Clindamycin

Clindamycin
Adult Indications & Dosage
Pediatric Indications & Dosage
Contraindications
Warnings & Precautions
Adverse Reactions
Drug Interactions
Use in Specific Populations
Administration & Monitoring
Overdosage
Pharmacology
Clinical Studies
How Supplied
Images
Patient Counseling Information
Precautions with Alcohol
Brand Names
Look-Alike Names

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Kiran Singh, M.D. [2]

Disclaimer

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Overview

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Adult Indications and Dosage

FDA-Labeled Indications and Dosage (Adult)

There is limited information regarding Clindamycin FDA-Labeled Indications and Dosage (Adult) in the drug label.

Off-Label Use and Dosage (Adult)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Clindamycin in adult patients.

Non–Guideline-Supported Use

There is limited information regarding Off-Label Non–Guideline-Supported Use of Clindamycin in adult patients.

Pediatric Indications and Dosage

FDA-Labeled Indications and Dosage (Pediatric)

There is limited information regarding Clindamycin FDA-Labeled Indications and Dosage (Pediatric) in the drug label.

Off-Label Use and Dosage (Pediatric)

Guideline-Supported Use

There is limited information regarding Off-Label Guideline-Supported Use of Clindamycin in pediatric patients.

Non–Guideline-Supported Use

There is limited information regarding Off-Label Non–Guideline-Supported Use of Clindamycin in pediatric patients.

Contraindications

There is limited information regarding Clindamycin Contraindications in the drug label.

Warnings

There is limited information regarding Clindamycin Warnings' in the drug label.

Adverse Reactions

Clinical Trials Experience

There is limited information regarding Clindamycin Clinical Trials Experience in the drug label.

Postmarketing Experience

There is limited information regarding Clindamycin Postmarketing Experience in the drug label.

Drug Interactions

There is limited information regarding Clindamycin Drug Interactions in the drug label.

Use in Specific Populations

Pregnancy

Pregnancy Category (FDA): There is no FDA guidance on usage of Clindamycin in women who are pregnant.
Pregnancy Category (AUS): There is no Australian Drug Evaluation Committee (ADEC) guidance on usage of Clindamycin in women who are pregnant.

Labor and Delivery

There is no FDA guidance on use of Clindamycin during labor and delivery.

Nursing Mothers

There is no FDA guidance on the use of Clindamycin in women who are nursing.

Pediatric Use

There is no FDA guidance on the use of Clindamycin in pediatric settings.

Geriatic Use

There is no FDA guidance on the use of Clindamycin in geriatric settings.

Gender

There is no FDA guidance on the use of Clindamycin with respect to specific gender populations.

Race

There is no FDA guidance on the use of Clindamycin with respect to specific racial populations.

Renal Impairment

There is no FDA guidance on the use of Clindamycin in patients with renal impairment.

Hepatic Impairment

There is no FDA guidance on the use of Clindamycin in patients with hepatic impairment.

Females of Reproductive Potential and Males

There is no FDA guidance on the use of Clindamycin in women of reproductive potentials and males.

Immunocompromised Patients

There is no FDA guidance one the use of Clindamycin in patients who are immunocompromised.

Administration and Monitoring

Administration

There is limited information regarding Clindamycin Administration in the drug label.

Monitoring

There is limited information regarding Clindamycin Monitoring in the drug label.

IV Compatibility

There is limited information regarding the compatibility of Clindamycin and IV administrations.

Overdosage

There is limited information regarding Clindamycin overdosage. If you suspect drug poisoning or overdose, please contact the National Poison Help hotline (1-800-222-1222) immediately.

Pharmacology

There is limited information regarding Clindamycin Pharmacology in the drug label.

Mechanism of Action

There is limited information regarding Clindamycin Mechanism of Action in the drug label.

Structure

There is limited information regarding Clindamycin Structure in the drug label.

Pharmacodynamics

There is limited information regarding Clindamycin Pharmacodynamics in the drug label.

Pharmacokinetics

There is limited information regarding Clindamycin Pharmacokinetics in the drug label.

Nonclinical Toxicology

There is limited information regarding Clindamycin Nonclinical Toxicology in the drug label.

Clinical Studies

There is limited information regarding Clindamycin Clinical Studies in the drug label.

How Supplied

There is limited information regarding Clindamycin How Supplied in the drug label.

Storage

There is limited information regarding Clindamycin Storage in the drug label.

Images

Drug Images

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Package and Label Display Panel

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Patient Counseling Information

There is limited information regarding Clindamycin Patient Counseling Information in the drug label.

Precautions with Alcohol

Alcohol-Clindamycin interaction has not been established. Talk to your doctor about the effects of taking alcohol with this medication.

Brand Names

There is limited information regarding Clindamycin Brand Names in the drug label.

Look-Alike Drug Names

There is limited information regarding Clindamycin Look-Alike Drug Names in the drug label.

Drug Shortage Status

Price

References

The contents of this FDA label are provided by the National Library of Medicine.

