Clindamycin is an antibiotic belonging to the class of lincosamides. It has an action spectrum very similar to that of macrolides and is used above all to treat infections caused by Gram-positive cocci and various types of anaerobic bacteria.
Clindamycin is also very useful in the treatment of Propionibacterium acnes infections.
Clindamycin - chemical structure
This antibiotic is available in the form of various pharmaceutical formulations suitable for vaginal, cutaneous, oral and parenteral administration.
Indications
For what it uses
The use of clindamycin is indicated for the treatment of:
- Infections caused by anaerobic bacteria (oral and parenteral administration);
- Infections caused by staphylococci, streptococci and pneumococci (oral and parenteral administration);
- Gynecological and pelvic infections caused by Chlamydia trachomatis when first choice antibiotics (tetracyclines) cannot be used (oral and parenteral administration);
- Opportunistic infections caused by Toxoplasma gondii and Pneumocystis carinii (now known as Pneumocystis jirovecii ) in immunocompromised patients (parenteral administration);
- Bacterial vaginosis or specific vaginitis supported by Gardnerella vaginalis, Mobiluncus spp., Bacteroides spp., Mycoplasma hominis or Peptostreptococcus spp. (vaginal administration);
- Acne vulgaris (cutaneous administration).
Warnings
The use of clindamycin can promote the development of superinfections with bacteria resistant to the antibiotic itself or to fungi. Such as Clostridium difficile infections that lead to the onset of pseudomembranous colitis. Such superinfections require adequate drug therapy.
During treatment with clindamycin - especially if continued for long periods - it is a good idea to carry out regular checks on blood counts and liver and kidney function.
A lot of caution should be used in the prescription of clindamycin in patients with a history of gastrointestinal pathologies - especially colitis - and in atopic patients.
Prolonged use of clindamycin topically (cutaneous or vaginal) may cause sensitization. Should these phenomena appear, it is necessary to immediately stop the treatment with the antibiotic and inform the doctor who will decide what to do.
Generally, clindamycin does not alter the ability to drive and / or operate machinery. However, in some cases it may slightly alter these abilities.
Interactions
Concomitant administration of clindamycin and warfarin or other oral anticoagulants may increase the risk of bleeding.
Clindamycin can enhance the activity of neuromuscular blocking drugs.
Synergistic action of clindamycin with metronidazole has been reported in the treatment of Bacteroides fragilis infections.
The combination of clindamycin and gentamicin may result in a synergistic effect.
Due to the onset of a possible antagonism between clindamycin and erythromycin, these two antibiotics should not be given concomitantly.
Clindamycin may reduce the effectiveness of oral contraceptives .
In any case, it is advisable to inform your doctor if you are taking - or if you have recently been - medicines of any kind, including over-the-counter medicines and herbal and / or homeopathic products.
Side effects
Clindamycin can cause various types of side effects, although not all patients experience them. The type of adverse effects and the intensity with which they occur depend on the different sensitivity that each patient has towards the drug.
Listed below are the main adverse effects that can occur during treatment with clindamycin.
Blood and lymphatic system disorders
Clindamycin therapy can lead to:
- Agranulocytosis, ie a decrease in the number of granulocytes in the bloodstream;
- Leukopenia, ie the reduction in the number of leukocytes in the bloodstream;
- Neutropenia, ie decrease in the number of neutrophils in the bloodstream;
- Piastrinopenia, ie the decrease in the number of platelets in the bloodstream;
- Eosinophilia, that is the increase in the number of eosinophils in the bloodstream.
Allergic reactions
Clindamycin may cause anaphylactic or rash reactions from drugs with eosinophilia and systemic symptoms (DRESS syndrome) in sensitive subjects.
Gastrointestinal disorders
Clindamycin treatment can cause:
- Diarrhea;
- Nausea or vomiting;
- Pseudomembranous colitis (caused by Clostridium difficile superinfections);
- Abdominal pain;
- Esophagitis;
- Esophageal ulcer.
Hepatobiliary disorders
Clindamycin therapy can alter liver function and promote jaundice.
Skin and subcutaneous tissue disorders
Clindamycin treatment can cause:
- Maculopapular rash;
- Urticaria;
- Itch;
- Acute generalized exanthematous pustulosis;
- Erythema multiforme;
- Bullous dermatitis;
- Exfoliative dermatitis;
- Exfoliation morbilliform;
- Stevens-Johnson syndrome;
- Toxic epidermal necrolysis.
