Lincocin Warnings

Lincomycin therapy, like therapy with other broad-spectrum antibiotics, has been associated with pseudomembranous colitis which may end fatally. Therefore, it should be reserved for serious infections where less toxic antimicrobial agents are inappropriate (see Indications). Diarrhea, colitis and pseudomembranous colitis have been observed to begin up to several weeks following cessation of therapy with lincomycin. Consequently, it is important to consider this diagnosis in patients with diarrhea subsequent to the administration of lincomycin.
Treatment with antibiotics alters the normal flora of the colon and may permit the overgrowth of clostridia. Studies indicate a toxin(s) produced by Clostridium difficile is the primary cause of antibiotic-associated colitis.
Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly allantibacterial agents, including lincomycin, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile.
C. difficile produces toxins A and B which contribute to the development of CDAD. Hypertoxin producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over 2 months after the administration of antibacterial agents.
After the diagnosis of pseudomembranous colitis has been established, therapeutic measures should be initiated.
Mild cases of colitis may respond to drug discontinuance alone. Moderate to severe cases should be managed promptly with fluid, electrolyte and protein supplementation as indicated. Vancomycin has been found to be effective in the treatment of antibiotic-associated pseudomembranous colitis produced by Clostridium difficile. The usual adult dose is vancomycin 500 mg to 2 g orally/day in 3-4 divided doses administered for 7-10 days. Cholestyramine or colestipol resins bind vancomycin in vitro. If both resin and vancomycin are to be administered concurrently, it may be advisable to separate the time of administration of each drug. Systemic corticoids and corticoid retention enemas may help relieve colitis. Other causes of colitis should also be considered.
A careful inquiry should be made concerning previous sensitivities to drugs and other allergens.
Use in pregnancy & lactation: Safety for use in pregnancy has not been established.
Lincomycin has been reported to appear in breast milk in ranges of 0.5-2.4 mcg/mL.
Use in children: Until further clinical experience is obtained, Lincocin preparations are not indicated in the newborn.