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Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. It should not be used in patients with nonbacterial infections such as most upper respiratory tract infections. Hypertoxin producing strains of C. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. Its use should be reserved for penicillin-allergic patients or other patients for whom, in the judgment of the physician, a penicillin is inappropriate. Because of the risk of antibiotic-associated pseudomembranous colitis, as described in the BOXED WARNING, before selecting clindamycin the physician should consider the nature of the infection and the suitability of less toxic alternatives e. Lower respiratory tract infections including pneumonia, empyema, and lung abscess caused by anaerobes, Streptococcus pneumoniae, other streptococci except E. Skin and skin structure infections caused by Streptococcus pyogenes, Staphylococcus aureus, and anaerobes. Intra-abdominal infections including peritonitis and intra-abdominal abscess caused by susceptible anaerobic organisms. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

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