Combination Therapy with Ciprofloxacin and Clindamycin

Indications and Recommendations

• The Infectious Diseases Society of America recommends ciprofloxacin plus clindamycin for infections caused by Aeromonas hydrophila 1, 2, 3
• For moderate to severe diabetic foot infections, ciprofloxacin plus clindamycin is listed as an acceptable combination regimen 2, 3, 4
• The American College of Clinical Microbiology recommends ciprofloxacin plus clindamycin as an alternative for patients allergic to penicillin with a history of immediate hypersensitivity reaction 5, 6, 7, 8
• For low-risk patients with neutropenia, ciprofloxacin plus clindamycin is a commonly used oral regimen for empirical outpatient treatment 5, 6, 7, 8

Considerations for Prescription

• Clindamycin provides coverage against anaerobes, Staphylococcus aureus, and Streptococcus spp. 1, 2, 3, 9
• For infections with significant anaerobic component, consider adding metronidazol instead of relying solely on clindamycin 1, 2, 3, 9, 4

Safety Warnings

• The FDA and European Medicines Agency have issued warnings about the risk of tendinopathy, increased risk of aortic rupture or dissection, and central nervous system effects with fluoroquinolones like ciprofloxacin 10
• Inform patients about these potential risks and monitor for complications 10
• Clindamycin may cause Clostridioides difficile colitis, especially with prolonged use 3
• Clindamycin can alter normal gastrointestinal flora 3