Clindamycin and Pseudomembranous Colitis Lawsuits? Another Day. Another Drug.

"medical negligence attorney pseudomembranous colitis".  That's what somebody typed into Google and found my blog.  Clindamycin is a classic drug linked with c difficile colitis

Pseudomembranous colitis is a complication of illness that results when the toxic antigen of the bacteria clostridium difficile overgrows in the gut. It is usually the result of taking powerful antibiotics that kill the good and the bad bacteria in the gut.

There was a fantastic discussion on a while back regarding how to tell if clostridium difficile infection in the bowel was the result of poor hygiene by medical staff through  by fecal-oral contamination or if it was present in the patient's gut on hospital admission  but overgrows as a result of antibiotic use. The result? You can't tell.  Clostridium difficile can coexist in our gut with good bacteria and only cause a problem when the good bacteria is removed. 

This is one of the reasons why considering clostridium difficile diarrhea and the more complicated pseudomembranous colitis as a hospital acquired infection is both unfair and unrealistic. There is no way to know who had it  on admission and who got it through a poor hospital worker hygiene. Good c.  difficile hand washing protocol can certainly decrease the risk of transmission between patients, but it won't prevent it in someone who brought it with them into the hospital.

For this reason alone, as a patient, you should not want to have antibiotics for you or your kids if your doctor doesn't think it is necessary. I have seen many a horrible colitis due to this infection, sometimes requiring complete removal of the entire colon. It can be a prolonged and painful recovery that carries with it long term morbidity and even mortality. The literature is ripe with information indicating the class of drugs known as quinolones and their association with especially virulent strains of the c. difficile bacteria. Cipro, Levaquin, Avelox, Gatifloxacin are just some of the drugs in the quinolone class. The classic drug that can cause pseudomembranous colitis  is clindamycin. But I've seen it with just about all all classes of antibiotics.  Most patients I see in the hospital have nothing to do with use of Clindamycin.  

A little under a year ago, an intriguing article came out. A randomized trial that suggested giving probiotics to a patient at the start of antibiotics and continuing for one week after discontinuing antibiotics had a number needed to treat of just 10 to prevent one case of clostridium difficile. Ten! That's amazing. Compare that to hundreds for heart attack prevention and statin therapy. While more research is necessary, I have started prescribing probiotics in many of my hospitalized patients on antibiotics. 

Every complication does not warrant a lawsuit. Should clindamycin be banned?  Heck no.  But for some folks,  clostridium difficile infection equates to malpractice and negligence and there will be entire cottage industries of lawyers suing hospitals on behalf of patients that develop pseudomembranous colitis by no means other than the natural pharmaco dynamics and physiology of illness.  Get ready for the pseudo lawsuits. I"m sure they are coming.  Make sure to check out all the original medical ecards from The Happy Hospitalist.

"I'm tired of dealing with your crap all day long. --- C diff."

I'm tired of dealing with your crap all day long.  C diff doctor ecard humor photo.

Some of this post is for entertainment purposes only and likely contains humor only understood by those in a healthcare profession. Read at your own risk.

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16 Outbursts:

  1. This is precisely what Panda Bear was talking about in the lawyer/physician wars. May he RIP.

  2. We need a better screening system to even prevent many of these yahoos from even filing a lawsuit.

  3. Anonymous @ 4:51

    We need a better screening system to even prevent many of these yahoos from even filing a lawsuit.
    Yeah, the screening test will be "have you been on antibiotics," followed by, "no, you don't need to be admitted. (or there is no doctor who will admit you)."

  4. I don't understand why more people in the U.S. don't do Kefir. It's the simplest thing in the world to do, just get some kefir "grains" & pour milk over them, change the milk every day. Every day, new kefir for a fraction of the cost of kefir in the store. And it's way better than that kefir, because it has all the good probiotics in it, not just the ones that are suited to mass-production. It's a billion times more probiotics than standard youghert, too. My kids have had to have antibiotics a few times, and I gave them kefir the whole time. They never even had side effects from the antibiotic, not diarrhea, not sore stomach, nothing. Kefir is one of the best things, EVER. Drink kefir regularly and use sourdough starter (pancakes, baking, etc.) and you'll live to be a hundred, I believe it.

    Don't do the kombucha though- lots of people that do kefir like to do the kombucha. That stuff can easily grow other organisms that can kill you, it's dangerous. Kefir is very very safe, there has never been any known deaths from kefir, but there has from runaway kombucha.

  5. My 75 year old mother had knee surgery in Florida, then got the awful c diff! Perhaps a lawsuit is the only way to make sure these facilities are cleaned properly. Seems to be the only thing to "light a fire" under these medical providers. Otherwise, you get denial of any responsiblilty. After all, doctors stick together. We are not interested in a law suit, just looking for information on line, but to the person who said "you suck"...let's see how you feel once your sweet, trusting, elderly mother suffers the way mine has. I think you suck!

  6. I agree that person does suck!! c diff is the most awful thing to deal with and doctors who perscribe clindamycin are terrible.

    1. Yeah especially when they don't warn you of the side effects and you're blinded by a 3 week stint of c diff that almost kills you.

  7. I am now in recovery from c-diff. I was in ICU and almost died due to clindamycin. I was only having oral surgery. I was not warned of the dangers and this nearly killed me. All I want is for the "experts" to stop prescribing this medication. So, do I still suck because I almost died? When you are in the emergency room and they are cutting holes in your neck while you are awake because they can't give you general anesthesia or you will die instantly, then come and tell us who is looking for a "jackpot lotto" and that we "suck."

