Indications
Clindamycin has been shown to be effective in the treatment of the following infections when caused by susceptible anaerobic bacteria or susceptible strains of gram positive bacteria such as Streptococci, Staphylococci and Pneumococci; Upper respiratory infections, Lower respiratory infections, Skin and soft tissue infections, Bone and joint infections, Pelvic infections, Intra-abdominal infections, Septicemia and endocarditis, Dental infections. As alternative therapy when used in combination with quinine or amlodiaquine for the treatment of multi-drug resistant Plasmodium infection.
Therapeutic Class
Miscellaneous Antibiotics
Pharmacology
Clindamycin inhibits protein synthesis by reversibly binding to the 50S ribosomal subunit, thus blocking the transpeptidation or translocation reactions of susceptible organisms resulting to stunted cell growth.
It has activity against-
Aerobic gram-positive cocci, including: Staphylococcus aureus, Staphylococcus epidermidis (penicillinase and non-penicillinase producing strains), Streptococci, Pneumococci.
Anaerobic gram-negative bacilli including: Bacteroides species, Fusobacterium species.
Anaerobic gram-positive non-spore forming bacilli including:
Propionibacterium species, Eubacterium species, Actinomyces species.
Anaerobic and microaerophilic gram-positive cocci including: Peptococcus species, Peptostreptococcus species, Microaerophilic streptococci, C. perferinges.
Dosage
Oral-
Severe anaerobic infections:
Adult: 150-300 mg 6 hourly, up to 450 mg in severe infections. Max: 1.8 g/day.
Child: 3-6 mg/kg 6 hourly.
Parenteral-
Severe anaerobic infections:
Adult: 0.6-2.7 g daily in 2-4 divided doses, increased to 4.8 g daily in life-threatening infections. Infuse IV admin over 10-60 min and at a rate of ≤30 mg/min. Single dose of IM inj should not exceed 600 mg nor is admin of above 1.2 g in a single 1 hour infusion.
Child: >1 month 15-25 mg/kg daily in 3 or 4 divided doses; in severe infections, increase to 40 mg/kg daily and a min dose of 300 mg daily should be given regardless of body wt.
Topical/Cutaneous-
Acne:
Adult: As 1% preparation: Apply a thin layer onto affected area bid.
Vaginal-
Bacterial vaginosis:
Adult: As pessary or 2% cream: 100 mg at bedtime for 3-7 days.
Administration
Clindamycin Lotion 1%: Clean the face or affected area gently with warm water or soap as recommended by the physician. After the skin is dried, apply a thin film of lotion to the affected areas twice daily, in the morning and in the evening.
Do not wash within three hours after using lotion. The treatment period is usually 6 weeks or as advised by the physician.
However, 8 to 12 weeks of treatment may be required for maximum benefit.
Clindamycin 2% Vaginal preparation: One applicator full (approximately 5 gm) intravaginally at bedtime for 7 consecutive days. In patients in whom a shorter treatment course is desirable, a 3 day regimen has been shown to be effective.
Interaction
Clindamycin enhance the action of other neuromuscular blocking agents. Therefore, it should be used with caution in patients receiving such agents. Antagonism has been demonstrated between clindamycin and erythromycin in vitro. Because of possible clinical significance, these two drugs should not be administered concurrently.
Contraindications
Clindamycin is contraindicated in patients previously found to be sensitive to clindamycin or any of the ingredients of this medicine.
Side Effects
Abdominal pain, oesophagitis and oesophagial ulcer, nausea, vomiting and diarrhoea, pruritus, skin rashes, urticaria.
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