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Drug Name: Clindamycin

Click on the titles below for drug details

  • Lincosamide antibiotic
  • Binds the 50s ribosomal subunit of bacteria, which disrupts protein synthesis, causing changes in the bacterial cell wall and decreases adherence of bacteria to host cells and increases intracellular killing of organisms
  • Also enhances optimization and phagocytosis of bacterial cells
  • Primarily bacteriostatic, but at higher concentrations can be bactericidal against certain strains
  • IV/IM (osteomyelitis or otherwise not tolerating PO)
    • 10mg/kg/dose q6hrs (Single dose maximum 900mg)
    • Maximum daily dose is 2700mg/day
  • Oral (non-osteomyelitis)
    • Typical dose: 10mg/kg/dose q8hrs OR 7.5mg/kg/dose q6hrs
    • Single dose maximum 600mg if q8hrs OR 450mg if q6hrs
    • Max daily dose 1800mg/day
  • Oral (osteomyelitis)
    • 10mg/kg/dose q6hr (Single dose maximum 600mg)
  • Dosage forms:
    • 150mg and 300mg capsule; 75mg capsule uncommon
    • 75mg/5mL solution
  • Spectrum
    • Covers anaerobic, streptococcal, staphylococcal infections
    • Achieves high levels in bone, can reduce toxin production in toxin-producing strains of staph/strep
      • Inhibits production of staph associated toxin that causes toxic shock syndrome
      • Completely inhibits alpha toxin expression in S. aureus (in contrast with beta-lactams which induce it)
    • Generally active against Staph species, Viridans-Group streptococci, Streptococcus pyogenes, and Streptococcus pneumoniae
    • DOES cover MRSA (though with some areas with increasing resistance)
    • Good anaerobic coverage, though there have been increasing rates of resistance particularly with B. Fragilis
    • Does NOT cover respiratory or enteric Gram-negatives (e.g., H. influenzae, Neisseria species, E. coli, etc.), Enterococci, or atypicals (e.g., Mycoplasma
  • Indications:
    • Complicated intra-abdominal infection
    • Osteoarticular infection
    • Peritonitis (in patients with PD catheter)
    • PJP treatment
    • CAP
    • Skin/soft tissue infection (staph and strep)
    • Group A strep (in patients with severe penicillin allergy)
    • Toxic shock syndrome and Staphylococcal Scalded Skin Syndrome
      • Previous research found that clindamycin in combination with a bactericidal agent (e.g., cefazolin/cephalexin) improved time-to-resolution for toxin-mediated infections due to clindamycin's activity against protein production. More recent research shows this isn't necessarily true, but clindamycin may still be added in severe cases.
  • Hypersensitivity to clindamycin or lincomycin
  • GI
    • 2-20% of patients experience diarrhea while on clindamycin, can occur during or even several weeks after cessation of therapy
    • Pseudomembranous colitis secondary to C. difficile reported in 0.1 - 10% of patients on clindamycin
      • Undergoes enterohepatic circulation, so it can cause disturbances in the gut flora for up to 2 weeks after administration
      • Dose and time related to cumulative antibiotic exposure
  • Allergic reactions
    • Maculopapular skin rash reported in up to 10% of patients
    • More rarely associated with severe dermatologic side effects such as DRESS or SJS
  • Cardiac
    • Hypotension following rapid IV administration
    • Less common but still reported to have thrombophlebitis with IV administration
  • Distributes throughout body fluids and tissues
  • Has > 90% oral bioavailability (can switch to PO dosing as soon as tolerating PO!)
  • Does not accumulate at significant levels in the CSF, even with inflamed meninges, so cannot be used for treatment of meningitis
  • Diarrhea is a very common side effect, more common with higher doses and longer duration of treatment
  • The liquid formulation is known to have a terrible taste; if switching from IV to PO dosing of this with a patient who is admitted, recommend trialing a dose before to d/c to make sure it can be tolerated.
    • Anecdotal evidence shows masking of the taste most effective when co-administered with chocolate or strawberry syrup.
    • Consider volume tolerable when ordering liquid (ex. 300mg dose of liquid is 20mL ; 450mg dose of liquid is 30mL)
  • Capsule should be taken with full glass of water to mitigate risk of pill esophagitis
  • May be taken with or without food