clindamycin

lincosamide antibiotic· Brands: Dalacin C, Cleocin, Clinamycin, Clindagel, ClindesseIMIVPOTOP

Mechanism of action

Clindamycin is a lincosamide antibiotic that inhibits bacterial protein synthesis by binding to the 50S subunit of the ribosomal RNA. This action prevents peptide bond formation and disrupts early polypeptide chain elongation. The drug is primarily bacteriostatic but can be bactericidal against susceptible organisms at high concentrations or with certain pathogens.

Pharmacokinetics

Clindamycin is well absorbed after oral administration, with a bioavailability of about 90%. It is widely distributed throughout the body, including bone and abscesses, but penetrates the cerebrospinal fluid poorly unless the meninges are inflamed. It is extensively metabolised in the liver, primarily via oxidation and conjugation, and excreted both in bile and urine. The elimination half-life is approximately 2 to 3 hours.

Indications & dosing

Anaerobic bacterial infections (e.g., intra-abdominal, pelvic)

For severe infections. Convert to oral when clinically stable.

adult · IV: 600–900 mg every 8 hours · For severe infections. Convert to oral when clinically stable.

Bone and joint infections

Long-term therapy often required. Consider oral switch for continuation.

adult · IV: 600–900 mg every 8 hours · Long-term therapy often required. Consider oral switch for continuation.

Skin and soft tissue infections

Use when anaerobic coverage is needed, e.g., bite wounds or diabetic foot infections.

adult · PO: 150–300 mg every 6 hours · Use when anaerobic coverage is needed, e.g., bite wounds or diabetic foot infections.

Dental abscess and periodontitis

Alternative to penicillin in penicillin-allergic patients.

adult · PO: 150–300 mg every 6 hours · Alternative to penicillin in penicillin-allergic patients.

Aspiration pneumonia

Often used in combination with other agents. Convert to oral when possible.

adult · IV: 600–900 mg every 8 hours · Often used in combination with other agents. Convert to oral when possible.

Contraindications & precautions

Hypersensitivity to clindamycin or lincomycin · Cross-reactivity may occur.
History of antibiotic-associated colitis
Inflammatory bowel disease (ulcerative colitis, Crohn's disease) · Increased risk of diarrhoea and colitis.
Myasthenia gravis · May exacerbate neuromuscular blockade.
Use with caution in patients with a history of gastrointestinal disease, particularly colitis.
Discontinue clindamycin if significant diarrhoea occurs.
Reduce dose in severe hepatic impairment.
Avoid in neonates: intravenous formulations may contain benzyl alcohol.
Prolonged use may cause overgrowth of non-susceptible organisms, including Clostridioides difficile.

Adverse effects

Diarrhoea
Nausea
Abdominal pain
Pseudomembranous colitis (Clostridioides difficile associated)serious
Skin rash
Urticaria
Anaphylaxisserious
Stevens-Johnson syndrome / toxic epidermal necrolysisserious
Blood dyscrasias (e.g. neutropenia)serious
Thrombophlebitis at injection site

Renal & hepatic adjustment

Hepatic impairment (mild): No dose adjustment required.
Hepatic impairment (moderate): Use with caution; monitor liver function.
Hepatic impairment (severe): Consider reducing dose or increasing dosing interval.

Monitoring, pregnancy & toxicity

Liver function tests · Baseline and periodically
Renal function · Periodically in prolonged therapy
Complete blood count · In prolonged therapy
Signs of C. difficile-associated diarrhoea · During therapy
Pregnancy: Clindamycin crosses the placenta but is generally considered safe in pregnancy. Use when clearly indicated; no dose adjustment required.
Toxicity: C. difficile-associated diarrhoea / pseudomembranous colitis · Discontinue clindamycin; treat with oral vancomycin or fidaxomicin; supportive care.
Toxicity: Hypersensitivity reactions (rash, anaphylaxis) · Discontinue; treat with antihistamines or corticosteroids; for anaphylaxis, treat with adrenaline.
Toxicity: Hepatotoxicity (rare) · Discontinue; monitor liver function; supportive care.

Clinical notes

Clindamycin is used to treat infections caused by Gram-positive cocci, anaerobes, and certain protozoa. Common indications include skin and soft tissue infections, bone and joint infections, anaerobic intra-abdominal and pelvic infections, and as an alternative for penicillin-allergic patients. It is also used in combination with other agents for severe infections. Adverse effects include diarrhoea, nausea, and a risk of Clostridioides difficile-associated colitis. Resistance can occur, so culture and susceptibility testing are advised for serious infections. Local formularies may restrict its use.

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BNF; local formulary