Clindamycin

clindamycin

(klin da mye' sin)

clindamycin hydrochloride

Oral:

Cleocin, Dalacin C (CAN)

clindamycin palmitate hydrochloride

Oral:

Cleocin Pediatric

clindamycin phosphate

Oral, parenteral, topical dermatologic solution for acne, vaginal preparation:

Cleocin Phosphate, Cleocin T, Cleocin Vaginal Ovules, Clinda-Derm (CAN), Clindagel, ClindaMax, Clindets, Dalacin C (CAN)

Pregnancy Category B

Drug class

Lincosamide antibiotic

Therapeutic actions

Inhibits protein synthesis in susceptible bacteria, causing cell death.

Indications

·        Systemic administration: Serious infections caused by susceptible strains of anaerobes, streptococci, staphylococci, pneumococci; reserve use for penicillin-allergic patients or when penicillin is inappropriate; less toxic antibiotics (erythromycin) should be considered

·        Parenteral: Treatment of septicemia caused by staphylococci, streptococci; acute hematogenous osteomyelitis; adjunct to surgical treatment of chronic bone and joint infections due to susceptible organisms; do not use to treat meningitis; does not cross the blood–brain barrier.

·        Topical dermatologic solution: Treatment of acne vulgaris

·        Vaginal preparation: Treatment of bacterial vaginosis

Contraindications and cautions

Systemic administration

·        Contraindicated with allergy to clindamycin, history of asthma or other allergies, tartrazine (in 75- and 150-mg capsules); hepatic or renal dysfunction; lactation.

·        Use cautiously in newborns and infants due to benzyl alcohol content; associated with gasping syndrome.

Topical dermatologic solution, vaginal preparation

·        Contraindicated with allergy to clindamycin or lincomycin.

·        Use caution with history of regional enteritis or ulcerative colitis; history of antibiotic-associated colitis.

Available forms

Capsules—75, 150, 300 mg; granules for oral solution—75 mg/5 mL; injection—150 mg/mL; topical gel—1%; topical lotion—1%; topical suspension—1%; vaginal cream—2%; vaginal suppository—100 mg

Dosages

ADULTS

Oral

150–300 mg q 6 hr, up to 300–450 mg q 6 hr in more severe infections.

Parenteral

600–2,700 mg/day in two to four equal doses; up to 4.8 g/day IV or IM may be used for life-threatening situations.

Vaginal

One applicator (100 mg clindamycin phosphate) intravaginally, preferably at hs for 7 consecutive days; or insert vaginal suppository, preferably at hs for 7 consecutive days, 3 days for Cleocin Vaginal Ovules.

Topical

Apply a thin film to affected area bid.

PEDIATRIC PATIENTS

Oral

For clindamycin HCl, 8–20 mg/kg/day in three or four equal doses. For clindamycin palmitate HCl, 8–25 mg/kg/day in three or four equal doses; for children weighing < 10 kg, use 37.5 mg tid as the minimum dose.

Parenteral

Neonates: 15–20 mg/kg/day in three or four equal doses.

> 1 mo: 15–40 mg/kg/day in three or four equal doses or 350 mg/m²/day to 450 mg/m²/day.

GERIATRIC PATIENTS OR PATIENTS WITH RENAL FAILURE

Reduce dose, and monitor patient's serum levels carefully.

Pharmacokinetics

Route	Onset	Peak	Duration
Oral	Varies	1–2 hr	8–12 hr
IM	20–30 min	1–3 hr	8–12 hr
IV	Immediate	Minutes	8–12 hr
Topical	Minimal systemic absorption

Metabolism: Hepatic; T_1/2: 2–3 hr

Distribution: Crosses placenta; enters breast milk

Excretion: Feces, urine

IV facts

Preparation: Store unreconstituted product at room temperature. Reconstitute by adding 75 mL of water to 100-mL bottle of palmitate in two portions. Shake well; do not refrigerate reconstituted solution. Reconstituted solution is stable for 2 wk at room temperature. Dilute reconstituted solution to a concentration of 300 mg/50 mL or more of diluent using 0.9% sodium chloride injection, 5% dextrose injection, or lactated Ringer's solution. Solution is stable for 16 days at room temperature.

