Look Up > Drugs > Clindamycin
Clindamycin
Pronunciation
U.S. Brand Names
Generic Available
Canadian Brand Names
Synonyms
Pharmacological Index
Use
Pregnancy Risk Factor
Contraindications
Warnings/Precautions
Adverse Reactions
Overdosage/Toxicology
Drug Interactions
Stability
Mechanism of Action
Pharmacodynamics/Kinetics
Usual Dosage
Dietary Considerations
Monitoring Parameters
Mental Health: Effects on Mental Status
Mental Health: Effects on Psychiatric Treatment
Dental Health: Local Anesthetic/Vasoconstrictor Precautions
Dental Health: Effects on Dental Treatment
Patient Information
Nursing Implications
Dosage Forms
References

Pronunciation
(klin da MYE sin)

U.S. Brand Names
Cleocin-3®; Cleocin HCl®; Cleocin Pediatric®; Cleocin Phosphate®; Cleocin T®; Clinda-Derm® Topical Solution; Clindets® Pledgets; C/T/S® Topical Solution

Generic Available

Yes: Injection


Canadian Brand Names
Dalacin® C [Hydrochloride]

Synonyms
Clindamycin Hydrochloride; Clindamycin Phosphate

Pharmacological Index

Antibiotic, Miscellaneous


Use

Dental: Alternate antibiotic, when amoxicillin cannot be used, for the standard regimen for prevention of bacterial endocarditis in patients undergoing dental procedures; an alternative to penicillin VK and erythromycin for treating orofacial infections; alternate antibiotic for prophylaxis for dental patients with total joint replacement

Medical: Treatment against aerobic and anaerobic streptococci (except enterococci), most staphylococci, Bacteroides sp and Actinomyces; used topically in treatment of severe acne, vaginally for Gardnerella vaginalis or bacterial vaginosis; alternate treatment for toxoplasmosis; prophylaxis in the prevention of bacterial endocarditis in high-risk patients undergoing surgical or dental procedures in patients allergic to penicillin; may be useful in PCP


Pregnancy Risk Factor

B


Contraindications

Hypersensitivity to clindamycin or any component; previous pseudomembranous colitis, hepatic impairment


Warnings/Precautions

Dosage adjustment may be necessary in patients with severe hepatic dysfunction; can cause severe and possibly fatal colitis; use with caution in patients with a history of pseudomembranous colitis; discontinue drug if significant diarrhea, abdominal cramps, or passage of blood and mucus occurs


Adverse Reactions

>10%: Gastrointestinal: Diarrhea

1% to 10%:

Dermatologic: Rashes

Gastrointestinal: Pseudomembranous colitis (more common with oral form), nausea, vomiting

<1%: Hypotension, urticaria, Stevens-Johnson syndrome, eosinophilia, neutropenia, granulocytopenia, thrombocytopenia, elevated liver enzymes, thrombophlebitis, sterile abscess at I.M. injection site, polyarthritis, rare renal dysfunction


Overdosage/Toxicology

Symptoms of overdose include diarrhea, nausea, vomiting; following GI decontamination

Treatment is supportive


Drug Interactions

CYP3A3/4 enzyme substrate


Stability

Do not refrigerate reconstituted oral solution because it will thicken; oral solution is stable for 2 weeks at room temperature following reconstitution; I.V. infusion solution in NS or D5W solution is stable for 16 days at room temperature


Mechanism of Action

Reversibly binds to 50S ribosomal subunits preventing peptide bond formation thus inhibiting bacterial protein synthesis; bacteriostatic or bactericidal depending on drug concentration, infection site, and organism


Pharmacodynamics/Kinetics

Absorption: ~10% of topically applied drug is absorbed systemically; 90% absorbed rapidly from GI tract following oral administration

Distribution: No significant levels are seen in CSF, even with inflamed meninges; crosses the placenta; distributes into breast milk; high concentrations in bone and urine

Metabolism: Hepatic

Half-life: Neonates: Premature: 8.7 hours; Full-term: 3.6 hours; Adults: 1.6-5.3 hours, average: 2-3 hours

Time to peak serum concentration: Oral: Within 60 minutes; I.M.: Within 1-3 hours

Elimination: Most of drug eliminated by hepatic metabolism


Usual Dosage

Avoid in neonates (contains benzyl alcohol)

Oral: 8-20 mg/kg/day as hydrochloride; 8-25 mg/kg/day as palmitate in 3-4 divided doses; minimum dose of palmitate: 37.5 mg 3 times/day

I.M., I.V.:

<1 month: 15-20 mg/kg/day

>1 month: 20-40 mg/kg/day in 3-4 divided doses

Children and Adults: Topical: Apply a thin film twice daily

Adults:

Oral: 150-450 mg/dose every 6-8 hours; maximum dose: 1.8 g/day

I.M., I.V.: 1.2-1.8 g/day in 2-4 divided doses; maximum dose: 4.8 g/day

Bacterial endocarditis prophylaxis: 600 mg 1 hour prior to the procedure

Pelvic inflammatory disease: I.V.: 900 mg every 8 hours with gentamicin 2 mg/kg, then 1.5 mg/kg every 8 hours; continue after discharge with doxycycline 100 mg twice daily or oral clindamycin 450 mg 5 times/day for 10-14 days

Pneumocystis carinii pneumonia:

