Clindamycin C. difficile Risk — FRCA Final MCQ

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EasyPreoperative AssessmentClindamycin C. difficile RiskFRCA Final

A 45-year-old man (ASA II) has a dental abscess requiring incision and drainage. He is allergic to amoxicillin (mild rash only, not anaphylaxis). He is given a single dose of IV clindamycin 600 mg as prophylaxis. What serious adverse effect of clindamycin must be warned about post-operatively?

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Correct answer: B — Anaphylaxis

Clindamycin is associated with Clostridioides difficile-associated diarrhoea (CDAD), including potentially fatal pseudomembranous colitis. Even a single dose can precipitate C. difficile infection. Patients must be advised to seek medical attention if they develop diarrhoea in the weeks following clindamycin administration. This risk has led many guidelines to recommend clindamycin only when no suitable alternative exists. For surgical prophylaxis in penicillin-allergic patients, alternatives include: teicoplanin, gentamicin, or co-trimoxazole depending on the indication and local guidelines.

Reference: BNF – 2025 – Clindamycin: adverse effects; NICE – 2021 – NG199 C. difficile