: Steven Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) are severe cutaneous adverse reactions (SCAR) differentiated by degree of skin detachment. Common triggers include anticonvulsants, sulfonamides, antibiotics (penicillin, cephalosporin, quinolones) and acetaminophen. Reports of clindamycin causing cutaneous complications are rare with only 6 published reports, none of which were reported in the Philippines. Though uncommon, it is an important consideration in patients presenting with erythematous to violaceous purpuric macules that progress to full thickness epidermal exfoliation. : A 59-year-old female who presented with erythematous maculopapular rash on both hands, dry crusted lesions on the mouth and positive Nikolsky sign within 28 days of administration of Clindamycin. Algorithm for assessment of drug causality in SJS and TENS (ALDEN) was done and Clindamycin scored 6 points, which points to a definite drug causality of SJS/TEN. : A female in her late 50s presented with fatigue, malaise, and sore throat. Initially managed as a case of sepsis peritonsillar abscess right but later in the course of admission, presented with erythematous maculopapular rash on both hands and dry crusted lesions on the mouth. Patient was clinically diagnosed with Steven-Johnson syndrome and toxic epidermal syndrome and was given a course of intravenous hydrocortisone. Patient unfortunately expired due to overwhelming sepsis. Severe cutaneous adverse reaction induced by clindamycin are rare but important life-threatening conditions which needs prompt recognition and treatment. SJS/TEN as a secondary diagnosis leads to a delay in management, therefore a high index of suspicion and the utility of validated scoring tools should be maintained throughout the course of treatment.
Clindamycin

BACKGROUND: The Clinical and Laboratory Standards Institute (CLSI) recommends testing for inducible clindamycin resistance in clindamycin non-resistant and erythromycin resistant (CNR-ER) staphylococci by using a D-zone test. Recently, the VITEK2 system was developed to detect inducible clindamycin resistance in staphylococci. We evaluated the performance of the VITEK2 system by comparing it with a D-zone test. METHODS: In detecting inducible clindamycin resistance, a total of 142 clinical isolates of staphylococci were tested by using the VITEK2 Antimicrobial Susceptibility Test (AST)-P601 card (bioMerieux, Marcy l'Etoile, France) and the D-zone test. Of the 142 isolates of staphylococci tested, 114 were CNR-ER staphylococci [40 coagulase-negative staphylococci (CoNS), 74 Staphylococcus aureus] and 28 were staphylococci, either resistant or susceptible to clindamycin and erythromycin (1 CoNS and 27 S. aureus). RESULTS: Of the 114 CNR-ER staphylococci, 98.6% (73/74) of S. aureus and 32.5% (13/40) of CoNS were inducible clindamycin resistant according to the Dzone test. Overall sensitivity and specificity of the VITEK2 system were 98.8% (85/86) and 98.2% (55/56) respectively, and the agreement between the VITEK2 system and the D-zone test was 98.6% (140/142). CONCLUSION: The VITEK2 system shows high concordance with a D-zone test. The inducible clindamycin resistance in staphylococci can be detected easily and conveniently by the VITEK2 system.
Clindamycin ; Erythromycin ; Sensitivity and Specificity ; Staphylococcus ; Staphylococcus aureus

No abstract available.
Animals ; Babesiosis* ; Clindamycin ; Humans ; Male* ; Quinine

No abstract available.
Animals ; Babesiosis* ; Clindamycin ; Humans ; Male* ; Quinine

BACKGROUND: The erythromycin-resistance rate and phenotype distribution of Streptococcus propenes are quite different by geographical variation and study period. The aim of the present study was to determine the evolution of resistance to erythromycin and the frequency of erythromycin resistance phenotype of S. pyogenes isolated from Wonju Christian Hospital. METHODS: The minimal inhibitory concentrations (MICs) of erythromycin and clindamycin for 94 S. pyogenes isolated from clinical specimens between 1990 to 1998 were investigated. Double disk test of erythromycin (78microgram) and clindamycin (25microgram) were performed for 15 isolates of erythromycin resistant S. pyogenes to evaluate the erythromycin resistance phenotype. RESULTS: The resistance rates of 94 isolates of S. pyogenes were 16%(15/94) to erythromycin and 4%(4/94) to clindamycin. The frequency of erythromycin resistance phenotype in decreasing order were M phenotype (47%), inducible resistance phenotype (40%), and constitutive resistance phenotype (13%). Erythromycin-resistant S. pyogenes did not exist until 1993, but was isolated since 1994, and ranged from 14.0% to 24.0% during the period of 1994-1998. CONCLUSIONS: Our finding documents the emergence of high resistance rates to erythromycin in S. pyogenes at Wonju area since 1994. The M phenotype (47%) and inducible resistance phenotype (40%) account for the majority of erythromycin-resistant S. pyogenes.
Clindamycin ; Erythromycin* ; Gangwon-do ; Phenotype* ; Streptococcus pyogenes* ; Streptococcus*

alpha-hemolytic streptococci (AHS) are common normal oropharyngeal flora that can transfer antibiotic-resistance genes to Streptococcus pneumoniae. Reports on antibiotic resistance in AHS from throats are rare in Korea. A total of 333 healthy school children were subjected to recovery of AHS from the throat, and antibiotic susceptibility tests were screened with the disk diffusion method. The rate of resistance to erythromycin was 22.2%, to clindamycin 12.0%, and to cefotaxime 3.0%. Whereas the resistance rate of S. pneumoniae to erythromycin exceeds 70% in Korea, pharyngeal AHS showed low resistance rates.
Cefotaxime ; Child ; Clindamycin ; Diffusion ; Drug Resistance, Microbial ; Erythromycin ; Humans ; Korea ; Pharynx ; Pneumonia ; Streptococcus pneumoniae