Other side effects
Other side effects that could occur during clindamycin therapy are:
- Vaginal infections;
- Decreased sense of taste;
- Hypotension or cardiovascular arrest (especially when clindamycin is administered parenterally);
- Injection site pain when the antibiotic is administered parenterally.
Side effects related to vaginal administration of clindamycin
In addition to some of the side effects described above, during the use of cream or eggs for vaginal administration, they can also arise:
- Headache;
- Vaginal infections caused by fungi;
- Urinary infections;
- Pain during urination;
- Pain and / or swelling at the application site;
- Problems with the menstrual cycle;
- Vaginal discharge;
- Vaginal or cervical irritation.
Side effects related to cutaneous administration of clindamycin
In addition to some previously listed adverse effects, clindamycin administered via the dermal route may lead to:
- folliculitis;
- Eye pain;
- contact dermatitis;
- Skin irritation;
- Oily or dry skin.
Overdose
Cases of clindamycin overdose are rare.
If an overdose of clindamycin is taken orally or parenterally, hemodialysis and peritoneal dialysis may be useful to remove excess antibiotic from the bloodstream.
In any case, if you suspect that you have accidentally taken or ingested an overdose of clindamycin, you must contact your doctor immediately and go to the nearest hospital.
Action mechanism
Clindamycin exerts its antimicrobial activity by interfering with the protein synthesis of bacteria.
Protein synthesis in bacterial cells takes place thanks to organelles called ribosomes. These organelles consist of ribosomal RNA and proteins associated with each other to form two subunits: the 30S subunit and the 50S subunit.
The ribosome binds and translates the messenger RNA from the cell nucleus and synthesizes the proteins for which it encodes.
Clindamycin binds to the 50S ribosomal subunit, thus interrupting protein synthesis. In this way, clindamycin inhibits the growth of bacterial cells.
Mode of Use - Posology
Clindamycin is available as:
- Hard capsules for oral administration;
- Solution for injection for intramuscular or intravenous administration;
- Cream and eggs for vaginal administration;
- Cutaneous solution, cutaneous emulsion and gel for cutaneous administration.
The dose of clindamycin to be administered and the duration of treatment must be established by the doctor, depending on the type and severity of the infection to be treated.
Below are some indications on clindamycin dosages usually used in therapy.
Oral administration
In adults, the dose of clindamycin usually administered is 600-1200 mg per day, to be divided into three or four administrations.
In children, the dose of clindamycin usually used is 8-20 mg / kg of body weight per day, to be taken in three or four divided doses.
Intramuscular or intravenous administration
In adults, the dose of clindamycin usually used is 600-2700 mg a day, to be taken in two, three or four divided doses. The amount of drug administered varies according to the severity of the infection.
For the treatment of very serious infections that endanger the patient's life, the dose of clindamycin administered can be increased up to 4800 mg a day, to be administered through the drip.
When clindamycin is administered intramuscularly, single doses higher than 600 mg of the drug should not be injected.
Clindamycin can be administered parenterally only in children over 2 years of age. In this category of patients, the dose of antibiotic usually administered is 15-40 mg / kg of body weight per day, to be taken in three or four divided doses. The amount of drug used depends on the severity of the infection to be treated.
Vaginal administration
It is recommended to apply the vaginal cream once a day at bedtime, for a period of 3-7 consecutive days.
The vaginal eggs must be taken following the doctor's instructions.
Both the cream and the eggs should not be used in pediatric patients.
Cutaneous administration
It is recommended to apply a thin layer of skin solution, skin emulsion or gel directly on the affected area twice a day.
After each application it is necessary to wash your hands.
Pregnancy and breastfeeding
The use of clindamycin by pregnant women should only be carried out if strictly necessary and only under the strict supervision of the doctor.
Because oral and parenteral clindamycin is excreted in breast milk, breastfeeding mothers should not take the medicine.
It is not known whether clindamycin administered vaginally or cutaneously is excreted in breast milk. Therefore, as a precaution it is advised not to breast-feed during the antibiotic treatment.
Contraindications
The use of clindamycin is contraindicated in the following cases:
- In patients with known hypersensitivity to clindamycin or lincomycin (another antibiotic belonging to the class of lincosamides);
- In patients with diarrhea or suffering from inflammatory bowel disorders (when clindamycin is administered orally);
- In patients who have suffered from colitis following the administration of other antibiotics;
- During lactation (when clindamycin is administered orally or parenterally).
