at higher risk and should be monitored more closely when using topical clindamycin, as recommended by the Infectious Diseases Society of America 4, 5
Concomitant use of other antibiotics or proton pump inhibitors may further increase the risk of C. difficile infection in patients using topical clindamycin, and the risk appears to be dose-dependent and related to the extent of systemic absorption 1, 4