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Clindamycin hydrochloride
Clindamycin hydrochloride(Cleocin Hydrochloride)
Clindamycin
(klin-dah-MY-sin)
Pregnancy Category: B Cleocin Dalacin C (Rx)
Clindamycin palmitate hydrochloride
Clindamycin palmitate hydrochloride(Cleocin Pediatric)
Clindamycin
(klin-dah-MY-sin)
Pregnancy Category: B Cleocin Pediatric Dalacin C Palmitate (Rx)
Clindamycin phosphate
Clindamycin phosphate (Cleocin Vaginal Cream, Cleocin Phosphate)
Clindamycin
(klin-dah-MY-sin)
Pregnancy Category: B (vaginal cream, topical gel, lotion, solution) Cleocin Phosphate Cleocin T Cleocin Vaginal Cream Clinda-Derm C/T/S Dalacin C Phosphate Dalacin T Topical Dalacin Vaginal Cream (Rx)

Classification: Antibiotic, clindamycin and lincomycin

See Also: See also Anti-Infectives.

Action/Kinetics: A semisynthetic antibiotic that suppresses protein synthesis by microorganism by binding to ribosomes (50S subunit) and preventing peptide bond formation. Is both bacteriostatic and bactericidal. Peak serum concentration: PO, 4 mcg/mL after 300 mg; IM, 4.9 mcg/mL after 300 mg; IV, 14.7 mcg/mL after 300 mg. t1/2: 2.4-3 hr. In serious infections the rate of IV administration is adjusted to maintain appropriate serum drug concentrations: 4-6 mcg/mL.

Uses: Should not be used for trivial infections. Systemic. Anareobes: Serious respiratory tract infections (e.g., empyema, lung abscess, anaerobic pneumonitis). Serious skin and soft tissue infections, septicemia, intra-abdominal infections (e.g., peritonitis, intra-abdominal abscess), infections of the female pelvis and genital tract (e.g., PID, endometritis, nongonococcal tubo-ovarian abscess, pelvic cellulitis, postsurgical vaginal cuff infection). Streptococci/staphylococci: Serious respiratory tract infections, serious skin and soft tissue infections, septicemia (parenteral use), acute staphylococcal hematogenous osteomyelitis (parenteral use). Pneumonococcus: Serious respiratory tract infections. Adjunct to surgery for chronic bone/joint infections. Investigational: Alternative to sulfonamides in combination with pyrimethamine in the acute treatment of CNS toxoplasmosis in AIDS clients. In combination with primaquine to treat Pneumocystis carinii pneumonia. Chlamydial infections in women. Bacterial vaginosis due to Gardnerella vaginalis. Topical Use. Used topically for inflammatory acne vulgaris. Vaginally to treat bacterial vaginosis. Investigational: Treatment of rosacea (lotion used).

Contraindications: Hypersensitivity to either clindamycin or lincomycin. Use in treating viral and minor bacterial infections or in clients with a history of regional enteritis, nonbacterial infections (e.g., most URIs), ulcerative colitis, meningitis, or antibiotic-associated colitis. Lactation.

Special Concerns: Use with caution in infants up to 1 month of age, in clients with GI disease, liver or renal disease, or a history of allergy or asthma. Safety and efficacy of topical products have not been established in children less than 12 years of age.

Side Effects: GI: N&V;, diarrhea, pseudomembranous colitis (more frequent after PO use), abdominal pain, esophagitis, unpleasant or metallic taste (after high IV doses), glossitis, stomatitis. CV: Hypotension, rarely, cardiopulmonary arrest after too rapid IV use. Allergic: Morbilliform rash (most common), skin rashes, urticaria, erythema multiforme, anaphylaxis, Stevens-Johnson-like syndrome maculopapular rash, angioneurotic edema. Hematologic: Leukopenia, neutropenia, thrombocytopenia, transient eosinophilia, agranulocytosis, aplastic anemia. Hepatic: Jaundice, abnormal LFT's. GU: Renal dysfunction (azotemia, oliguria, proteinuria), vaginitis. Miscellaneous: Superinfection, tinnitus, polyarthritis. Also sore throat, fatigue, urinary frequency, headache.
Following IV use: Thrombophlebitis, erythema, pain, swelling. Following IM use: Pain, induration, sterile abscesses.
Following topical use: Erythema, irritation, dryness, peeling, itching, burning, oiliness of skin.
Following vaginal use: Cervicitis, vaginitis, vulvar irritation, urticaria, rash.
NOTE: The injection contains benzyl alcohol, which has been associated with a fatal ``gasping syndrome'' in infants.

