Clindamycin

Last updated 22/03/18

Definition

• Lincosamide antibiotic available in oral or parenteral form

Features

• More potent than Lincomycin which it has largely replaced in clinical practice
• May be used in place of penicillins or cephalosporins when anaphylactic
• Semisynthetic

Mechanism

• Binds 50S subunit of bacterial ribosome inhibiting protein synthesis
• Bacteriostatic

Indications

• In place of penicillins or cephalosporins when anaphylactic
• Bacterial Coverage
• May display cross-resistance with macrolides
• Staphylcoccus aureus
• Staphlycoccus epidermidis
• Streptococci
• Except Enterococcus faecalis
• Anaerobes
• Broader coverage than Lincomycin
• Presentations
• Infective Endocarditis (IE) prophylaxis
• Aspiration pneumonia
• Community Acquired Pneumonia (CAP)
• Dental infections
• Skin and soft tissue infections: boils, cellulitis
• Necrotising fasciitis: reduces bacterial toxin production
• Osteomyelitis (OM)
• Sepsis
• Toxoplasma encephalitis/abscess (with Pyrimethamine)
• Bacterial Vaginosis (BV)
• Pneumocystis jiroveci pneumonia (with Primaquine)
• Malaria (with Quinine)
• Acne
• Surgical antibiotic prophylaxis

Dose

• PO, PV, IV or IM
• Tablets: 150mg
• No oral liquid but can be made 50mg/ml by dissolving 1 capsule in 3ml water
• Can be mixed with juice or food to give to infants
• Ampules: 150mg/ml in 2ml or 4ml (Dalacin)
• Dilute in Glucose 5% or normal saline
• Slow infusion (not >30mg/min) to reduce risk of adverse effects
• 2% cream: BV
• PO
• Usual dose 150-450mg PO 6-8/24
• Dental infections: 300-450mg PO 8/24 5-7/7
• BV: 300mg PO BD 7/7
• IE prophylaxis: 600mg (Child > 1 month 20mg/kg, max 600mg) PO 1 hour prior to procedure
• Malaria (with Quinine): 450mg (Child >1 month 7mg/kg, max 450mg) PO 8/24 7/7
• Pneumocystis jiroveci pneumonia (with Primaquine): 450mg PO 6-8/24
• Toxoplasma encephalitis/abscess: 600mg PO 6/24
• Parenteral
• 600-2700mg IV daily in 2-4 divided doses
• Commonly 450-900mg 8/24
• Toxoplasma encephalitis/abscess (with Pyrimethamine): 600mg IV 6/24

Side Effects/Precuations/Contraindications

• Side Effects
• Taste disturbance
• Diarrhoea, nausea, vomiting, abdo cramps
• Clostridium Difficile Assocaited Diarrhoea (CDAD)
• Jaundice, deranged LFTs
• Rash, itch
• Anaphylaxis
• IV Use
• Hypotension
• Cardiac arrest if administered rapidly
• Toxic epidermal necrolysis (rare)
• Precautions
• Pregnancy: A
• Lactation: safe, may cause loose bowel motions
• Contraindications
• Allergic reaction to Lincomycin (also a lincosamide)

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References

1. AMH: Clindamycin. July 2018
2. MIMMS: Clindamycin. 01/11/2018