Research presented at the 2025 European Alliance of Associations for Rheumatology (EULAR) Congress suggests that the antibiotic clindamycin is linked to a higher risk of gout flares than the commonly used alternative, trimethoprim/sulfamethoxazole (T/S)—especially in people with chronic kidney disease (CKD). The findings highlight the important role of gut bacteria in managing uric acid, particularly when kidney function is reduced.

Higher Gout Risk Seen with Clindamycin

Researchers used a method called target trial emulation to analyze real-world data from 1997 to 2023. They identified more than 612,000 adults who had newly started a five-day or longer course of oral clindamycin or T/S, with no prior gout diagnosis or antibiotic use in the past year. To ensure balanced comparison, the team used matching techniques across more than 60 health-related factors.

Among the matched patients (mean age 47 years; 43% men), those who took clindamycin experienced more gout flares both at 3 months and at 12 months after treatment started. The difference was especially sharp in patients with CKD. In that group of 13,550 people, clindamycin users had: 

• 37.2 flares per 1000 person-years, compared to 
• 10.3 in the T/S group. 

This means clindamycin users with CKD were more than three times as likely to experience a gout flare. The risk was also higher, though less dramatically, in patients without CKD.

Gut Bacteria May Play a Protective Role

The study supports the idea that certain gut bacteria, which help break down purines (a source of uric acid), may help prevent gout flares. Clindamycin may disrupt these bacteria, leading to higher uric acid levels, especially harmful in people with CKD, who rely more on the gut to clear uric acid.

Researchers also found clindamycin users had a higher risk of C. difficile infection, but no increased risk for osteoarthritis. These results suggest doctors should be cautious when prescribing clindamycin, particularly for patients with kidney problems. If you have gout or are at risk for it, inform your doctor and ask about all your antibiotic options.

*Kuhns, L. (2025, June 20). Clindamycin Use Linked to Gout Flares in Chronic Kidney Disease. Renal and Urology News. https://www.renalandurologynews.com/news/clindamycin-linked-to-gout-flares-in-ckd/ 

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