Clindamycin (Cleocin) is an antibiotic used for 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.
Generic Names & Brand Names
(klin da mye‘ sin)
Oral: Cleocin, Cleocin Suppository, Dalacin C (CAN)
clindamycin palmitate hydrochloride
Oral: Cleocin Pediatric
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)
- Lincosamide antibiotic
- Pregnancy Category B
Inhibits protein synthesis in susceptible bacteria, causing cell death.
- 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
- 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 cautiously with history of regional enteritis or ulcerative colitis; history of antibiotic-associated colitis.
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
150–300 mg q 6 hr, up to 300–450 mg q 6 hr in more severe infections.
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.
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.
Apply a thin film to affected area bid.
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.
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 300 mg/m2/day to 400 mg/m2/day; in severe infections, give 300 mg/day regardless of weight.
GERIATRIC PATIENTS OR PATIENTS WITH RENAL FAILURE
Reduce dose, and monitor patient’s serum levels carefully.
|Oral||Varies||1–2 hr||8–12 hr|
|IM||20–30 min||1–3 hr||8–12 hr|
|Topical||Minimal systemic absorption|
Metabolism: Hepatic; T1/2: 2–3 hr
Distribution: Crosses placenta; enters breast milk
Excretion: Urine and feces
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, carbenicillin. Incompatible in syringe with tobramycin.
- 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
- GU: Cervicitis, vaginitis, vulvar irritation
- Increased neuromuscular blockade with neuromuscular blocking agents
- Decreased GI absorption with kaolin, aluminum salts
- 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; complete blood count, renal and liver function tests
- 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 renal and liver 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.
- Give intravaginally, preferably at hs.
- 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 copious amounts of cool water.
- Report abdominal pain, diarrhea.
- 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.