Clindamycin – action, dosage and side effects

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Clindamycin is an antibiotic primarily with a bacteriostatic effect. In some cases, it is bactericidal. It is prescribed by prescription for infections caused by microbes that are sensitive to clindamycin. The antibiotic is mainly used in dermatology, venereology, gynecology and obstetrics. What is the composition of the drug and how does the antibiotic Clindamycin work? What are the indications and contraindications to its use and what side effects can it cause? How to take Clindamycin and with what drugs not to combine it?

Clindamycin – drug characteristics

Clindamycin is an antibiotic with antibacterial activity. The drug is prescribed by prescription to a specific patient and must not be passed on because it may harm another person, even if the symptoms are the same.

The active substance of the drug is the organic chemical compound clindamycin (Latin clindamycinum). In medicine, it is a semi-synthetic antibiotic from the group of lincosamides. It was approved for general circulation in 1970 in the United States, and the entity responsible for registration was Pharmacia & Upjohn. In the same year, it was introduced to the European market by the Swiss branch of Pfizer.

The Marketing Authorization Holder in Poland is MIP Pharma Polska Sp. z o. o. with its seat in Gdańsk.

Clindamycin is available in various forms, such as: skin emulsion, granules for syrup preparation, capsules, hard capsules, vaginal cream, skin lotion, solution for injection and infusion, coated tablets and gel.

On the other hand, the antibiotic Clindamycin is sold in the form of coated tablets. The drug package contains PVC / Al foil blisters in a cardboard box. Clindamycin MIP 150/300/600 is available on the pharmaceutical market with an active ingredient dose of 150 mg, 300 mg, and 600 mg.

A package of Clindamycin-MIP 150/300 mg may contain:

1. 6 coated tablets (1 blister);
2. 12 coated tablets (2 blisters);
3. 16 coated tablets (2 blisters);
4. 30 film-coated tablets (5 blisters).

A pack of Clindamycin-MIP 600 mg may contain:

1. 6 coated tablets (1 blister);
2. 12 coated tablets (2 blisters);
3. 16 coated tablets (2 blisters);
4. 30 coated tablets (5 blisters);
5. 32 film-coated tablets (4 blisters).

However, not all pack sizes may be marketed.

The 150 mg and 300 mg film-coated tablets are white, round and biconvex, while the 600 mg film-coated tablets are white, oblong, scored so that they can be divided into halves.

Clindamycin antibiotic price depends on the dose and packaging as well as the specific refund. The price varies between PLN 10 and PLN 35 per package.

Clindamycin is characterized by a wide spectrum of activity. It is a drug that works against many types of bacteria, including gram-positive bacteria (including many MRSA strains) and anaerobic bacteria. In addition, it has a positive effect on infections caused by Mycoplasma, Toxoplasma gondii, Pneumocystis carini, Chlamydia and in some protozoal infections, e.g. Plasmodium falciparum and Plasmodium vivax.

Keep the antibiotic out of the sight and reach of children at a temperature lower than 30 degrees Celsius, keeping the original box and the leaflet attached to it.

What are antibiotics and when should they be included in treatment? Check: Antibiotics – types, action, use and side effects [EXPLAIN]

Clindamycin – composition and action

The active substance of the antibiotic Clindamycin is clindamycin, which inhibits the synthesis of bacterial proteins. One film-coated tablet of the drug contains approximately 300 or 600 mg of clindamycin, a semi-synthetic lincomycin derivative.

The other ingredients are microcrystalline cellulose, mannitol, talc, colloidal anhydrous silica, magnesium stearate, crospovidone, Eudragit E 12,5% ​​and titanium dioxide (E 171).

Mechanism of action of the antibiotic Clindamycin it is closely related to the action of the active substance and is common to the entire group of lincosamides. The whole process is to block the bacterial ribosomes, the cellular structures that are essential for protein synthesis. This stops the growth and multiplication of bacterial cells.

Depending on the sensitivity of the microorganism and the concentration of the antibiotic, it may have a bacteriostatic or bactericidal effect.

For an antibiotic to work effectively, it must reach the concentration at the site of infection that will be necessary to inhibit the growth of the pathogenic microorganism, while at the same time the concentration must be safe for human cells.

The active substance Clindamycin is almost completely absorbed after oral administration. The maximum concentration is reached 2-3 hours after administration. The antibiotic easily penetrates into all body spaces, also in bones and joint fluid, but penetrates into the cerebrospinal fluid much less well. 10% of its active form is excreted in the urine, the rest of the drug is metabolized in the liver and excreted in the bile.

If you want to know the most popular myths about antibiotics, check out: Six myths about antibiotics

Clindamycin – dosage and use

The antibiotic Clindamycin should be used in accordance with the indications of the attending physician, who will determine the amount of the dose as well as the duration of use of the drug.

