Should Clindamycin Be Banned?

I wrote a post a long time ago about getting ready for pseusomembranous colitis lawsuits from clindamycin.  I defend clindamycin as a very important drug in the battle against out of control Staphylococcus aureus (MRSA) drug resistance.  In fact, clindamycin is often a first line drug in the oral treatment of MRSA in emergency rooms and hospitals everywhere.  Let me give you a personl experience with clindamycin and why it has a very important role in the care of patients every where.

I cared for a patient with garden variety cellulitis of the leg.  The patient was otherwise healthy with borderline elevated blood sugars indicating perhaps an undiagnosed diabetes.  He was placed on Unasyn on admission by the admitting hospitalist.  Not a bad choice.  However, after considering the rampant nature of MRSA in my community, I added Vancomycin for MRSA coverage.  I had the nurse mark the lines of demarcation every day.  Then I waited.

Day after day the erythema would slightly lighten, but the lines of demarcation would slowly expand.  After three days, I contemplated that perhaps this was not your garden variety cellulitis and I switched the patient to Zosyn, Levaquin and Vancomycin, perhaps believing this was an unusual case of pseudomonas resistance.  With no cultures to go off of, I presumed that the patient's failure to respond to Unasyn + Vanco meant this was not your normal Staph. species.

The following day, the lines of demarcation had spread again.  I'm frustrated.  The patient is frustrated.  I told him I couldn't explain why he wasn't getting better.  So I asked for an infectious disease consult.  They stopped all antibiotics and started the patient on clindamycin.  With in 24 hours the cellulitis lines had markedly decelerated and the erythema was almost gone and the patient was able to be discharged.  I spoke with the doctor by phone to find out why they had improved so dramatically.  I learned that clindamycin is helpful in the bacteriostatic growth phase and is not dependent on the bacterial turnover.  I probably had a bacteria that I had prevented from growing, but I couldn't get it to die.  That's why clindamycin was able to kick its butt.

For all the misinformed, angry and emotional patients who choose to blame doctors and drug makers for their misfortune from clindamycin, it's important to know that this drug saves lives every year.  Should clindamycin be banned?  Let's try asking all the patients this drug helps to do wonderful things for them. 

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