CLINDAMYCIN HYDROCHLORIDE

CLINDAMYCIN HYDROCHLORIDE
(klin-da-mye'sin)
Cleocin, Dalacin C 
CLINDAMYCIN PALMITATE HYDROCHLORIDE
Cleocin Pediatric
CLINDAMYCIN PHOSPHATE
Cleocin Phosphate, Cleocin T, Dalacin C, Evoclin, Cleocin Vaginal Ovules or Cream
Classifications: lincosamide antibiotic;
Therapeutic: antibiotic

Pregnancy Category: B

Availability

75 mg, 150 mg, 300 mg capsules; 75 mg/5 mL oral suspension; 150 mg/mL injection; 2% vaginal cream; 100 mg suppositories; 10 mg gel, lotion; 1% foam

Action

Semisynthetic derivative of lincomycin with a greater degree of antibacterial activity in vitro, better absorption, and lower incidence of GI adverse effects than lincomycin. Suppresses protein synthesis by binding to 50 S subunits of bacterial ribosomes, and, therefore, inhibits other antibiotics (e.g., erythromycin) that act at this site.

Therapeutic Effect

Particularly effective against susceptible strains of anaerobic streptococci. Also effective against aerobic gram-positive cocci.

Uses

Serious infections when less toxic alternatives are inappropriate. Topical applications are used in treatment of acne vulgaris. Vaginal applications are used in treatment of bacterial vaginosis in nonpregnant women.

Unlabeled Uses

In combination with pyrimethamine for toxoplasmosis in patients with AIDS.

Contraindications

History of hypersensitivity to clindamycin or lincomycin; history of regional enteritis, ulcerative colitis, or antibiotic-associated colitis; viral infection.

Cautious Use

History of GI disease, renal or hepatic disease; atopic individuals (history of eczema, asthma, hay fever); older patients >60 y; pregnancy (category B).

Route & Dosage

Moderate to Severe Infections
Adult: PO 150–450 mg q6h IM/IV 600–1200 mg/d in divided doses (max: 2700 mg/d)
Child: PO 10–30 mg/kg/d q6–8h IM/IV 20–40 mg/kg/d in divided doses
Neonate: IM/IV ≤7 d, ≤2000 g, 10mg/kg/d q12h  ≤7 d, >2000 g, 15 mg/kg/d q8h  >7 d, <1200 g, 10 mg/kg/d q12h  >7 d, 1200 g–2000 g, 15 mg/kg/d q8h  >7 d, >2000 g, 20 mg/kg/d q6–8h

Acne Vulgaris
Adult: Topical Apply to affected areas b.i.d.; 1% foam qd application

Bacterial Vaginosis
Adult: Topical Insert 1 suppository intravaginally at bedtime times 3 d, or insert 1 applicator full of cream intravaginally at bedtime times 7 d

Administration

  • Determine history of any previous sensitivities to drugs or other allergens prior to administration.
Oral
  • Administer clindamycin capsules with a full [240 mL (8 oz)] glass of water to prevent esophagitis.
  • Note expiration date of oral solution; retains potency for 14 d at room temperature. Do not refrigerate, as chilling causes thickening and thus makes pouring it difficult.
Intramuscular
  • Deep IM injection is recommended. Rotate injection sites and observe daily for evidence of inflammatory reaction. Single IM doses should not exceed 600 mg.
Intravenous
  • IV administration to neonates, infants, and children: Verify correct IV concentration and rate of infusion with physician.

PREPARE: Intermittent: Each 18 mg must be diluted with at least 1 mL of D5W, NS, D5/.45% NaCl, or other compatible solution. Final concentration should never exceed 18 mg/mL.  

ADMINISTER: Intermittent: Never give a bolus dose. Do not give >1200 mg in a single 1-h infusion. Infusion rate should not exceed 30 mg/min.  

INCOMPATIBILITIES Solution/additive: Aminophylline, barbituates, calcium gluconate, magnesium sulfate, ceftriaxone, ciprofloxacin, gentamicin, ranitidine. Y-site: Allopurinol, azithromycin, doxapram, filgrastim, fluconazole, idarubicin, lansoprazole.

  • Store in tight containers at 15°–30° C (59°–86° F) unless otherwise directed.

Adverse Effects (≥1%)

Body as a Whole: Fever, serum sickness, sensitization, swelling of face (following topical use), generalized myalgia, superinfections, proctitis, vaginitis, pain, induration, sterile abscess (following IM injections); thrombophlebitis (IV infusion). CV: Hypotension (following IM), cardiac arrest (rapid IV). GI: Diarrhea, abdominal pain, flatulence, bloating, nausea, vomiting, pseudomembranous colitis; esophageal irritation, loss of taste, medicinal taste (high IV doses), jaundice, abnormal liver function tests. Hematologic: Leukopenia, eosinophilia, agranulocytosis, thrombocytopenia. Skin: Skin rashes, urticaria, pruritus, dryness, contact dermatitis, gram-negative folliculitis, irritation, oily skin.

Diagnostic Test Interference

Clindamycin may cause increases in serum alkaline phosphatase, bilirubin, creatine phosphokinase (CPK) from muscle irritation following IM injection; AST, ALT.

Interactions

Drug: Chloramphenicol, erythromycin possibly are mutually antagonistic to clindamycin; neuromuscular blocking action enhanced by neuromuscular blocking agents (atracurium, tubocurarine, pancuronium).

Pharmacokinetics

Absorption: Approximately 90% absorbed from GI tract; 10% of topical application is absorbed through skin. Peak: 45–60 min PO; 3 h IM. Duration: 6 h PO; 8–12 h IM. Distribution: Widely distributed except for CNS; crosses placenta; distributed into breast milk. Metabolism: In liver. Elimination: In urine and feces. Half-Life: 2–3 h.

Nursing Implications

Assessment & Drug Effects

  • Lab tests: Culture and susceptibility testing should be performed initially and periodically during therapy. Periodic CBC with differential and platelet count.
  • Monitor BP and pulse in patients receiving drug parenterally. Hypotension has occurred following IM injection. Advise patient to remain recumbent following drug administration until BP has stabilized.
  • Severe diarrhea and colitis, including pseudomembranous colitis, have been associated with oral (highest incidence), parenteral, and topical clindamycin. Report immediately the onset of watery diarrhea, with or without fever; passage of tarry or bloody stools, pus, intestinal tissue, or mucus; abdominal cramps, or ileus. Symptoms may appear within a few days to 2 wk after therapy is begun or up to several weeks following cessation of therapy.
  • Closely observe older adult and bedridden patients, as they are at a higher risk of developing severe colitis.
  • Be alert to signs of superinfection (see Appendix F).
  • Be alert for signs of anaphylactoid reactions (see Appendix F), that require immediate attention.

Patient & Family Education

  • Take drug for the full course of therapy as prescribed.
  • Report loose stools or diarrhea promptly.
  • Stop drug therapy if significant diarrhea develops (more than 5 loose stools daily) and notify physician.
  • Do not self-medicate with antidiarrheal preparations. Antiperistaltic agents may prolong and worsen diarrhea by delaying removal of toxins from colon.
  • If using topical preparation for acne, discontinue other acne preparations unless otherwise directed by physician. Keep medication away from eyes.
  • Since 10% absorption of topical medication is possible, report the onset of systemic reactions to physician.

Common adverse effects in italic, life-threatening effects underlined; generic names in bold; classifications in SMALL CAPS; Canadian drug name; Prototype drug

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