Gastrointestinal Distress

Common ADEs associated with antibacterial agents, but especially with macrolides, are nausea, vomiting, epigastric distress, and diarrhea.^{34,37,61,70,77} These symptoms may be amplified in patients on metronidazole with concurrent use of alcohol.⁷⁰ When a patient has been taking an antibacterial agent for 1 to 2 days, diarrhea is probably due to the mild irritating action of the drug; however, bloody diarrhea with abdominal cramping is highly suggestive of pseudomembranous colitis, a superinfection with Clostridiodes difficile.¹¹⁸ Colitis has been reported with the use of nearly all antibacterial agents, but especially with clindamycin.^{34,37,61,70,77}Up to 15% of community-acquired *C difficile* infection may be attributable to antibiotics prescribed for a dental procedure and a single dose of clindamycin may cause complications, including death, from C difficile infection.¹²²