Oral Vancomycon and Clindamycin

[_Rob_]

Any thoughts on this one:-

Came across a chart today for a patient who had perfuse diarrhoea, thought to be a c.diff infection and was prescribed oral Vanc. The patient also had an infected cannula site too....and for this was prescribed oral clindamycin!

I have acted already but didn't think this was safe or effective prescribing. Just curious to what others think???

[Steve G]

If it is C.diff then vancomycin is a reasonable choice, but metronidazole may be a more cost-effective choice (depending how ill the patient is). But giving the same patient clindamycin! Which idiot came up with that idea? Give flucloxacillin instead?

[Cathedral]

I believe you are right as clindamycin is also the one to blame for cases of Clostridium infections. It would surely worsen that diarrhea problem. Isn't that possible to treat that infected site externally?

[johnep]

Could try Fucidin cream generously applied around site.
johnep

[admin]

Originally Posted by Cathedral

I believe you are right as clindamycin is also the one to blame for cases of Clostridium infections. It would surely worsen that diarrhea problem. Isn't that possible to treat that infected site externally?

Would it not depend on how infected the site was - aren't topical anti-biotics frowned upon because of the resistance they can cause?

[johnep]

Normally you would not use a topical antibiotic in a closed situation such as a hospital ward, but I have heard of this application with suitable precautions, ie not more than 10-14 days. Usually infection clears rapidly or not at all.
johnep

[_Rob_]

Infections from indewling medical devices/catheters usually require systemic treatment. The problem with cannula site infections is the risk of tracking down into the lower tissues from where the cannula was inserted. We always treat with oral ABx for this type of infection because topical application won't treat a tracking infection.

Just out of interest, if you read the SPC for Clindamycin, it cautions/CI in patients with all types of colitis (c.diff induces or pseudomembranous) because of the risk of toxic megacolon. I got the chart changed to to oral Flucloxacillin - just seemed a bit nicer for the poor ol' patient.

[bss_1981]

i think it is ok to give vancomycine to this patient

[admin]

Originally Posted by bss_1981

i think it is ok to give vancomycine to this patient

Welcome to bss_1981. I was chatting with him in the chat room and he's from Iraq. So if anyone wants to know what the life of a MSc pharmacy student is like at the moment in Iraq, he's the man to ask!

[bss_1981]

Thank u very much admin for this introduction and i wellcome any other pharmacist to be friends