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Abstract
Drug reactions are increasingly being recognised in HIV-infected persons (1). The use of clindamycin for prophylaxis and treatment for toxoplasmic encephalitis (TE) (2) and treatment of Pneumocystis carinii pneumonia (PCP) (3) has been found to be associated with a significantly high incidence of advcrse cffccts. Wc report our experience of toxicity following clindamycin administration necessitating its withdrawal in 5 HIV-infected patients who had received the drug for treatment of PCP (n = 2). bacterial overgrowth confirmed on duodenal aspiration (n= I), deep skin abscess (n= 1) and a finger pulp infection (n = I). The dose of clindamycin ranged from 600 to 1800 mg daily. All patients were males aged 35-39 years with a mean CD4 cell count of 100/p1. Four patients developed diarrhoea though none wcrc found to have Clostridium difficile toxin in their stools. The onset of diarrhoea varied from 3 to 13 days after initiation of therapy. Three patients developed a generalised maculopapular rash after 5-13 days. In all cases symptoms resolved rapidly after discontinuation of clindamycin. Our cxpcriencc suggests that clindamycin is poorly tolerated in HIV-infected persons and this may be ii ma.ior limiting factor in its use not only in both active and prophylactic treatment for PCP and TE but other related infections which are susceptible to clindamycin.
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