Classes
DEA Class; Rx
Common Brand Names; Cleocin, Cleocin Pediatric
- Antibiotics, Lincosamide
clindamycin topical (Rx)
- Classes: Acne Agents, Topical
clindamycin vaginal (Rx)
- Classes: Vaginal Preparations, Other
Description
Oral/parenteral/topical/vaginal antibiotic derived from lincomycin
Commonly used for anaerobic infections; also used for skin and soft tissue infections, osteomyelitis, septic arthritis, pneumonia, and gynecologic infections
Diarrhea is common with clindamycin, and it has been associated with severe C. difficile colitis
Indications
Aerobic gram-positive cocci and the more susceptible anaerobes (NOT generally including Bacteroides fragilis, Peptococcus species and Clostridium species other than Clostridium perfringens)
Indicated for the treatment of Serious Infections Caused by Anaerobic Bacteria, Amnionitis, Inhalational & Gastrointestinal Anthrax (Off-label), Bacterial Vaginosis, Surgical Prophylaxis.
Indicated in Acne Vulgaris
Indicated for bacterial vaginosis
Indicated for Bite Wounds (Human or Animal)
Contraindications
Hypersensitivity to clindamycin, lincomycin, or formulation components
Adverse Effects
- Abdominal pain
- Agranulocytosis
- Eosinophilia (transient)
- Diarrhea
- Fungal overgrowth
- Pseudomembranous colitis
- Hypersensitivity
- Stevens-Johnson syndrome
- Rashes
- Urticaria
- Hypotension
- Nausea
- Vomiting
- Sterile abscess at IM site
- Thrombophlebitis
- Granulocytopenia
- Neutropenia
- Thrombocytopenia
- Polyarthritis
- Renal dysfunction
- Postmarketing reports
- Metallic taste
- Clostridium difficile colitis
- Acute generalized exanthematous pustulosis (AGEP)
- Erythema multiforme, some resembling Stevens-Johnson syndrome
- Acute kidney injury
- Drug reaction with eosinophilia and systemic symptoms (DRESS)
Warnings
Clindamycin is potentially nephrotoxic; acute kidney injury including acute renal failure reported; consider monitoring of renal function of patients with pre-existing renal dysfunction or taking concomitant nephrotoxic drugs; monitoring of renal function should be performed if therapy is prolonged
Endocarditis prophylaxis: Use only for high-risk patients, per recent AHA guidelines
Risk of potentially fatal pseudomembranous colitis, fungal or bacterial superinfection on prolonged use; discontinue therapy if significant abdominal cramps, diarrhea, or passage of blood and mucus occurs
May increase risk of drug-resistant bacteria if prescribed in the absence of proven or strongly suspected bacterial infection
Use caution in hepatic impairment, monitor for hepatic abnormalities; periodic liver enzyme determinations should be made when treating patients with severe liver disease
Not for use in meningitis due to inadequate penetration into CSF
Severe skin reactions including toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (DRESS), and Stevens-Johnson syndrome (SJS), some with fatal outcome, reported; permanently discontinue if reactions occur
Parenteral product contains benzyl alcohol, which has been associated with gasping syndrome and death in newborns
Use with caution in patients with history of gastrointestinal disease, especially colitis
Not for administration as a bolus; infuse over 10-60 min
Consider possibility of clostridium difficile in all patients who present with diarrhea following antibiotic use
Serious anaphylactic reactions require immediate emergency treatment with epinephrine; oxygen and intravenous corticosteroids should also be administered as indicated
Prescribe with caution in atopic individuals
Indicated surgical procedures should be performed in conjunction with antibiotic therapy
Clindamycin dosage modification may not be necessary in patients with renal disease
Discontinue therapy permanently and institute appropriate therapy if anaphylactic or severe hypersensitivity reaction occurs
When solution is administered to pediatric population (birth to 16 years) appropriate monitoring of organ system functions is desirable
Pregnancy and Lactation
In clinical trials with pregnant women, systemic administration of clindamycin during the second and third trimesters, has not been associated with increased frequency of congenital abnormalities
Clindamycin has been reported to appear in breast milk in range of 0.5 to 3.8 mcg/mL; clindamycin has potential to cause adverse effects on breastfed infant’s gastrointestinal flora; if oral or intravenous clindamycin is required by nursing mother, it is not a reason to discontinue breastfeeding, but alternate drug may be preferred; monitor infant for possible adverse effects on gastrointestinal flora, such as diarrhea, candidiasis (thrush, diaper rash) or rarely, blood in stool indicating possible antibiotic-associated colitis
Maximum Dosage
2,700 mg/day IV; up to 4,800 mg/day IV has been used for life-threatening infections; 2,400 mg/day IM; 1,800 mg/day PO. Topical formulations: 2 applications/day topically for gel, solution, lotion, or pledget; 1 application/day topically for foam. Vaginal creams: 1 applicatorful (100 mg clindamycin/5 g cream)/day for most products; 1 applicatorful (100 mg clindamycin/5 g cream) once for Clindesse. Vaginal ovules/suppositories: 1 ovule (100 mg clindamycin)/day.