Clindamycin

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Clinical data
Pregnancy category	AU: A US: B (No risk in non-human studies)
Routes of administration	Oral, topical, IV, intravaginal
ATC code	J01FF01 (WHO) G01AA10 (WHO)
Legal status
Legal status	Schedule 4 (Aust) POM (UK) Prescription only (U.S.)
Pharmacokinetic data
Bioavailability	90% (oral) 4–5% (topical)
Protein binding	90%
Metabolism	Hepatic
Elimination half-life	2–3 hours
Excretion	Renal
Identifiers
IUPAC name (2S,4R)-N-((1R)-2-chloro- 1-((3R,4R,5S,6R)-3,4,5-trihydroxy- 6-(methylthio)-tetrahydro-2H-pyran-2-yl)propyl)- 1-methyl-4-propylpyrrolidine-2-carboxamide
CAS Number	18323-44-9
PubChem CID	29029
DrugBank	APRD00566
E number	{{#property:P628}}
ECHA InfoCard	{{#property:P2566}}
Chemical and physical data
Formula	C18H33ClN2O5S
Molar mass	424.98 g/mol

WikiDoc Resources for Clindamycin
Articles
Most recent articles on Clindamycin Most cited articles on Clindamycin Review articles on Clindamycin Articles on Clindamycin in N Eng J Med, Lancet, BMJ
Media
Powerpoint slides on Clindamycin Images of Clindamycin Photos of Clindamycin Podcasts & MP3s on Clindamycin Videos on Clindamycin
Evidence Based Medicine
Cochrane Collaboration on Clindamycin Bandolier on Clindamycin TRIP on Clindamycin
Clinical Trials
Ongoing Trials on Clindamycin at Clinical Trials.gov Trial results on Clindamycin Clinical Trials on Clindamycin at Google
Guidelines / Policies / Govt
US National Guidelines Clearinghouse on Clindamycin NICE Guidance on Clindamycin NHS PRODIGY Guidance FDA on Clindamycin CDC on Clindamycin
Books
Books on Clindamycin
News
Clindamycin in the news Be alerted to news on Clindamycin News trends on Clindamycin
Commentary
Blogs on Clindamycin
Definitions
Definitions of Clindamycin
Patient Resources / Community
Patient resources on Clindamycin Discussion groups on Clindamycin Patient Handouts on Clindamycin Directions to Hospitals Treating Clindamycin Risk calculators and risk factors for Clindamycin
Healthcare Provider Resources
Symptoms of Clindamycin Causes & Risk Factors for Clindamycin Diagnostic studies for Clindamycin Treatment of Clindamycin
Continuing Medical Education (CME)
CME Programs on Clindamycin
International
Clindamycin en Espanol Clindamycin en Francais
Business
Clindamycin in the Marketplace Patents on Clindamycin
Experimental / Informatics
List of terms related to Clindamycin

See also: Clindamycin hydrochloride, Clindamycin palmitate hydrochloride, and Clindamycin phosphate

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [3]

Overview

Clindamycin (rINN) (IPA: Template:IPA) is a lincosamide antibiotic used in the treatment of infections caused by susceptible microorganisms. 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 names including Dalacin (Pfizer), Cleocin (Pfizer), and in a foam as Evoclin (Connetics) and Duac(Stiefel).

Indications

Clindamycin is used primarily to treat infections caused by susceptible anaerobic bacteria. Such infections might include infections of the respiratory tract, septicemia and peritonitis. In patients with hypersensitivity to penicillins, clindamycin may be used to treat infections caused by susceptible 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.

It is most effective against infections involving the following types of organisms:

• Aerobic gram-positive cocci, including some members of the Staphylococcus and Streptococcus (eg. pneumococcus) genera.
• Anaerobic gram-negative bacilli, including some members of the Bacteroides and Fusobacterium genera.

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 breakdown of the cell membrane, and clindamycin, which inhibits toxin synthesis.

Clindamycin has been proven to decrease the risk of preterm births in women diagnosed with bacterial vaginosis during early pregnancy to about a third of the risk of untreated women (Lamont, 2005).

Recently, clindamycin has been found to be useful in skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus (Daum, 2007).

Available forms

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.

Adverse effects

Common adverse drug reactions (ADRs) associated with clindamycin therapy—found in over 1% of patients—include: diarrhea, pseudomembranous colitis, nausea, vomiting, abdominal pain or cramps, rash, and/or itch. High intravenous doses may cause a metallic taste, and topical application may cause contact dermatitis (Rossi, 2006).

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 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).

Rarely—in less than 0.1% of patients—clindamycin therapy has been associated with anaphylaxis, blood dyscrasias, polyarthritis, jaundice, raised liver enzymes and/or hepatotoxicity (Rossi, 2006).

Pharmacology

Pharmacokinetics

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 cells, most importantly neutrophils. (Klempner and Styrt, 1981)

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).

Mechanism of action

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.

Veterinary use

In cats

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.

References

• Daum RS (2007). "Clinical practice. Skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus". N Engl J Med. 357 (4): 380–90. doi:10.1056/NEJMcp070747. PMID 17652653.
• Klasco RK, editor. Drugdex system, volume 128. Greenwood Village (CO): Thomson Micromedex; 2006.
• Klempner MS, Styrt B (1981). "Clindamycin uptake by human neutrophils". J. Infect. Dis. 144 (5): 472–9. PMID 6171600.
• Lamont RF (2005). "Can antibiotics prevent preterm birth--the pro and con debate". BJOG. 112 Suppl 1: 67–73. doi:10.1111/j.1471-0528.2005.00589.x. PMID 15715599.
• Plaisance KI; et al. (1989). "Pharmacokinetic evaluation of two dosage regimens of clindamycin phosphate". Antimicrob Agents Chemother. 33 (5): 618–20. PMID 2751277.CS1 maint: Explicit use of et al. (link) PMC 172501.
• Rossi S, editor. Australian Medicines Handbook 2006. Adelaide: Australian Medicines Handbook; 2006.