Lincomycin

C. difficile-associated diarrhea (CDAD) has been reported. May range in severity from mild to severe (and possibly fatal). Lincomycin therapy should be reserved for serious infections for which less toxic antimicrobial agents are inappropriate. It should not be used in patients with nonbacterial infections, such as most upper respiratory tract infections. CDAD has been observed more than 2 months postantibiotic treatment.

Hypersensitivity reactions, including anaphylaxis and erythema multiforme, have been reported. Discontinue use if allergic reaction occurs.

Prolonged use may result in bacterial or fungal superinfection, particularly yeasts. Concomitant antimonilial infection treatment should be given in patients with preexisting monilial infections. Disease-related concerns:

Use with caution in patients with significant allergies.

Use with caution in patients with a history of asthma.

Use with caution in patients with a history of gastrointestinal disease (particularly colitis).

Use with caution in patients with hepatic impairment; half-life may be prolonged 2-fold.

Use with caution in patients with renal impairment; half-life may be prolonged; dosage adjustment necessary with severe impairment. Concurrent drug therapy concerns:

Potentially significant interactions may exist, requiring dose or frequency adjustment, additional monitoring, and/or selection of alternative therapy. Consult drug interactions database for more detailed information. Special populations:

Use with caution in the elderly; monitor closely for bowel changes. Dosage form specific issues:

Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity ("gasping syndrome") in neonates; the "gasping syndrome" consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension, and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggest that benzoate displaces bilirubin from protein binding sites (Ahlfors, 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer’s labeling. Other warnings/precautions:

Do not use undiluted as an IV bolus.

Generally reserved for use when treatment with other antibiotics is inappropriate. Not appropriate for use in the treatment of meningitis due to inadequate penetration into the cerebrospinal fluid.