The effectiveness of the antibiotic Clindamycin depends on achieving the appropriate concentration at the site of infection.

Dosage method of Clindamycin it depends on the patient’s weight, comorbidities, age, disease, severity and location of the infection.

The maximum daily dose of clindamycin is 4,8 g. In adults and adolescents over 14 years of age, oral Clindamycin is administered at a dose of 600 to 1800 mg per day, administered in 3-4 divided doses.

The use of antibiotics in children over 5 years of age is allowed in doses from 8 to 25 mg of the active substance per kilogram of body weight per day in 3-4 divided doses.

If it is necessary to administer a lower dose of the active substance, the preparation with a lower content of clindamycin should be used.

Children who have difficulty swallowing the tablet are recommended other forms of the medical device.

In the case of clindamycin as a solution for injection, the recommended daily dose in severe infections is usually 1,2 g to 2,7 g of the active substance. Intravenous administration is only possible after appropriate preparation of the solution.

The dosage of Clindamycin should be adjusted in patients suffering from impaired renal or hepatic function. Patients should be constantly monitored by a doctor who will monitor the concentration of the active substance in the blood. Your doctor may decide to reduce or increase the dose, or increase the interval between doses, based on your blood results.

The antibiotic in the form of tablets should be taken orally, swallowed without chewing, regardless of meals and washed down with a sufficient amount of liquid.

Clindamycin should be taken regularly, at the same time each time for the period prescribed by your doctor. Long-term use of an antibiotic may cause excessive development of resistant bacteria and fungi.

If the preparation is used for a period longer than 3 weeks, it is necessary to perform check-ups of blood counts as well as kidney and liver function. In addition, you cannot make your own decisions about stopping the drug, as it may not work properly.

Any doubts about taking the Clindamycin antibiotic should be consulted with a doctor and not decide to change the dosage on your own, as it may harm your health and life.

What is an antibiogram? Check: Antibiogram

Clindamycin – indications for use

Clindamycin is an antibiotic used to treat infections caused by strains of bacteria that are susceptible to the action of the drug’s active substance, clindamycin.

The substance may act against such microorganisms as: staphylococci (Staphylococcus aureus, Staphylococcus epidermidis), Streptococcus pneumoniae, Streptococcus pyogenes group A, Streptococcus viridans, Bacteroides spp., Fusobacterium spp., Actinomoceptocp. Propionibacterium, Mycoplasma hominis.

Susceptibility to clindamycin is different for Clostridium spp. And some species are resistant to it.

Szczepami opornymi są natomiast Enterococcus spp. (E. faecalis, E. faecium), Neisseria spp. (eg N. gonorrhoeae, N. meningitidis), Haemophilus spp., Escherichia coli, Klebsiella, Enterobacter, Serratia, Proteus spp., Pseudomonas, Salmonella, Shigella and Nocardia.

Depending on the sensitivity of the microorganism and the concentration of the antibiotic, clindamycin may have a bacteriostatic or bactericidal effect. Clindamycin is perfect for the treatment of infections caused by bacteria sensitive to clindamycin and is indicated for the treatment of:

1. ear, nose and throat infections;
2. tooth infections and those caused by these infections: inflammation of the bones of the jaw and mandible;
3. lower respiratory tract infections;
4. scarlet fever;
5. skin and soft tissue infections;
6. genital and pelvic infections;
7. sepsis;
8. endocarditis;
9. intra-abdominal infections;
10. infections related to the locomotor system (bones and joints).

Severe infections require intravenous Clindamycin instead of oral administration. The effectiveness of an antibiotic depends on the appropriate concentration of the active substance in the place where the infection has occurred.

After what time can the effects of the antibiotic be expected? Check: How long does the antibiotic work for?

Clindamycin – contraindications to use

The antibiotic Clindamycin, although there are indications for its use, may not always be used in every patient.

The main contraindication to the use of this drug is hypersensitivity, i.e. allergy to the active substance, penicillin or other substances present in the composition.

The contraindications to the use of Clindamycin also include certain diseases and circumstances that may require you to completely abandon this drug or change the dosage of the preparation. The use of Clindamycin may require specific check-ups and a thorough medical history.

Among the circumstances that require caution in the use of Clindamycin, the following are distinguished:

1. neuromuscular conduction disorders (e.g. in people with myasthenia gravis or Parkinson’s disease);
2. liver dysfunction;
3. gastrointestinal diseases (including mainly colitis).

Clindamycin is not recommended for the treatment of meningitis as clindamycin has poor penetration into the cerebrospinal fluid.

In addition, this antibiotic is indicated for the effective treatment of viral respiratory infection.

There are no contraindications for the use of Clindamycin by pregnant women, however, it is recommended that before starting therapy with this drug, consult a doctor who will carefully analyze the expected benefits for the mother in terms of the potential risk to the child.