Laboratory Test Alterations: Levels of AST, ALT, NPN, alkaline phosphatase, bilirubin, BSP retention, and platelet count.

Drug Interactions: Antiperistaltic antidiarrheals (opiates, Lomotil) / Diarrhea due to removal of toxins from colon Ciprofloxacin HCl / Additive antibacterial activity Cyclosporine / Cyclosporine serum levels Erythromycin / Cross-interference effect of both drugs Kaolin/Pectin (e.g., Kaopectate) / Effect due to GI tract absorption Neuromuscular blocking agents / Effect of blocking agents

How Supplied: Clindamycin hydrochloride: Capsule: 75 mg, 150 mg, 300 mg Clindamycin palmitate: Granule for oral solution: 75 mg/5 mL Clindamycin phosphate: Gel: 1%; Injection: 150 mg/mL, 300 mg/50 mL, 600 mg/50 mL, 900 mg/50 mL; Lotion: 1%; Solution: 1%; Swab: 1%; Vaginal cream: 2%; Vaginal Suppository

Dosage
•Capsules, Oral Solution Serious infections.
Adults: 150-300 mg q 6 hr. Pediatric, Clindamycin hydrochloride: 8-16 mg/kg/day divided into three or four equal doses. Pediatric, clindamycin palmitate hydrochloride: 8-12 mg/kg/day divided into three or four equal doses.
More severe infections.
Adults: 300-450 mg q 6 hr. Pediatric, Clindamycin hydrochloride: 16-20 mg/kg/day divided into three or four equal doses. Pediatric, clindamycin palmitate hydrochloride: 13-25 mg/kg/day divided into three or four equal doses. Children less than 10 kg: Minimum recommended dose is 37.5 mg t.i.d.
•IM, IV Serious infections due to aerobic gram-positive cocci.
Adults: 600-1,200 mg/day in two to four equal doses. Pediatric, over 1 month to 16 years: 350 mg/m²/day.
More severe infections due to B. fragilis, Peptococcus or Clostridium (other than C.perfringens).
Adults: 1,200-2,700 mg/day in two to four equal doses. May have to be increased in more serious infections. Pediatric, over 1 month to16 years: 450 mg/m²/day.
Life-threatening infections.
Adults: 4.8 g IV. Pediatric, 1 month to 16 years: 20-40 mg/kg/day in three to four equal doses depending on severity of infections. Pediatric, less than 1 month of age: 15-20 mg/kg/day in three or four equal doses.
Acute pelvic inflammatory disease.
IV: 900 mg q 8 hr plus gentamicin loading dose of 2 mg/kg IV or IM; then, gentamicin, 1.5 mg/kg q 8 hr IV or IM. Therapy may be discontinued 24 hr after client improves. After discharge from the hospital, continue with doxycycline PO, 100 mg b.i.d. for 10-14 days. Alternatively, give clindamycin, PO, 450 mg q.i.d. for 14 days.
•Topical Gel, Lotion, or Solution
Apply thin film b.i.d. to affected areas. One or more pledgets may also be used.
•Vaginal Cream (2%) Bacterial vaginosis.
One applicatorful (containing about 100 mg clindamycin phosphate), preferably at bedtime, for 3 (nonpregnant women) or 7 (pregnant and nonpregnant women) consecutive days.
•Vaginal Suppository Bacterial vaginosis.
One suppository daily for 3 days in nonpregnant women.