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