Oral: 300-450 mg 4 times/day with primaquine

I.M., I.V.: 1200-2400 mg/day with pyrimethamine

I.V.: 600 mg 4 times/day with primaquine

Vaginal: One full applicator (100 mg) inserted intravaginally once daily before bedtime for 3 or 7 consecutive days

Intravaginal suppositories: Insert one ovule (100 mg clindamycin) daily into vagina at bedtime for 3 days

Dosing adjustment in hepatic impairment: Adjustment recommended in patients with severe hepatic disease


Dietary Considerations

Peak concentrations may be delayed with food; may be taken with food


Monitoring Parameters

Observe for changes in bowel frequency, monitor for colitis and resolution of symptoms; during prolonged therapy monitor CBC, liver and renal function tests periodically


Mental Health: Effects on Mental Status

None reported


Mental Health: Effects on Psychiatric Treatment

May cause neutropenia; use caution with clozapine and carbamazepine


Dental Health: Local Anesthetic/Vasoconstrictor Precautions

No information available to require special precautions


Dental Health: Effects on Dental Treatment

No effects or complications reported


Patient Information

Oral: Take each dose with a full glass of water. Complete full prescription, even if feeling better. You may experience nausea or vomiting (small frequent meals, frequent mouth care, chewing gum, or sucking lozenges may help). Report dizziness; persistent gastrointestinal effects (pain, diarrhea, vomiting); skin redness, rash, or burning; fever; chills; unusual bruising or bleeding; signs of infection; excessive fatigue; yellowing of eyes or skin; change in color of urine or blackened stool; swelling, warmth, or pain in extremities; difficult respirations; bloody or fatty stool (do not take antidiarrheal without consulting prescriber); or lack or improvement or worsening of condition.

Topical: Wash hands before applying or wear gloves. Apply thin film of gel, lotion, or solution to affected area. May apply porous dressing. Report persistent burning, swelling, itching, or worsening of condition.

Vaginal: Wash hands before using. At bedtime, gently insert full applicator into vagina and expel cream. Wash applicator with soap and water following use. Remain lying down for 30 minutes following administration. Avoid intercourse during 7 days of therapy. Report adverse reactions (dizziness, nausea, vomiting, stomach cramps, or headache) or lack of improvement or worsening of condition.


Nursing Implications

Administer by I.V. intermittent infusion over at least 10-60 minutes, at a rate not to exceed 30 mg/minute; final concentration for administration should not exceed 12 mg/mL

Observe for changes in bowel frequency; during prolonged therapy monitor CBC, liver and renal function tests periodically


Dosage Forms

Capsule, as hydrochloride: 75 mg, 150 mg, 300 mg

Cream, vaginal: 2% (40 g)

Gel, topical, as phosphate: 1% [10 mg/g] (7.5 g, 30 g)

Granules for oral solution, as palmitate: 75 mg/5 mL (100 mL)

Infusion, as phosphate, in D5W: 300 mg (50 mL); 600 mg (50 mL)

Injection, as phosphate: 150 mg/mL (2 mL, 4 mL, 6 mL, 50 mL, 60 mL)

Lotion: 1% [10 mg/mL] (60 mL)

Pledgets: 1%

Solution, topical, as phosphate: 1% [10 mg/mL] (30 mL, 60 mL, 480 mL)

Suppository, vaginal: 2.5 g (clindamycin 100 mg)


References

"Advisory Statement. Antibiotic Prophylaxis for Dental Patients With Total Joint Replacements. American Dental Association; American Academy of Orthopedic Surgeons," J Am Dent Assoc, 1997, 128(7):1004-8.

Dajani AS, Taubert KA, Wilson W, et al, "Prevention of Bacterial Endocarditis. Recommendations by the American Heart Association," JAMA, 1997, 277(22):1794-801.

Falagas ME and Gorbach SL, "Clindamycin and Metronidazole," Med Clin North Am, 1995, 79(4):845-67.

Katlama C, De Wit S, O'Doherty E, et al, "Pyrimethamine-Clindamycin vs Pyrimethamine-Sulfadiazine as Acute and Long-Term Therapy for Toxoplasmic Encephalitis in Patients With AIDS," Clin Infect Dis, 1996, 22(2):268-75.

Smilack JD, Wilson WR, and Cockerill FR 3d, "Tetracyclines, Chloramphenicol, Erythromycin, Clindamycin, and Metronidazole," Mayo Clin Proc, 1991, 66(12):1270-80.

Toma E, Thorne A, Singer J, et al, "Clindamycin With Primaquine vs Trimethoprim-Sulfamethoxazole Therapy for Mild and Moderately Severe Pneumocystis carinii Pneumonia in Patients With AIDS: A Multicenter, Double-Blind, Randomized Trial (CTN 004). CTN-PCP Study Group," Clin Infect Dis, 1998, 27(3):524-30.

Wynn RL and Bergman SA, "Antibiotics and Their Use in the Treatment of Orofacial Infections, Part I and Part II," Gen Dent, 1994, 42(5):398-402, 498-502.

Wynn RL, "Clindamycin: An Often Forgotten but Important Antibiotic," AGD Impact, 1994, 22:10.

Yoshikawa TT, "Antimicrobial Therapy for the Elderly Patient," J Am Geriatr Soc, 1990, 38(12):1353-72.


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