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| {{DrugProjectFormSinglePage | | {{Details0|Clindamycin hydrochloride (injection)}} |
| |authorTag={{KS}} | | {{Details0|Clindamycin hydrochloride (oral)}} |
| |hasBlackBoxWarning=Yes
| | {{Details0|Clindamycin hydrochloride (vaginal)}} |
| |blackBoxWarningTitle=WARNING
| | {{Details0|Clindamycin phosphate (gel)}} |
| |blackBoxWarningBody=Clostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including CLEOCIN HCl and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon, leading to overgrowth of C. difficle.
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| Because CLEOCIN HCl 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, as described in the INDICATIONS AND USAGE section. It should not be used in patients with nonbacterial infections such as most upper respiratory tract infections.
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| C. difficile produces toxins A and B, which contribute to the development of CDAD. Hypertoxin producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents.
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| If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated.
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| |offLabelAdultGuideSupport=There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of Clindamycin in adult patients.
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| |offLabelAdultNoGuideSupport=There is limited information regarding <i>Off-Label Non–Guideline-Supported Use</i> of Clindamycin in adult patients.
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| |offLabelPedGuideSupport=There is limited information regarding <i>Off-Label Guideline-Supported Use</i> of Clindamycin in pediatric patients.
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| |offLabelPedNoGuideSupport=There is limited information regarding <i>Off-Label Non–Guideline-Supported Use</i> of Clindamycin in pediatric patients.
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| |alcohol=Alcohol-Clindamycin interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.
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| }} | |
| {{drugbox | | |
| |image=Clindamycin skeletal.svg | |
| |IUPAC_name = (2''S'',4''R'')-''N''-((1''R'')-2-chloro-<br />1-((3''R'',4''R'',5''S'',6''R'')-3,4,5-trihydroxy-<br />6-(methylthio)-tetrahydro-2''H''-pyran-2-yl)propyl)-<br />1-methyl-4-propylpyrrolidine-2-carboxamide
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| |CAS_number = 18323-44-9
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| | ATC_prefix=J01
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| | ATC_suffix=FF01
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| | ATC_supplemental={{ATC|G01|AA10}}
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| | PubChem=29029
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| | DrugBank=APRD00566
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| | C=18 | H=33 | Cl=1 | N=2 | O=5 | S=1
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| |molecular_weight = 424.98 g/mol
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| |bioavailability = 90% (oral)<br />4–5% (topical)
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| |metabolism = [[Liver|Hepatic]]
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| |protein_bound = 90%
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| |elimination_half-life = 2–3 hours
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| |excretion = [[Kidney|Renal]]
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| |pregnancy_US = B
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| |pregnancy_AU = A
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| |legal_status = Schedule 4 ([[Australia|Aust]])<br />POM ([[United Kingdom|UK]])<br />Prescription only ([[U.S.]])
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| |routes_of_administration = Oral, [[topical]], [[intravenous|IV]], [[pessary|intravaginal]]
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| }} | |
| {{SI}} | |
| __NOTOC__
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| {{See also|Clindamycin hydrochloride|Clindamycin palmitate hydrochloride|Clindamycin phosphate}}
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| {{CMG}} | |
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| ==Overview==
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| '''Clindamycin''' ([[International Nonproprietary Name|rINN]]) ([[International Phonetic Alphabet|IPA]]: {{IPA|[klɪndəˈmaɪsən]}}) is a [[lincomycin|lincosamide]] [[antibiotic]] used in the treatment of [[infection]]s caused by susceptible [[microorganism]]s. Clindamycin is a semisynthetic antibiotic derived from [[lincomycin]] by 7(''S'')-[[chloro]]-substitution of the 7(''R'')-[[hydroxyl]] group of the lincomycin. Clindamycin is marketed under various [[trade name]]s including '''Dalacin''' ([[Pfizer]]), '''Cleocin''' ([[Pfizer]]), and in a foam as '''Evoclin''' (Connetics) and '''Duac'''([[Stiefel]]).
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| ==Indications==
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| Clindamycin is used primarily to treat infections caused by susceptible [[anaerobic organism|anaerobic]] [[bacteria]]. Such infections might include infections of the [[respiratory tract]], [[septicemia]] and [[peritonitis]]. In patients with [[hypersensitivity]] to [[penicillin]]s, clindamycin may be used to treat infections caused by susceptible [[aerobic organism|aerobic]] bacteria as well. It is also used to treat bone infections caused by ''[[Staphylococcus aureus]]''. [[Topical application]] of clindamycin phosphate can be used to treat moderate to severe [[acne]]. | |
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| It is most effective against infections involving the following types of organisms:
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| * Aerobic [[gram-positive]] [[cocci]], including some members of the ''[[Staphylococcus]]'' and ''[[Streptococcus]]'' (eg. [[pneumococcus]]) [[genus|genera]].
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| * Anaerobic [[gram-negative]] [[bacilli]], including some members of the ''[[Bacteroides]]'' and ''[[Fusobacterium]]'' genera.
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| Clindamycin is also used occasionally in cases of suspected [[toxic shock syndrome]] in combination with a [[bactericidal]] agent such as [[vancomycin]]. The rationale for this approach is a presumed synergy between the bactericidal antibiotic, which causes the death of the bacteria by [[lysis|breakdown of the cell membrane]], and clindamycin, which inhibits toxin synthesis.