WARNING: Infusion: Do not administer more than 1,200 mg in a single 1-hr infusion. Infusion rates: 300 mg in 50 mL diluent, 10 min; 600 mg in 50 mL diluent, 20 min; 900 mg in 50–100 mL diluent, 30 min; 1,200 mg in 100 mL diluent, 40 min. Rapid infusion can cause cardiac arrest.

Incompatibilities: Do not mix with calcium gluconate, ampicillin, phenytoin, barbiturates, aminophylline, and magnesium sulfate. May be mixed with sodium chloride, dextrose, calcium, potassium, vitamin B complex, kanamycin, gentamicin, penicillin, carbencillin. Incompatible in syringe with tobramycin.

Adverse effects

Systemic administration

·        CV: Hypotension, cardiac arrest (with rapid IV infusion)

·        GI: Severe colitis, including pseudomembranous colitis, nausea, vomiting, diarrhea, abdominal pain, esophagitis, anorexia, jaundice, liver function changes

·        Hematologic: Neutropenia, leukopenia, agranulocytosis, eosinophilia

·        Hypersensitivity: Rashes, urticaria to anaphylactoid reactions

·        Local: Pain following injection, induration and sterile abscess after IM injection, thrombophlebitis after IV use

Topical dermatologic solution

·        CNS: Fatigue, headache

·        Dermatologic: Contact dermatitis, dryness, gram-negative folliculitis

·        GI: Pseudomembranous colitis, diarrhea, bloody diarrhea; abdominal pain, sore throat

·        GU: Urinary frequency

Vaginal preparation

·        GU: Cervicitis, vaginitis, vulvar irritation

Interactions

Systemic administration

Drug-drug

·        Increased neuromuscular blockade with neuromuscular blocking agents

·        Decreased GI absorption with kaolin, aluminum salts

Nursing considerations

Assessment

·        History: Allergy to clindamycin, history of asthma or other allergies, allergy to tartrazine (in 75- and 150-mg capsules); hepatic or renal dysfunction; lactation; history of regional enteritis or ulcerative colitis; history of antibiotic associated colitis

·        Physical: Site of infection or acne; skin color, lesions; BP; R, adventitious sounds; bowel sounds, output, liver evaluation; CBC, LFTs, renal function tests

Interventions

Systemic administration

·        Culture infection before therapy.

·        Administer oral drug with a full glass of water or with food to prevent esophageal irritation.

·        Do not give IM injections of more than 600 mg; inject deep into large muscle to avoid serious problems.

·        Do not use for minor bacterial or viral infections.

·        Monitor LFTs and renal function tests, and blood counts with prolonged therapy.

Topical dermatologic administration

·        Keep solution away from eyes, mouth and abraded skin or mucous membranes; alcohol base will cause stinging. Shake well before use.

·        Keep cool tap water available to bathe eye, mucous membranes, abraded skin inadvertently contacted by drug solution.

Vaginal preparation

·        Give intravaginally, preferably at hs.

Teaching points

Systemic administration

·        Take oral drug with a full glass of water or with food.

·        Take full prescribed course of oral drug. Do not stop taking without notifying health care provider.

·        You may experience these side effects: Nausea, vomiting (eat frequent small meals); superinfections in the mouth, vagina (use frequent hygiene measures; request treatment if severe).

·        Report severe or watery diarrhea, abdominal pain, inflamed mouth or vagina, skin rash or lesions.

Topical dermatologic administration

·        Apply thin film of acne solution to affected area twice daily, being careful to avoid eyes, mucous membranes, abraded skin; if solution contacts one of these areas, flush with lots of cool water.

·        Report abdominal pain, diarrhea.

Vaginal preparation

·        Use vaginal preparation for 7 or 3 consecutive days, preferably at bedtime. Refrain from sexual intercourse during treatment with this product.

·        Report vaginal irritation, itching; diarrhea, no improvement in complaint being treated.