Clindamycin
Anton C. de Groot in Monographs in Contact Allergy, 2021
Clindamycin is a semisynthetic broad-spectrum antibiotic produced by chemical modification of the parent compound lincomycin. This agent dissociates peptidyl-tRNA from the bacterial ribosome, thereby disrupting bacterial protein synthesis. Clindamycin is indicated for the treatment of serious infections caused by susceptible anaerobic bacteria, including Bacteroides spp., Peptostreptococcus, anaerobic streptococci, Clostridium spp., and microaerophilic streptococci. The antibiotic may be useful in polymicrobial infections such as intra-abdominal or pelvic infections, osteomyelitis, diabetic foot ulcers, aspiration pneumonia and dental infections. Another use of clindamycin is vaginally to treat vaginosis caused by Gardnerella vaginosa. Clindamycin reduces the toxin-producing effects of S. aureus and S. pyogenes and as such, may be particularly useful for treating necrotizing fasciitis. In topical preparations, clindamycin is widely used in the treatment of inflammatory acne vulgaris (1).
Clindamycin
Thomas T. Yoshikawa, Shobita Rajagopalan in Antibiotic Therapy for Geriatric Patients, 2005
Although clindamycin has been used in clinical practice for quite some time, only limited data exist concerning its pharmacodynamic properties. Even though clindamycin is traditionally classified as a bacterostatic agent, it is bactericidal against some organisms such as gram-positive cocci and Bacteroides spp. It displays time-dependent killing at concentrations that exceed four times the minimal inhibitory concentration (MIC) and demonstrates a prolonged Post-Antibiotic Effect (PAE) against certain susceptible bacteria. This PAE is dependent on both the concentration and the duration of exposure to clindamycin, and is believed to be due to the persistence of the drug at the ribosomal binding site. At subinhibitory concentrations, clindamycin enhances opsonization of bacteria and their subsequent phagocytosis. Clindamycin has also been shown to inhibit glycocalyx production and bacterial adherence to host cells, In a rabbit model of viridans streptococcal endocarditis, Dall et al. (7) reported that animals receiving clindamycin had smaller vegetations that were sterilized faster than control animals receiving no treatment or penicillin alone. Organisms cultured from clindamycin-treated animals had markedly less glycocalyx formation. Thus, it is believed that clindamycin might lead to improved antimicrobial penetration into infected cardiac vegetations by inhibiting glycocalyx production in vivo (7).
Bacterial Vaginosis
William J. Ledger, Steven S. Witkin in Vulvovaginal Infections, 2017
Fortunately, there is the alternative of using a clindamycin product. None of the clindamycin alternatives seems as effective as the 7-day oral or 5-day vaginal metronidazole regimen. Clindamycin vaginal cream 2% can be used with 5 g applied intravaginally for 7 days.42 Occasionally, patients have a local reaction to the cream, usually due to propylene glycol, a preservative present in this formulation, and the subsequent vaginal burning and increased vaginal discharge is often worse than the original problem. Some of this vaginal clindamycin is absorbed, and rarely patients have developed pseudomembranous enterocolitis after using one of the vaginal products.43 For the patient who does not want to use a vaginal clindamycin product, oral clindamycin can be prescribed 300 mg twice a day for 7 days.42 Alternative regimens include tinidazole 2 g orally once a day for 2 days or tinidazole 1 g orally for 5 days.42 For the patient with an acute episode, most of the regimens work in the short term with an immediate resolution of symptoms. Other problems related to treatment can occur. Patients given oral or vaginal antibiotics can develop a Candida vaginitis. This occurs more commonly with the clindamycin products. When it occurs, it represents another vaginal infection to be treated and is a setback for the patient.
Bioavailability testing of a newly developed clindamycin oral suspension in a pediatric porcine model
Published in Pharmaceutical Development and Technology, 2019
Grace A. Goode, Santosh J. Wagh, David J. Irby, Dejian Ma, Richard F. Jacobs, Gregory L. Kearns, Hassan Almoazen
Clindamycin is a lincosamide antibiotic that inhibits bacterial protein synthesis through binding to the 50S rRNA and inhibiting ribosomal translocation (Johnson 2018). Clindamycin is used to treat anaerobic, streptococcal, and staphylococcal infections (Johnson 2018). It has experienced a resurgence of use in pediatrics consequent to an increased incidence of skin and soft tissue infections being produced by methicillin-resistant strains of S. aureus in the community (Herigon et al. 2010). The population pharmacokinetics of clindamycin have been previously described following both oral and intravenous administration (Bouazza et al. 2012). The drug has an average plasma elimination half-life of 2 to 3 h in adults and has excellent oral bioavailability (approximately 85–90%). The oral clindamycin liquid formulation available for pediatric and adult use in the U.S. is a palmitic acid ester, which enhances solubility and is nearly completely cleaved in the gastrointestinal tract to liberate free drug.
Hidradenitis suppurativa for the nondermatology clinician
Published in Baylor University Medical Center Proceedings, 2020
Kavina Patel, Lucy Liu, Benjamin Ahn, Annika S. Silfvast-Kaiser, So Yeon Paek
Systemic combination therapy with oral clindamycin and rifampin is the best studied antibiotic regimen and is used first line for Hurley stage II or III disease. Several case series have shown combination twice-daily clindamycin 300 mg and rifampin 300 mg for up to 10 weeks to be effective. In one study, 47% of patients treated for 10 weeks reported total remission and 35% had at least some improvement in their HS.23 Nearly 70% of 116 patients in one survey reported significant improvement after 10 weeks of treatment.24 Common side effects of clindamycin include Clostridium difficile–associated diarrhea, rash, and hepatotoxicity.25 Rifampin causes orange-tinged bodily fluids and CYP450 interactions. The use of clindamycin and rifampin up to 12 weeks is supported by all HS guidelines.
Prolonged postoperative antibiotic administration reduces complications after medial thigh lift
Published in Journal of Plastic Surgery and Hand Surgery, 2022
J. Weber, Z. Kalash, F. Simunovic, B. Bonaventura
There were no side-effects of clindamycin noted in this study, such as allergic reaction or diarrhea, and all patients completed the two-week course of antibiotics. While fully aware of the undesirable effects, such as acquired antibiotic resistance, we believe that patients undergoing MTL surgery may benefit from prolonged antibiotic administration. In these patients, there is a high (possibly 100%) rate of subclinical wound breakdown in the early postoperative period, which can lead to deep tissue infections. Clindamycin is a reasonable choice as it has high tissue and fluid concentrations after oral intake, excellent tissue penetration and is effective against Gram-positive aerobe bacteria, such as staphylococcus and various streptococcus strains, as well as against anaerobic bacteria [31]. The optimal time of antibiotic administration needs to be further evaluated.
Related Knowledge Centers
- Acne
- Antibiotic
- Endocarditis
- Otitis Media
- Pelvic Inflammatory Disease
- Pneumonia
- Septic Arthritis
- Streptococcal Pharyngitis
- Osteomyelitis
- Pathogenic Bacteria