Clindamycin as an anti-staphylococcal agent--indications and limitations.

In a general survey it is stated that for single Staphylococcus aureus infections, clindamycin is not considered to be a first-line drug. Its chief indication is penicillin allergy. Penetration and accumulation of clindamycin within leukocytes demonstrated in vitro may be of value in the treatment of S. aureus diseases resulting in large abscesses. An insidious risk of the development of Clostridium difficile diarrhoea limits the use of clindamycin in ambulatory long-term treatment of diabetic osteitis and chronic osteomyelitis. Such patients must therefore be carefully checked during clindamycin therapy. In staphylococcal endocarditis treated with clindamycin, relapses and development of resistance have been reported. Mixed staphylococcal and anaerobic infections in skin, subcutaneous tissue, the diabetic foot, bone and joints are primary indications for clindamycin. S. epidermidis infections, especially septicemia and endocarditis, are not suitable for clindamycin therapy due to a high rate of resistance.