Hospital-wide restriction of clindamycin: effect on the incidence of Clostridium difficile-associated diarrhea and cost

Ann Intern Med. 1998 Jun 15;128(12 Pt 1):989-95. doi: 10.7326/0003-4819-128-12_part_1-199806150-00005.


Background: Widespread antibiotic use has been associated with increases in both bacterial resistance and nosocomial infection.

Objective: To characterize the impact of hospital-wide clindamycin restriction on the incidence of Clostridium difficile-associated diarrhea and on antimicrobial prescribing practices.

Design: Prospective, observational cohort study.

Setting: University-affiliated Veterans Affairs Medical Center.

Patients: Hospitalized patients with symptomatic diarrhea.

Measurements: Clinical data on individual patients and data on antibiotic use were obtained from hospital pharmacy records. Hospital-wide use of antimicrobial agents was monitored. Isolates of C. difficile underwent antimicrobial susceptibility testing and molecular typing.

Results: An outbreak of C. difficile-associated diarrhea was caused by a clonal isolate of clindamycin-resistant C. difficile and was associated with increased use of clindamycin. Hospital-wide requirement of approval by an infectious disease consultant of clindamycin use led to an overall reduction in clindamycin use, a sustained reduction in the mean number of cases of C. difficile-associated diarrhea (11.5 cases/month compared with 3.33 cases/month; P < 0.001), and an increase in clindamycin susceptibility among C. difficile isolates (9% compared with 61%; P < 0.001). A parallel increase was noted in the use of and costs associated with other antibiotics with antianaerobic activity, including cefotetan, ticarcillin-clavulanate, and imipenem-cilastin. The hospital realized overall cost savings as a result of the decreased incidence of C. difficile-associated diarrhea.

Conclusions: Hospital formulary restriction of clindamycin is an effective way to decrease the number of infections due to C. difficile. It can also lead to a return in clindamycin susceptibility among isolates and can effect cost savings to the hospital.

MeSH terms

  • Anti-Bacterial Agents / economics*
  • Anti-Bacterial Agents / therapeutic use
  • Clindamycin / economics*
  • Clindamycin / therapeutic use
  • Clostridioides difficile* / drug effects
  • Clostridium Infections / epidemiology*
  • Cross Infection / epidemiology*
  • Cross Infection / microbiology
  • Diarrhea / epidemiology*
  • Diarrhea / microbiology
  • Drug Resistance, Microbial
  • Drug Utilization / economics
  • Humans
  • Incidence
  • Pharmacy Service, Hospital / economics*
  • Prospective Studies
  • Risk Factors


  • Anti-Bacterial Agents
  • Clindamycin