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clindamycin (Cleocin, Cindesse, ClindaMax)
Tradename: Cleocin.
Indications:
1) Gm+ aerobic or anaerobic bacterial infections
a) skin or soft tissue infection
- diabetic foot infection
b) infectious arthritis, osteomyelitis
c) intra-abdominal infection
- gastrointestinal infection
- diverticulitis
- pelvic inflammatory disease
d) sepsis
e) respiratory tract infection
- sinusitis
- Pneumocystis pneumonia
- parapneumonic effusion
f) acute otitis media
3) alternative agent in treatment of
a) malaria
b) toxoplasmosis (with pyrimethamine)
c) Pneumocystis carinii (with primaquine)
c) babesiosis
4) empiric treatment for fever of unknown origin [8]
5) prophylaxis for bacterial endocarditis
6) prophylaxis for perioperative infection
- gynecologic surgery [8]
4) topical treatment of rosacea & severe acne
5) intravaginally for treatment of bacterial vaginosis
Contraindications:
- not to be used in combination with beta-lactam/ beta-lactamase antibiotics, i.e. Unasyn, Zosyn, Augmentin
Dosage: 600-900 mg IV every 8 hours. 150-450 mg PO every 6 hours.
100 mg (1 full applicator) inserted intravaginally QHS for 7 days. Clindesse: 100 mg one time application (2% cream) [7]
Cream: 2% 20 mg/g (40 g) "
Gel: 10 mg/g (7.5 g, 30 g) (as phosphate)
Lotion: 10 mg/g (60 mL) "
Solution: topical 1% (60 mL) "
Injection: 150 mg/mL (2, 4, 6 mL) "
Tabs: 150 mg (as hydrochloride)
Topical agent for acne:
1) apply thin film BID
2) maximum benefit may not be seen for 12 weeks
Pharmacokinetics:
1) well absorbed orally
2) distributes to most body fluids & bone
3) poor CSF penetration
4) metabolized by the liver
5) eliminated in the bile, urine & feces
6) 1/2life 2-3 hours
7) concentration slightly altered by dialysis
, 10% of topically applied drug is absorbed systemically.
Antimicrobial activity:
Gram positive
- Streptococcus
- Streptococcus group A
- Streptococcus group B
- Streptococcus group C
- Streptococcus group G
- Streptococcus pneumonia
- Staphylococcus aureus (MSSA)
Gram negative
- Haemophilus ducreyi
Anaerobes
- Actinomyces
- Bacteroides fragilis
- Bacteroides melaninogenicus
Adverse effects:
1) common (> 10%)
- diarrhea
2) less common (1-10%)
- pseudomembranous colitis, nausea/vomiting, skin rashes
3) uncommon (< 1%)
- thrombophlebitis, hypotension, urticaria, Stevens-Johnson syndrome, eosinophilia, neutropenia, granulocytopenia, thrombocytopenia, increased serum transaminases, sterile abscess at IM injection site, polyarthritis, renal dysfunction (rare)
4) topical
- rash, hypersensitivity, dryness of skin
- Clindesse weakens latex condoms & diaphragms for 5 days
Drug interactions:
1) clindamycin may enhance activity of neuromuscular blocking agents
2) do NOT take with erythromycin
3) kaolin-pectin incombination reduces clindamycin levels; take 2 hours apart
Mechanism of action:
1) binds to 50S ribosomal subunit inhibiting bacterial protein synthesis
2) bacteriostatic
Interactions
drug interactions
General
lincosamide; linosamide
other antibiotic
Properties
MISC-INFO: elimination route LIVER
1/2life 1.6-5.3 HOURS
protein-binding 94%
pregnancy-category B
safety in lactation ?
Database Correlations
PUBCHEM correlations
References
- Harrison's Principles of Internal Medicine, 13th ed.
Companion Handbook. Isselbacher et al (eds),
McGraw-Hill Inc. NY, 1995, pg 166.
- The Pharmacological Basis of Therapeutics, 9th ed.
Gilman et al, eds. Permagon Press/McGraw Hill, 1996
- Sanford Guide to antimicrobial therapy 1997
- Medical Knowledge Self Assessment Program (MKSAP) 11, American
College of Physicians, Philadelphia 1998
- Kaiser Permanente Northern California Regional Drug
Formulary, 1998
- Drug Information & Medication Formulary, Veterans Affairs,
Central California Health Care System, 1st ed., Ravnan et al
eds, 1998
- Prescriber's Letter 12(2): 2005
Clindesse (Clindamycin Vaginal Cream, 2%)
Detail-Document#: 210213
(subscription needed) http://www.prescribersletter.com
- Deprecated Reference
Component-of
adapalene/clindamycin
all trans retinoic acid/clindamycin
all trans retinoic acid/clindamycin/phosphate
benzoyl peroxide/clindamycin (BenzaClin)
benzoyl peroxide/clindamycin/phosphate