BACKGROUND: Erythromycin (EM) or other macrolides have been used commonly for the treatment of bacterial pharyngitis. Recently, however, EM-resistant group A streptococci (GAS) are being reported with increasing frequency. The phenotypic expression of macrolide resistance is classified as constitutive, inducible, and M. EM resistance is mediated by ermB, ermTR, or mefA genes. The emm gene encoding M protein has variable sequences at 5'end terminus. METHODS: GAS was isolated from patients with acute pharyngitis at a local clinic in Jinju from November 2001 to May 2002. Antimicrobial susceptibility testing was performed using the disk diffusion method. The phenotypes of EM and clindamycin (CC) resistance were evaluated, and the frequency of ermB and mefA genes was determined by PCR. The emm genotype was identified with PCR and sequencing. RESULTS: A total of 125 strains of group A streptococci was isolated. The resistance rate to EM and CC was 44.8% and 19.2%, respectively. Constitutive resistance was observed in 42.1%, M phenotype in 57.9%, but inducible resistance was not seen. The ermB and mefA genes were positive in 39.3% and 58.9%, respectively. Most emm12 strains showed constitutive resistance, while emm18 and emm75 showed M phenotype. CONCLUSIONS: The EM and CC resistance rates of group A streptococci isolated from acute pharyngitis were remarkably high compared to the previous reports. M phenotype was more common than constitutive resistance in acute pharyngitis. The resistance pattern was variable according to the emm types, suggesting an association between the emm gene and resistant genes.
Clindamycin* ; Diffusion ; Erythromycin* ; Genotype ; Gyeongsangnam-do ; Humans ; Macrolides ; Pharyngitis* ; Phenotype ; Polymerase Chain Reaction

BACKGROUND: The mechanism of erythromycin resistance of Streptococcus pyogenes results from target modification or active efflux. The purpose of this study was to determine the positive rate of ermAM gene modifying 23S rRNA and that of mefA gene related with efflux for erythromycin-resistant S. pyogenes. METHODS: The minimal inhibitory concentrations (MICs) of erythromycin, azithromycin, clarithromycin, and clindamycin against S. pyogenes were tested by agar dilution method. ermAM and mefA genes were amplified by polymerase chain reaction (PCR) for 32 strains of erythromycin-resistant S. pyogenes. RESULTS: Among the 32 erythromycin-resistant S. pyogenes strains, 20 (62.5%) strains were positive for ermAM gene and 10 (31.1%) for mefA gene. Eighteen (90.0%) out of 20 strains with ermAM gene showed high-level erythromycin resistance (MIC> OR =64 microgram/mL), while all ten strains with mefA gene had low-level erythromycin resistance (MIC< OR =16 microgram/mL). CONCLUSION: Two-thirds of the S. pyogenes strains acquired erythromycin resistance by modification of target site, while the others by active efflux. Each mechanism of resistance is closely associated with range of MICs of erythromycin.
Agar ; Azithromycin ; Clarithromycin ; Clindamycin ; Erythromycin ; Polymerase Chain Reaction ; Streptococcus pyogenes* ; Streptococcus*

Lemierre's syndrome is characterized by a rare fulminant condition resulting from primary oropharyngeal infection followed by secondary septic thrombophlebitis of the internal jugular vein and metastatic infection. A forty-year-old man who had been on ventilator due to severe chest trauma, showed severe reddish inflammatory swelling of the right cervical soft tissue and newly developed pneumonia. He went into in septic condition shortly thereafter. Thrombophlebitis with central abscess in the right internal jugular vein was identified by neck CT and MRA(magnetic resonance angiography). Right cervical swelling worsened in spite of clindamycin and heparin therapy. We performed immediate surgery for removal of septic thrombus and resection of internal jugular vein. Patient's septic condition, pneumonia, and local inflammatory reaction were improved within several days after surgery.
Abscess ; Clindamycin ; Heparin ; Jugular Veins ; Lemierre Syndrome* ; Neck ; Pneumonia ; Thorax ; Thrombophlebitis ; Thrombosis ; Ventilators, Mechanical

Contact allergy to clindamycin is rare, especially in relation to its widespread use in topical formulation. Neverthless, when patients using topical clindamycin complain of itching, patch testing with this preparation and its separate ingredients should be considered. We report a case of allergic contact dermatitis due to clindamycin solution for acne vulgaris therapy in a 24-year-old woman.
Acne Vulgaris ; Clindamycin* ; Dermatitis, Allergic Contact* ; Dermatitis, Contact ; Female ; Humans ; Hypersensitivity ; Patch Tests ; Pruritus ; Young Adult