Clindamycin (Surgical Prophylaxis — Penicillin Allergy)

How it works

It inhibits bacterial protein synthesis by binding the 50S ribosomal subunit, acting in a bacteriostatic manner.

Prescribing in practice

• It is strongly associated with Clostridioides difficile infection, so use should be reserved, kept short, and stopped promptly if significant diarrhoea develops.
• When given intravenously it should be infused slowly rather than as a rapid bolus to avoid cardiovascular reactions.
• It is a useful choice in beta-lactam allergy but does not provide the Gram-negative cover that some procedures require, so additional cover may be needed.

Monitoring

Monitor for diarrhoea and signs of Clostridioides difficile infection, clinical response, and infusion-related effects with intravenous use.

Counselling the patient

• Report any diarrhoea, especially if severe, watery, or with blood, even after finishing the antibiotic.
• This may be given because you are allergic to penicillin-type antibiotics.
• Tell staff about all your allergies and any previous bowel infections.

Evidence & guidelines

Clindamycin is an established option for surgical prophylaxis in beta-lactam allergy, with its Clostridioides difficile risk well documented in stewardship guidance.