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| Clindamycin has been proven to decrease the risk of [[preterm birth]]s in women diagnosed with [[bacterial vaginosis]] during early pregnancy to about a third of the risk of untreated women (Lamont, 2005).
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| Recently, clindamycin has been found to be useful in skin and [[soft tissue]] infections caused by [[methicillin-resistant Staphylococcus aureus|methicillin-resistant ''Staphylococcus aureus'']] (Daum, 2007).
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| == Available forms ==
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| Clindamycin preparations for oral administration include capsules (containing clindamycin [[hydrochloride]]) and oral suspensions (containing clindamycin [[palmitate]] hydrochloride). It is also available for [[topical]] administration, in [[gel]] form and in a foam delivery system (both containing clindamycin [[phosphate]]), primarily as a prescription acne treatment.
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| == Adverse effects ==
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| Common [[adverse drug reaction]]s (ADRs) associated with clindamycin therapy—found in over 1% of patients—include: [[diarrhea]], [[pseudomembranous colitis]], [[nausea]], [[vomiting]], [[abdomen|abdominal]] pain or [[cramp]]s, [[rash]], and/or [[itch]]. High [[intravenous]] doses may cause a metallic taste, and topical application may cause [[contact dermatitis]] (Rossi, 2006).
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| [[Pseudomembranous colitis]] is a potentially-[[lethal]] condition commonly associated with clindamycin, but which also occurs with other antibiotics. Overgrowth of ''[[Clostridium difficile]]'', which is inherently [[antibiotic resistance|resistant]] to clindamycin, results in the production of a toxin that causes a range of adverse effects, from diarrhea to [[colitis]] and [[toxic megacolon]] (Rossi, 2006).
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| Rarely—in less than 0.1% of patients—clindamycin therapy has been associated with [[anaphylaxis]], blood [[dyscrasia]]s, [[polyarthritis]], [[jaundice]], [[elevated transaminases|raised liver enzymes]] and/or [[hepatotoxicity]] (Rossi, 2006).
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| == Pharmacology ==
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| === Pharmacokinetics ===
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| Approximately 90% of an oral dose of clindamycin is absorbed from the [[gastrointestinal tract]] and it is widely distributed throughout the body, excluding the [[central nervous system]]. Adequate therapeutic concentrations can be achieved in [[bone]]. There is also active uptake into [[white blood cell]]s, most importantly [[neutrophil granulocyte|neutrophil]]s. (Klempner and Styrt, 1981)
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| Clindamycin is extensively metabolised in the liver, with some metabolites being active, such as ''N''-dimethyl clindamycin and clindamycin [[sulfoxide]]. The [[elimination half-life]] is 1.5 to 5 hours. Clindamycin is primarily eliminated by hepatic metabolism; after an intravenous dose of clindamycin phosphate, about 4.5% of the dose is excreted in urine as clindamycin and about 0.35% as the phosphate salt (Plaisance, 1989). The metabolites of clindamycin are excreted primarily in the urine (Klasco, 2006).
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| === Mechanism of action ===
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| Clindamycin has a [[bacteriostatic]] effect. It interferes with bacterial [[protein synthesis]], in a similar way to [[erythromycin]] and [[chloramphenicol]], by binding to the [[50S]] subunit of the bacterial [[ribosome]]. This causes antagonism if administered simultaneously and possible cross-resistance.
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| == Veterinary use ==
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| === In cats ===
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| Clindamycin has been used successfully in treating cats that are displaying symptoms of [[toxoplasmosis]]. This disease rarely causes symptoms in cats, but can do so in very young or [[immunocompromised]] kittens and cats. Toxoplasmosis is contagious to humans, and therefore cat owners, particularly pregnant women, should take precautions to prevent the spread of the disease.
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| == References ==
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| *{{cite journal |author=Daum RS |title=Clinical practice. Skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus |journal=N Engl J Med |volume=357 |issue=4 |pages=380–90 |year=2007 |pmid=17652653 |doi=10.1056/NEJMcp070747}}
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| * Klasco RK, editor. Drugdex system, volume 128. Greenwood Village (CO): Thomson Micromedex; 2006.
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| * {{cite journal |author=Klempner MS, Styrt B |title=Clindamycin uptake by human neutrophils |journal=J. Infect. Dis. |volume=144 |issue=5 |pages=472–9 |year=1981 |pmid=6171600 |doi=}}
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| * {{cite journal |author=Lamont RF |title=Can antibiotics prevent preterm birth--the pro and con debate |journal=BJOG |volume=112 Suppl 1 |issue= |pages=67–73 |year=2005 |pmid=15715599 |doi=10.1111/j.1471-0528.2005.00589.x}}
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| * {{cite journal |author=Plaisance KI ''et al.'' |title=Pharmacokinetic evaluation of two dosage regimens of clindamycin phosphate |journal=Antimicrob Agents Chemother |volume=33 |issue=5 |pages=618–20 |year=1989 |pmid=2751277 |doi=}} {{PMC|172501}}.
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| * Rossi S, editor. [[Australian Medicines Handbook]] 2006. Adelaide: Australian Medicines Handbook; 2006.
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| [[Category:Antibiotics]]
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| [[Category:Wikinfect]]
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