  8. Whatever, All the docs told me that clindmycin is only to be given in extreme cases. The FDA sent "Dear Doctor" letters stating that this drug is to be used in extreme cases only because of the risks. I had a dang tooth removed and I am not allergic to penicillin so there was no need for this drug. I was given NO warnings, I am looking at the bottle right now and NO warnings. I didn't need this drug. It took everything out of me. Do your research on all of the patients who became seriously ill and the pregnant woman who died after taking it. I am sure, like me she trusted her doctor or dentist. This site must be paid by the makers of this drug. I went to the dang dentist, I was not in the hospital. I "was" perfectly healthy and now I have to deal with this. Yes, I am angry. I have had many antibiotics in the past and have never had such a problem. I didn't have MRSA or any other life threatening illness warranting this drug. But, thanks to the dentist and clindamycin I do now.

  9. I agree - I was prescribed this drug for a bug bite in Florida - when I developed c diff my doctor was shocked that the urgent care prescribed clyn for me. It took forever to be diagnosed and then the flagyl that they gave me almost killed me as well. What a nightmare for a just a bug bite. It went on for months and months. I will never allow my family to take it and I let everyone I know to tell their doctor the same - the risks far outweigh the benefits and it should be taken off the market.

  10. Just take probiotics!! It's really that simple. And like another poster said, DRINK KEFIR. Antibiotics are a necessary evil, and we are the ones who are in control of our own health. If it weren't for antibiotics, many of us would be dead.

    Do your research and repopulate your healthy gut bacteria. It's really that simple.

  11. I was given clynda back in 2007 repeatedly over a 3 month time span by my oral surgeon shortly after that i got cdiff colitis...back then there were no warnings listed on the side effect panel or for that matter anywhere on the drug info sheet...but there all over the labels now haha go figure maybe cause it killed so many you tell me i dont have a right to sue for that although i was near death for 2 years and still have problems today from that disease and not informed as people are today that that specific drug is the number one trigger for cdiff colitis...heres what i say to you go blow it out your ass because i guarentee if that were you that had to suffer through that you would be out for some compensation for pain suffering thousands and thousands of unnecessary dollars wasted on healthcare and the stomach illnesses afterwards that encurr because of cdiff

  12. Clindamycin did not give you C.diff. C.diff was already present in your intestinal flora. Antibiotics can alter your intestinal flora allowing the bad bacteria already present, C. diff, to flourish. So the fact that your Dr. gave you C. diff is false. All antibiotics put you at risk for this to occur and like the person above said, this occurs frequently in those not even on antibiotics.

  13. I'm posting in the course of doing research for a friend who has a cdiff infection. She was given clindamycin as a prophylactic before having a root canal, and her dentist's response to the resulting cdiff infection was to give her more clindamycin. Her family doctor told her not to take the clindamycin and to instead take flagyl. That didn't kill the cdiff, so she's had 2 courses of vancomycin, but still has the infection.

    While the clindamycin did not cause the cdiff, it did facilitate the development of cdiff infection. It seems to me that the clindamycin was overkill as a prophylactic. I am curious, HH, what your take is on this. Especially given studies like this:

    It seems clear that while clindamycin is useful in many situations, it should be avoided unless absolutely necessary. Is that a fair assumption?

  14. You are correct -- every medicine has risks. That is why they should be used only where warranted. That means not merely as promoted by the manufacturer, but where peer-reviewed research-based evidence establishes a benefit that outweighs the risks, and where no other effective but less risky medicine is available. And even then, only after a meaningful disclosure of the risks to the patient, allowing the patient the informed basis on which to make the decision to undertake that risk for themselves.

    I think the statements you object to, that Clindamycin and Levaquin should be "banned," are reactions -- a somewhat loosely phrased and very frustrated objection from people who were very seriously injured in situations where the risks were neither adequately disclosed (as, honestly, they rarely are in a meaningful way) nor warranted. I think it would be fair to give these people the benefit of the doubt that what they really mean is that the drugs should not be prescribed where not warranted.

    Quinalones (like Levaquin) and Clindamycin are big guns that can save lives where warranted -- e.g., in situations involving a very serious infection that has not responded to other lower-risk antibiotics, and/or in penicillin adverse patients. I doubt a single one of these complaining folks, when presented with a choice between the significant risks of these drugs or a much higher risk of dying, would choose death. However, that is not how these medicines are often used or prescribed, and not really what these folks are crying out against. For example, the dental / oral surgery community appears to prescribe Clindamycin (with its attendant risks) casually and almost universally, without any appropriate risk factors warranting its use, without disclosing the risks meaningfully to the patient, and without any research or statistical evidence of prophylactic benefit! Levaquin (and quinalones) are often prescribed in very minor / low-risk situations (e.g., minor sinus infections), with an occasional life ruined needlessly as a result. That is really what these folks are crying out against. Each of these drugs has warnings from the FDA indicating their use for only very serious situations. (And I won't even begin to touch on how inadequate our FDA system is for vetting drugs and tracking adverse reactions.) I cannot contemplate why anyone would argue against using these drugs only where warranted.

  15. "Jackpot"?? Whoever thinks that watching their mother die from complications of c. diff, and then suing the facility that refused to treat those complications, constitutes "hitting the jackpot" is a dolt. My mother is dead because her nursing home physician apparently felt that acknowledging (and treating) the dehydration, malnutrition, and, ultimately, sepsis, that the c. diff caused constituted admitting to negligence. In other words, he actually committed negligence to avoid appearing negligent! Please do us all a favor and save the glib, rude, and cavalier sentiments for a topic less tragic. May none of you ever know the pain and horror of watching a loved one die in this manner.


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