CLOSTRIDIUM-DIFFICILE TOXIN-INDUCED COLITIS AFTER USE OF CLINDAMYCIN PHOSPHATE VAGINAL CREAM

OBJECTIVE: To report a case of toxin-positive Clostridium difficile-in duced colitis (CDIC) after use of clindamycin phosphate vaginal cream. CASE SUMMARY: A 25-year-old postpartum white woman developed multiple watery stools and abdominal cramping on day 6 of therapy with clindam ycin vaginal cream for bacterial vaginosis. She received no other conc omitant medications. The patient's stool sample was found to be positi ve for the C. difficile toxin. Due to the costs and risks of standard therapy, we decided to manage the patient supportively. Complete resol ution of the diarrhea occurred shortly thereafter. DISCUSSION: No publ ished clinical studies in patients receiving clindamycin vaginal cream for bacterial vaginosis have documented C. difficile toxin in stool s amples of patients with diarrhea. Approximately 5-6% of intravaginal c lindamycin is absorbed in the bloodstream making systemic effects poss ible. CONCLUSIONS: This report indicates clindamycin phosphate vaginal cream as the most probable cause of CDIC due to the temporal relation ship between the occurrence of diarrhea and clindamycin administration , lack of concomitant medications, and documentation of C. difficile t oxin.