On the other hand, the use of the drug by breastfeeding women is not recommended, because the active substance of the drug passes into breast milk and may cause the risk of hypersensitivity, as well as diarrhea or yeast infections.

If you have any doubts about the use of an antibiotic, consult your doctor who will decide whether to include the drug in the treatment process.

You can read more about the effects of antibiotics here: Antibiotics aren’t working

Clindamycin – side effects of use

The antibiotic Clindamycin, like any drug, can cause side effects in a patient that do not have to occur in every person using this drug.

After authorization of the medicinal product, it is important to report any suspected adverse reactions so that the benefit / risk balance of the medicinal product can be monitored.

The general classification of the frequency of adverse body reactions (ADRs) is based on the following principles: very common (≥1 / 10), common (≥1 / 100 to <1/10), uncommon (≥1 / 1 to <000/1), rare ( ≥100 / 1 to <10 / 000), very rare (<1 / 1), not known (cannot be estimated from the available data).

The most common side effect of using Clindamycin is the possibility of anaphylactic shock. It may occur in the case of people who are allergic, i.e. hypersensitive to any component of the drug, to lincomycin and penicillin.

Possible reactions are: rash, itching, hives, angioedema (possible swelling of the lips, tongue, throat, larynx making breathing difficult), hypotension, shortness of breath, and severe skin reactions such as erythema multiforme, Stevens-Johnson syndrome, exfoliative and bullous dermatitis, toxic spreading necrosis.

If you experience the first symptoms of any of the above hypersensitivity reactions, please consult your doctor immediately. Among other side effects that may occur after using Clindamycin, the following can be distinguished, taking into account the frequency of occurrence in patients:

1. common (≥1 / 100 to <1/10): diarrhea, eosinophilia, liver function abnormalities, pseudomembranous enteritis, maculopapular rash, itchy skin, irritation, nausea;
2. uncommon (≥1 / 1 to <000/1): vaginitis, injection site sterile abscess, induration, phlebitis, abdominal pain, nausea, vomiting or mild diarrhea, all of these symptoms are dose-dependent and disappear during or after treatment, possibly causing oesophagitis, tongue or oral mucosa;
3. rare (> 1 / 10 to <000 / 1): measles-like rash, itching and hives; thrombocytopenia (decreased number of platelets), leukopenia (decreased number of white blood cells), eosinophilia (increased number of eosinophils), neutropenia (decreased number of neutrophils) or granulocytopenia (decreased number of granulocytes), transient slight increases in serum aminotransferase, muscular;
4. very rare (<1 / 10): pseudomembranous enteritis, edema (Quincke’s edema, joint swelling), drug fever, erythema multiforme (e.g. Stevens-Johnson syndrome), Lyell’s syndrome and anaphylactic shock (these reactions may occur after the first administration of the drug), transient hepatitis with jaundice cholestatic, pruritus, exfoliative and bullous dermatitis, vaginitis, polyarthritis, changes in taste and smell.

Long-term use (about three weeks) of the antibiotic Clindamycin may result in the development of bacteria resistant to this drug or the occurrence of fungal superinfections.

Antibiotic therapy may also reduce the natural microflora of the gut, which is the cause of the over-prevalence of Clostridium difficile. The toxins produced by Clostridium cause an increase in the severity of the disease as well as an increase in mortality.

If you experience any side effects, including any side effects not listed above, please inform your doctor or pharmacist. By reporting side effects, you can help provide more information on the safety of this medicine.

What is the natural human bacterial flora? Check: Microscopic tenants of our bodies

Clindamycin – interactions with other pharmaceuticals

The initiation of treatment with the use of the Clindamycin antibiotic requires a detailed history of all currently and recently taken medications, including over-the-counter medications.

The use of certain medications at the same time as taking Clindamycin can cause serious side effects.

Before taking the drug, tell your doctor or pharmacist about all the drugs you are taking, or have recently taken, and about the drugs you plan to start taking.

Antibiotics from the macrolide group and erythromycin in combination with clindamycin may weaken each other’s effect and reduce the effectiveness of clindamycin.

In addition, care should be taken in combining Clindamycin antibiotic with:

1. lincomycin (lincomycin-resistant microorganisms also show resistance to clindamycin);
2. neuromuscular blocking drugs;
3. muscle relaxants, including ether, tubocurarine, pancuronium halides (the effect of combining clindamycin with these preparations may be a threat to health or life, because clindamycin strengthens the effects of drugs blocking neuromuscular and muscle relaxants),
4. oral contraceptives (clindamycin may reduce the effectiveness of the medicine).

Always tell your doctor or pharmacist what prescription, over-the-counter or herbal products you are taking before using Clindamycin antibiotic and your doctor will individually assess your risk and treatment options based on this.

Which drugs should never be combined with each other? Check: Dangerous interactions