Clindamycin
Indications
Clindamycin is used for:
Dental infections, Respiratory tract infections, Skin and soft tissue infections, peritonitis, acne, anaerobic infections, endocarditis, Toxic shock syndrome, Bacterial vaginosis, Pelvic inflammatory disease
Adult Dose
Adult: PO Serious anaerobic infections 150-300 mg 6 hrly, up to 450 mg 6 hrly for severe infections.
Max: 1.8 g/day.
Prophylaxis of endocarditis 600 mg 1 hr before dental procedure.
IV Serious anaerobic infections 0.6-2.7 g/day in divided does, up to 4.8 g/day for severe infections.
Toxic shock syndrome W/ penicillin G or ceftriaxone: 900 mg 8 hrly.
Pelvic inflammatory disease W/ gentamicin: 900 mg 8 hrly.
Bacterial Vaginosis: 300 mg PO q12hr for 7 days
Child Dose
Neonates (less than 1 month): 15 to 20 mg/kg/day in 3 to 4 equal doses. The lower effective dosage may be adequate for small prematures.
Child: PO 10–25 mg/kg/day q8h
30–40 mg/kg/day for CA-MRSA, intra-abdominal infection, or AOM
Parenteral (IV/IM) administration: 20–40 mg/kg/day q8h. The higher doses would be used for more severe infections.
Renal Dose
Administration
Cap: May be taken with or without food. Swallow whole w/ a full glass of water & in an upright position.
Granules: Should be taken with food.
IV Preparation
Dilute 300 and 600 mg in 50 mL of D5W
Dilute 900 mg in 50-100 mL of D5W
Dilute 1200 mg in 100 mL of D5W
IV Administration
Intermittent IV infusion
Infuse over 10-60 min at a rate not exceeding 30 mg/min
300 mg doses infuse over 10 min
600 mg doses infuse over 20 min
900 mg doses infuse over 30 min
1200 mg doses infuse over 60 min; no more than 1200 mg of drug should be given by IV infusion in 1 hr
Continuous IV infusion
May give continuous IV infusion instead of intermittent after first dose has been given by rapid IV infusion
Contra Indications
Hypersensitivity.
Precautions
Renal and hepatic diseases; pregnancy and lactation; GI disease; elderly, females, neonates, atopic patients. Regular monitoring of blood counts, liver and kidney functions.
Lactation: Excreted in breast milk; manufacturer suggests discontinue drug or do not nurse (AAP Committee states compatible with nursing)
Pregnancy-Lactation
Interactions
May enhance the action of neuromuscular blocking agents (e.g. atracurium). May antagonise the effects of parasympathomimetics. May competitively inhibit the effects of macrolides, ketolides, streptogramins, linezolid and chloramphenicol. Increased coagulation tests (prothrombin time/INR) and/or bleeding w/ vit K antagonists (e.g. warfarin, acenocoumarol, fluindione).
Adverse Effects
Side effects of Clindamycin :
Diarrhoea, nausea, vomiting, abdominal pain; erythema multiforme, contact dermatitis, exfoliative and vesiculous dermatitis, urticaria; eosinophilia; local irritation, thrombophloebitis.
Potentially Fatal: Gasping syndrome (neonates); pseudomembranous colitis.
Mechanism of Action
Clindamycin inhibits protein synthesis by reversibly binding to the 50S subunit of the ribosomal thus blocking the transpeptidation or translocation reactions of susceptible organisms resulting to stunted cell growth.