clindamycin hydrochloride
Cleocin

clindamycin palmitate hydrochloride
Cleocin Pediatric

clindamycin phosphate
Cleocin Phosphate, Cleocin T

Available forms
Available by prescription only
Capsules: 75 mg, 150 mg, 300 mg
Gel, lotion, pledgets, topical solution: 1%
Infusion for I.V. use: 150 mg/ml (300 mg, 600 mg, 900 mg)
Injection: 150 mg/ml
Solution (granules): 75 mg/5 ml
Vaginal cream: 2%

Indications and dosages
 Infections caused by sensitive organisms. Adults: 150 to 450 mg P.O. q 6 hours. Or, 600 to 2,700 mg I.M. or I.V. daily divided into two to four equal doses.
Children older than age 1 month: 8 to 20 mg/kg P.O. daily or 20 to 40 mg/kg I.V. daily divided into three or four equal doses.
Children younger than age 1 month: 15 to 20 mg/kg I.V. daily divided into three or four equal doses.
 Bacterial vaginosis. Adults: 100 mg (one applicatorful of clindamycin phosphate) intravaginally h.s. for 7 days.
 Acne vulgaris. Adults: Apply thin film of topical solution, gel, or lotion to affected areas b.i.d.
 Toxoplasmosis (cerebral or ocular) in immunocompromised patients ◇. Adults and adolescents: 300 to 450 mg P.O. q 6 to 8 hours with pyrimethamine (25 to 75 mg once daily) and leucovorin (10 to 25 mg once daily).
Infants and children: 20 to 30 mg/kg daily P.O. in four divided doses with oral pyrimethamine (1 mg/kg daily) and oral leucovorin (5 mg once every 3 days).
 Pneumocystis carinii pneumonia ◇. Adults: 600 mg I.V. q 6 hours or 300 to 450 mg P.O. q.i.d. With primaquine, give 15 to 30 mg P.O. daily.

Pharmacodynamics
Antibacterial action: Drug inhibits bacterial protein synthesis by binding to ribosome’s 50S subunit. Clindamycin may produce bacteriostatic or bactericidal effects on susceptible bacteria, including most aerobic gram-positive cocci and anaerobic gram-negative and gram-positive organisms. It’s considered a first-line drug in the treatment of Bacteroides fragilis and most other gram-positive and gram-negative anaerobes. It’s also effective against Mycoplasma pneumoniae, Leptotrichia buccalis, and some gram-positive cocci and bacilli.

Pharmacokinetics
Absorption: When given orally, drug is absorbed rapidly and almost completely from the GI tract, regardless of formulation. When given I.M.,absorption is good. With 300-mg dose, peak levels are about 6 mcg/ml; with 600-mg dose, about 10 mcg/ml.
Distribution: Distributed widely to most body tissues and fluids (except CSF) and crosses the placental barrier. About 93% of drug is bound to plasma proteins.
Metabolism: Metabolized partially to inactive metabolites.
Excretion: About 10% of dose is excreted unchanged in urine; rest is excreted as inactive metabolites (with some drug appearing in breast milk). Plasma half-life is 2 1/2 to 3 hours in patients with normal renal function; 3 1/2 to 5 hours in anephric patients; and 7 to 14 hours in patients with hepatic disease. Peritoneal dialysis and hemodialysis don’t remove drug.

Contraindications and precautions
Contraindicated in patients hypersensitive to the antibiotic congener lincomycin; in those with a history of ulcerative colitis, regional enteritis, or antibiotic-associated colitis; and in those with a history of atopic reactions.
  Use cautiously in patients with asthma, impaired renal or hepatic function, or history of GI diseases or significant allergies.

Interactions
Drug-drug. Acne preparations: Topical clindamycin may cause cumulative irritant or drying effect. Monitor patient carefully.
Diphenoxylate, opiates: May prolong or worsen clindamycin-induced diarrhea. Monitor patient closely.
Erythromycin: May block clindamycin from reaching its site of action. Avoid use together.
Kaolin: May reduce GI absorption of clindamycin. Separate administration times.
Neuromuscular blockers: May potentiate neuromuscular blockade. Monitor patient closely.
Drug-food. Diet foods with sodium cyclamate: Decreases serum drug levels. Discourage use together.

Adverse reactions
GI: esophagitis, nausea, vomiting, abdominal pain, diarrhea,pseudomembranous colitis.
GU: cervicitis, vaginitis, Candida albicans overgrowth, vulvar irritation.
Hematologic: transient leukopenia, eosinophilia, thrombocytopenia.
Hepatic: jaundice.
Skin: maculopapular rash, urticaria, dryness, redness, pruritus, swelling, irritation, contact dermatitis, burning.
Other: anaphylaxis.

Effects on lab test results
• May increase bilirubin, AST, and alkaline phosphatase levels.
• May increase eosinophil count. May decrease WBC and platelet counts.

Overdose and treatment
No information available.

Special considerations
• Take culture and sensitivity tests before treatment starts; repeat as needed.
• Don’t refrigerate reconstituted oral solution because it will thicken. Drug remains stable for 2 weeks at room temperature.
• I.M. preparation should be given deep I.M. Rotate sites. Doses exceeding 600 mg aren’t recommended.
• I.M. injection may increase creatine kinase levels because of muscle irritation.
• For I.V. infusion, dilute each 300 mg in 50 ml of D₅W, normal saline solution, or lactated Ringer’s solution and give no more than 30 mg/minute. Don’t administer more than 1.2 g/hour.
• Topical form may produce adverse systemic effects.
• Monitor renal, hepatic, and hematopoietic functions during prolonged therapy.
Breast-feeding patients
• Drug appears in breast milk. An alternative to breast-feeding should be used during clindamycin therapy.
Pediatric patients
• Administer drug cautiously, if at all, to neonates and infants. Monitor patient closely, especially for diarrhea.
Geriatric patients
• Elderly patients may tolerate drug-induced diarrhea poorly. Monitor patient closely for change in bowel frequency and dehydration.

Patient education
• Warn patient that I.M. injection may be painful.
• Instruct patient to report adverse effects, especially diarrhea. Warn patient not to self-treat diarrhea.
• Advise patient to take capsules with 8 oz (240 ml) of water to prevent dysphagia.
• Instruct patient using topical solution to wash, rinse, and dry affected areas before application. Warn patient not to use topical solution near eyes, nose, mouth, or other mucous membranes, and advise patient not to share washcloths and towels with family members.

Reactions may be common, uncommon, life-threatening, or COMMON AND LIFE THREATENING.
◆ Canada only
◇ Unlabeled clinical use