LINCOMYCIN HYDROCHLORIDE

LINCOMYCIN HYDROCHLORIDE
(lin-koe-mye'sin)
Lincocin
Classifications: lincosamide antibiotic;
Therapeutic:antibiotic

Prototype: Clindamycin
Pregnancy Category: B

Availability

300 mg injection

Action

Derived from Streptomyces lincolnensis and binds to the 50 S ribosomal subunits of the bacteria and inhibits protein synthesis, eventually resulting in inhibition of bacterial cell growth or bacterial death. Antibacterial activity primarily results from inhibition of peptide bond formation.

Therapeutic Effect

Bacteriostatic or bactericidal depending on concentration used and sensitivity of organism. Effective against most of the common gram-positive pathogens, particularly streptococci, pneumococci, and staphylococci. Also effective against many anaerobic bacteria.

Uses

Reserved for treatment of serious infections caused by susceptible bacteria in penicillin-allergic patients or patients for whom penicillin is inappropriate.

Contraindications

Previous hypersensitivity to lincomycin and clindamycin; impaired liver function, known monilial infections (unless treated concurrently); use in newborns, lactation.

Cautious Use

Impaired kidney function; history of GI disease, particularly colitis; history of liver, endocrine, or metabolic diseases; history of asthma, hay fever, eczema, drug or other allergies; older adult patients, pregnancy (category B).

Route & Dosage

Infections
Adult: IM 600 mg q12–24 h IV 600 mg–1 g q8–12h (max: 8 g/d)
Child: IM 10 mg/kg q12–24h IV 10–20 mg/kg/d q8–12h

Administration

Intramuscular
  • Give injection deep into large muscle mass; inject slowly to minimize pain. Rotate injection sites.
Intravenous

PREPARE: Intermittent: Dilute each 1 g of lincomycin in at least 100 mL of D5W, NS, or other compatible solution.  

ADMINISTER: Intermittent: Give at a rate ≤1 g/h.  

INCOMPATIBILITIES Solution/additive: Carbenicillin, kanamycin, methicillin, penicillin G, phenytoin.

  • Follow manufacturer's directions for further information on reconstitution, storage time, compatible IV fluids, and IV administration rates.

Adverse Effects (≥1%)

Body as a Whole: Hypersensitivity [pruritus, urticaria, skin rashes, exfoliative and vesiculobullous dermatitis, erythema multiforme (rare), angioedema, photosensitivity, anaphylactoid reaction, serum sickness]; superinfections (proctitis, pruritus ani, vaginitis); vertigo, dizziness, headache, generalized myalgia, thrombophlebitis following IV use; pain at IM injection site. CV: Hypotension, syncope, cardiopulmonary arrest (particularly after rapid IV). GI: Glossitis, stomatitis, nausea, vomiting, anorexia, decreased taste acuity, unpleasant or altered taste, abdominal cramps, diarrhea, acute enterocolitis, pseudomembranous colitis (potentially fatal). Hematologic: Neutropenia, leukopenia, agranulocytosis, thrombocytopenic purpura, aplastic anemia. Special Senses: Tinnitus.

Interactions

Drug: Kaolin and pectin decrease lincomycin absorption; tubocurarine, pancuronium may enhance neuromuscular blockade.

Pharmacokinetics

Peak: 30 min IM. Duration: 12–14 h IM; 14 h IV. Distribution: High concentrations in bone, aqueous humor, bile, and peritoneal, pleural, and synovial fluids; crosses placenta; distributed into breast milk. Metabolism: Partially in liver. Elimination: In urine and feces. Half-Life: 5 h.

Nursing Implications

Assessment & Drug Effects

  • Lab tests: Perform C&S initially and during therapy to determine continued microbial susceptibility. Periodic liver & kidney function tests and CBC are indicated during prolonged drug therapy.
  • Take a careful history of previous sensitivities to drugs or other allergens.
  • Monitor BP and pulse. Have patient remain recumbent following drug administration until BP stabilizes.
  • Monitor closely and report changes in bowel frequency. Discontinue drug if significant diarrhea occurs.
  • Diarrhea, acute colitis, or pseudomembranous colitis (see Appendix F) may occur up to several weeks after cessation of therapy.
  • Examine IM/IV injection sites daily for signs of inflammation.
  • Monitor serum drug levels closely in patients with severe impairment of kidney function (levels tend to be higher).
  • Superinfections by nonsusceptible organisms are most likely to occur when duration of therapy exceeds 10 d (see Appendix F).

Patient & Family Education

  • Notify physician immediately of symptoms of hypersensitivity (see Appendix F). Drug should be discontinued.
  • Notify physician promptly of the onset of perianal irritation, diarrhea, or blood and mucus in stools. Do not self-medicate for diarrhea—anti-diarrheal agents may prolong and worsen diarrhea by delaying removal of toxins from colon.
  • Take drug as prescribed for full course of therapy.

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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