Clostridium difficile toxin-induced colitis after use of clindamycin phosphate vaginal cream.
OBJECTIVE
To report a case of toxin-positive Clostridium difficile-induced colitis (CDIC) after use of clindamycin phosphate vaginal cream.


METHODS
A 25-year-old postpartum white woman developed multiple watery stools and abdominal cramping on day 6 of therapy with clindamycin vaginal cream for bacterial vaginosis. She received no other concomitant medications. The patient's stool sample was found to be positive for the C. difficile toxin. Due to the costs and risks of standard therapy, we decided to manage the patient supportively. Complete resolution of the diarrhea occurred shortly thereafter.


CONCLUSIONS
No published clinical studies in patients receiving clindamycin vaginal cream for bacterial vaginosis have documented C. difficile toxin in stool samples of patients with diarrhea. Approximately 5-6% of intravaginal clindamycin is absorbed in the bloodstream, making systemic effects possible.


CONCLUSIONS
This report indicates clindamycin phosphate vaginal cream as the most probable cause of CDIC due to the temporal relationship between the occurrence of diarrhea and clindamycin administration, lack of concomitant medications, and documentation of C. difficile toxin.
Meadowcroft
A M
AM
School of Pharmacy, University of North Carolina, Chapel Hill 27599, USA.
Diaz
P R
PR
Latham
G S
GS
D000328:Adult; D000900:Anti-Bacterial Agents / Q000009:adverse effects*; D001427:Bacterial Toxins; D002981:Clindamycin / Q000009:adverse effects / Q000031:analogs & derivatives*; D016360:Clostridioides difficile / Q000302:isolation & purification; D003092:Colitis / Q000139:chemically induced / Q000188:drug therapy* / Q000382:microbiology; D003967:Diarrhea / Q000628:therapy; D004761:Enterocolitis, Pseudomembranous / Q000188:drug therapy*; D004768:Enterotoxins / Q000032:analysis*; D005260:Female; D006801:Humans; D014622:Vaginal Creams, Foams, and Jellies; D016585:Vaginosis, Bacterial / Q000188:drug therapy
D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D004768:Enterotoxins; D014622:Vaginal Creams, Foams, and Jellies; C041348:tcdA protein, Clostridium difficile; D002981:Clindamycin; C007084:clindamycin phosphate