Clindamycin (Cleocin)

Category:

  • Antibiotic

Description:

  • Lincosamide antibiotic

Indications:

  • Anaerobic infections (empyema, lung abscesses, intra-abdominal infections and absecesses, peritonitis, endometriosis)

  • Streptococci and Staphylococci infections (serious respiratory and skin infections, septicemia, osteomyelitis)

  • Pneumococci infections (respiratory infections)

  • Adjunctive therapy to surgical treatment of bone and joint infections

  • Dental procedure prophylaxis

  • Unlabeled uses:

  • CNS toxoplasmosis in AIDS patients

  • Pneumocystis carinii

  • Pelvic Inflammatory Disease: Chlamydia trachomatis

  • Bacterial vaginitis: Gardnerella vaginalis

Contraindications:

  • May cause a fatal colitis, characterized by severe diarrhea, cramping, and passage of blood and mucous

  • Not for treatment of minor bacterial or viral infections

Precautions:

  • Pregnancy category B

  • Risk of fatal colitis

  • Does not adequately diffuse into CSF, therefore not for meningitis therapy

  • Clindamycin crosses into breast milk

  • Closely monitor organ system functions when administering to newborns and infants

  • Monitor liver/kidney functions and blood counts if administering for prolonged periods

  • DO NOT administer as an IV bolus, infuse over 10-60 minutes

Adverse Reactions (Side Effects):

  • Hypotension

  • CNS: Headache, mild depression, confusion

  • Gastrointestinal: diarrhea (2-20%), pseudomembranous colitis (>10% with oral tx), nausea, vomiting, abdominal pain, esophagitis

  • Jaundice

  • Local injection site pain, thrombophlebitis

  • Hypersensitivity reactions: urticaria, erythema multiforme, generalized morbilliform-like rash

  • Take each dose with a full glass of water (decreases esophageal iritiation)

  • May be taken without regard for meals

  • Complete full course of therapy

Dosage:

  • Administered orally (capsules and solution) and deep IM or IV injection

  • Adults:

    • 150-300mg every 6 hours

  • serious infections:

    • 300-450mg every six hours

  • CNC toxoplasmosis: 

    • 1200-2400mg/day with pyrimethamine

  • Pelvic Inflammatory Disease: 

    • 900mg every 8 hours IV with gentamicin (LD: 2mg/kg IV followed by 1.5mg/kg every 8 hours IV), therapy continued for 24 hours after patient improvement

  • Pneumocystis carinii

    • 600mg qid IV or 900mg tid IV with primaquine

  • Bacterial vaginitis: 

    • 300mg bid for 7 days

  • Children:

    • 8-16mg/kg/day in divided doses three to four times a day

    • serious infections: 16-20mg/kg/day in divided doses three to four times a day

  • Parenteral:

    • Adults (>16 years old):

    • Aerobic gram-positive cocci and sensitive anaerobes: 600-1200mg/day in 2-4 equal doses

    • B. fragilis, Peptococcus species or Clostridium species: 1.2-2.7grams per day in 2-4 equal doses

    • Life-threatening situations: 4.8 grams per day

  • Children (>1 month):

    • 20-40mg/kg/day divided into 3-4 equal doses

  • Neonates (<1 month):

    • 15-20mg/kg/day in 3-4 divided doses

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