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.
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.
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.
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.
- Adult: As 1% preparation: Apply a thin layer onto affected area bid.
- Adult: As pessary or 2% cream: 100 mg at bedtime for 3-7 days.
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.
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.
Clindamycin is contraindicated in patients previously found to be sensitive to clindamycin or any of the ingredients of this medicine.
Abdominal pain, oesophagitis and oesophagial ulcer, nausea, vomiting and diarrhoea, pruritus, skin rashes, urticaria.
Pregnancy Category B: Clindamycin crosses the placenta in humans. After multiple doses, amniotic fluid concentrations were approximately 30% of maternal concentrations. Clindamycin should be used in pregnancy only if clearly needed.
Lactation: Clindamycin has been reported to appear in breast milk. Therefore, it is not recommended for nursing mothers if not clearly needed.
Clindamycin should be prescribed with caution in individuals with a history of gastrointestinal disease, particularly colitis.
Overdosage with orally administered clindamycin has been rare. Adverse reactions similar to those seen with normal doses can be expected, however, unexpected reactions could occur. Haemodialysis and peritoneal dialysis are not effective in removing clindamycin from the serum. Overdosage should be treated with simple gastric lavage. No specific antidote is known.
Store between 20-25°C. Do not refrigerate or freeze.