Drug information of Clindamycin

Mechanism of effect

Inhibits protein synthesis in susceptible organisms by reversibly binding to 50S ribosomal subunits. It has activity against Gram-positive aerobes and anaerobes, as well as some Gram-negative anaerobes. Clindamycin is bacteriostatic.

Pharmacodynamic

Distribution :
Distributed into many body tissues and fluids. Only small amounts of the drug diffuse into CSF. Readily crosses the placenta and is distributed into milk .
Plasma Protein Binding
93%
Metabolism
Partially metabolized to bioactive and inactive metabolites.
Elimination Route
Excreted in urine, bile, and feces
Half-life
2–3 hours in adults and children with normal renal function.
Serum half-life in neonates depends on gestational and chronologic age and body

Pharmacokinetics

- To reduce the development of drug-resistant bacteria and maintain the effectiveness of clindamycin and other antibacterial drugs, clindamycin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria.
- Because clindamycin therapy has been associated with severe colitis which may end fatally, it should be reserved for serious infections where less toxic antimicrobial agents are inappropriate
- It should not be used in patients with nonbacterial infections such as most upper respiratory tract infections.
- Clinical experience indicates that C. difficile-associated diarrhea and colitis seen in association with anti-infectives may occur more frequently and be more severe in geriatric patients (>60 years of age).Geriatric patients receiving clindamycin should be carefully monitored for development of diarrhea.
- Use with caution in patients with a history of GI disease, particularly colitis.

Drug indications

Dosage

• Adults
General Adult Dosage
• Serious Infections
Oral
150–300 mg every 6 hours.
IV or IM
600 mg to 1.2 g daily in 2–4 equally divided doses.
• More Severe Infections
Oral
300–450 mg every 6 hours.
IV or IM
1.2–2.7 g daily in 2–4 equally divided doses.
For life-threatening infections, dosage may be increased up 4.8 g daily.
• Gynecologic Infections
Pelvic Inflammatory Disease
IV, then Oral
Initially, 900 mg IV every 8 hours;used in conjunction with IV or IM gentamicin. After clinical improvement occurs, discontinue IV clindamycin and gentamicin and switch to oral clindamycin in a dosage of 450 mg 4 times daily to complete 14 days of therapy.Alternatively, oral doxycycline can be used to complete 14 days of therapy.
• Pharyngitis and Tonsillitis
Treatment of Symptomatic Patients with Multiple, Recurrent Episodes Known to Caused by Streptococcus pyogenes
Oral
600 mg daily in 2–4 divided doses given for 10 days.
• Anthrax
Treatment of Inhalational Anthrax
IV
900 mg every 8 hours.
Used in multiple-drug regimens that initially include IV ciprofloxacin or IV doxycycline and 1 or 2 other anti-infectives predicted to be effective.
Duration of treatment is 60 days if anthrax occurred as the result of exposure to anthrax spores in the context of biologic warfare or bioterrorism.
• Babesiosis+
Oral
600 mg 3 times daily given for 7–10 days recommended by IDSA and others;used in conjunction with oral quinine (650 mg every 6–8 hours for 7–10 days).
IV
IDSA recommends 300–600 mg every 6 hours for 7–10 days; used in conjunction with oral quinine (650 mg every 6–8 hours for 7–10 days).Others recommend 1.2 g twice daily given for 7–10 days; used in conjunction with oral quinine (650 mg 3 times daily for 7–10 days).
• Bacterial Vaginosis
Treatment in Pregnant or nonpregnant Women
Oral
300 mg twice daily given for 7 days.
• Malaria
Treatment of Uncomplicated Chloroquine-resistant P. falciparum Malaria
Oral
20 mg/kg daily in 3 equally divided doses given for 7 days; used in conjunction with oral quinine sulfate (650 mg 3 times daily given for 3 days if infection was acquired in Africa or South America or for 7 days if acquired in Southeast Asia).
Treatment of Severe P. falciparum Malaria
Oral
20 mg/kg daily in 3 equally divided doses given for 7 days; used in conjunction with IV quinidine gluconate (followed by oral quinine sulfate) given for a total duration of 3–7 days.
IV, then Oral
10-mg/kg IV loading dose followed by 5 mg/kg IV every 8 hours; when oral therapy is tolerated, switch to oral clindamycin 20 mg/kg daily in 3 divided doses and continue for a total duration of 7 days.
• Toxoplasmosis
Treatment
Oral or IV
600 mg every 6 hours; used in conjunction with oral pyrimethamine (200-mg loading dose then 50–75 mg once daily) and oral leucovorin (10–20 mg once daily; higher dosage may be needed).
Continue acute treatment for ≥6 weeks.
Prevention of Recurrence (Secondary Prophylaxis)
Oral
300–450 mg every 6–8 hours; used in conjunction with oral pyrimethamine (25–50 mg once daily) and oral leucovorin (10–25 mg once daily).
Initiate long-term suppressive therapy or chronic maintenance therapy (secondary prophylaxis) in all patients who have completed initial treatment of toxoplasmosis encephalitis (TE).
Consideration can be given to discontinuing secondary prophylaxis in adults or adolescents who successfully completed initial treatment for TE, are asymptomatic with respect to TE, and have a sustained (≥6 months) increase in CD4+ T-cell counts to >200/mm3.
Reinitiate secondary prophylaxis if CD4+ T-cell count decreases to <200/mm3.
• Prevention of Bacterial Endocarditis
Patients Undergoing Certain Dental or Respiratory Tract Procedures
Oral
600 mg as a single dose given 30–60 minutes prior to the procedure.
IM or IV
600 mg as a single dose given 30–60 minutes prior to the procedure.
Prevention of Perinatal Group B Streptococcal Disease
Women at Risk Who Should Not Receive β-lactam Anti-infectives
IV
900 mg every 8 hours; initiate at time of labor or rupture of membranes and continue until delivery.
• Perioperative Prophylaxis
Head or Neck Surgery
IV
600–900 mg given at induction of anesthesia (within 0.5–1 hour prior to incision); used with or without IV gentamicin. Additional intraoperative doses suggested every 3–6 hours for prolonged procedures (>4 hours) or if major blood loss occurs.

Side effects

Interactions

Alerts

- To reduce the development of drug-resistant bacteria and maintain the effectiveness of clindamycin and other antibacterial drugs, clindamycin should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria.
- Because clindamycin therapy has been associated with severe colitis which may end fatally, it should be reserved for serious infections where less toxic antimicrobial agents are inappropriate
- It should not be used in patients with nonbacterial infections such as most upper respiratory tract infections.
- Clinical experience indicates that C. difficile-associated diarrhea and colitis seen in association with anti-infectives may occur more frequently and be more severe in geriatric patients (>60 years of age).Geriatric patients receiving clindamycin should be carefully monitored for development of diarrhea.
- Use with caution in patients with a history of GI disease, particularly colitis.

Points of recommendation

- May be taken with or without food.
- Clindamycin may cause diarrhea, and in some cases it can be severe. It may occur 2 months or more after you stop using clindamycin. Do not take any medicine to treat diarrhea without first checking with your doctor.
- Advice patients importance of completing full course of therapy, even if feeling better after a few days.
- Take clindamycin hydrochloride capsules with a full glass of water to avoid the possibility of esophageal irritation.

Pregnancy level

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