Clindamycin

Introdution :
Clindamycin : is usually used to treat infections with anaerobic bacteria but can also be used to treat some protozoal diseases, such as malaria. It is a common topical treatment and can be useful against some methicillin-resistant Staphylococcus aureus (MRSA) infections.

Chemistry:
Clindamycin is a semisynthetic derivative of lincomycin, a natural antibiotic produced by the actinobacterium Streptomyces. It is obtained by 7(S)-chloro-substitution of the 7(R)-hydroxyl group of lincomycin.

Mechanism of action :
Clindamycin has a bacteriostatic effect. It is a bacterial protein synthesis inhibitor by inhibiting ribosomal translocation,in a similar way to macrolides. by binding to the 50S rRNA of the large bacterial ribosome subunit.

Interactions
Clindamycin may prolong the effects of neuromuscular-blocking drugs.

Its similarity to the mechanism of action of macrolides and chloramphenicol means they should not be given simultaneously, as this causes antagonism] and possible crossresistance.

Antibacterial activity:

Active against G+ cocci, including penicillin- resistant Staph. and many anaerobes.

Not effective against Gaerobes

Pharmacokinetics
Absorption 90% absorbed from the GI tract (oral) absorbed from the skin (topical) systemically (intravaginal) NB : rate of absorption may be reduced by the presence of food.

Metabolism Hepatic; converted to N-dimethyl and sulfoxide metabolites and some inactive metabolites.

Excretion By Bile 2-3 hours (elimination half-life), may be prolonged in preterm neonates and severe renal impairment.

Dose and Dosage Form

For clindamycin capsules : the usual dosage for adults ranges from 150 mg to 450 mg every six hours, depending on the particular infection For the injectable form, typical doses range from 1200 mg up to 2700 mg total per day, divided into two to four smaller doses per day. The maximum capsule dosage is 1800 mg per day; the maximum injectable dosage is 4800 mg per day. For serious infections clindamycin is often combined with other antibiotics.

 lotion, gel, foam, or solution clindamycin products are usually applied to the skin once a day For bacterial vaginosis, cream or suppository clindamycin products are applied once daily before bedtime.

Capsules

Injection solution

Gel

Lotion

 For preventing endocarditis in some at-risk patients before certain procedures, the recommended dose of clindamycin is 600 mg (either capsule or injectable form) shortly before the procedure

NB :Amounts for children are calculated based on weight.

adverse drug reactions

pseudo membranous colitis nausea vomiting abdominal pain or cramps rash, and/or itch

High doses (both intravenous and oral) may cause a metallic tasteand topical application may cause contact dermatitis. NOTE: Diarrhea, vomiting, and nausea are common if the individual lies down for an extended period of time within 30 minutes of taking clindamycin

 Pseudomembranous colitis is a potentially lethal condition commonly associated with clindamycin. In addition, severe heartburn can be expected for up to three days if the individual does not stay in an elevated position for at least 30 minutes.

 Rarely in less than 0.1% of patients clindamycin therapy has been associated with anaphylaxis, polyarthritis, jaundice, raised liver enzyme levels, and/or hepatotoxicity.

Therapeutic uses and indications

Clindamycin is used primarily to treat anaerobic infections caused by susceptible anaerobic bacteriaincluding dental infections And infections of the respiratory tract, skin and soft tissue infections, and peritonitis. In patients with hypersensitivity to penicillins we can use clindamycin. clindamycin may be used to treat infections caused by susceptible aerobic bacteria, as well. It is also used to treat bone and joint infections, particularly those caused by Staphylococcus aureus. Topical application of clindamycin phosphate can be used to treat mild to moderate 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 (e.g. pneumococcus) genera, but not enterococci.
Anaerobic, Gram-negative rod-shaped bacteria(bacilli)

It can also be useful in skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus (MRSA).

Contraindications
hypersensitive to drug/class/component. Ulcerative/pseudomembranous colitis caution if hepatic impairment caution if renal impairment

Thank you