2,700 mg/day IV; up to 4,800 mg/day IV has been used for life-threatening infections; 2,400 mg/day IM; 1,800 mg/day PO. Topical formulations: 2 applications/day topically for gel, solution, lotion, or pledget; 1 application/day topically for foam. Vaginal creams: 1 applicatorful (100 mg clindamycin/5 g cream)/day for most products; 1 applicatorful (100 mg clindamycin/5 g cream) once for Clindesse. Vaginal ovules/suppositories: 1 ovule (100 mg clindamycin)/day.
17 years: 2,700 mg/day IV; 2,400 mg/day IM; 25 mg/kg/day PO is FDA-approved maximum dosage; however, doses up to 40 mg/kg/day PO (Max: 1,800 mg/day) are used off-label. Topical formulations: 2 applications/day topically for gel, solution, lotion, or pledget; 1 application/day topically for foam. Vaginal creams: 1 applicatorful (100 mg clindamycin/5 g cream)/day for most products; 1 applicatorful (100 mg clindamycin/5 g cream) once for Clindesse. Vaginal ovules/suppositories: 1 ovule (100 mg clindamycin)/day.
13 to 16 years: 40 mg/kg/day IV/IM (Max: 2,700 mg/day IV; 2,400 mg/day IM); 25 mg/kg/day PO is FDA-approved maximum dosage; however, doses up to 40 mg/kg/day PO (Max: 1,800 mg/day) are used off-label. Topical formulations: 2 applications/day topically for gel, solution, lotion, or pledget; 1 application/day topically for foam. Vaginal creams: 1 applicatorful (100 mg clindamycin/5 g cream)/day for most products; 1 applicatorful (100 mg clindamycin/5 g cream) once for Clindesse. Vaginal ovules/suppositories: 1 ovule (100 mg clindamycin)/day.
12 years: 40 mg/kg/day IV/IM (Max: 2,700 mg/day IV; 2,400 mg/day IM); 25 mg/kg/day PO is FDA-approved maximum dosage; however, doses up to 40 mg/kg/day PO (Max: 1,800 mg/day) are used off-label. Topical formulations: 2 applications/day topically for gel, solution, lotion, or pledget; 1 application/day topically for foam.
1 to 11 years: 40 mg/kg/day IV/IM (Max: 2,700 mg/day IV; 2,400 mg/day IM); 25 mg/kg/day PO is FDA-approved maximum dosage; however, doses up to 40 mg/kg/day PO (Max: 1,800 mg/day) are used off-label.
40 mg/kg/day IV/IM; 25 mg/kg/day PO is FDA-approved maximum dosage; however, doses up to 40 mg/kg/day PO are used off-label.
20 mg/kg/day IV/IM and 25 mg/kg/day PO are the FDA-approved maximum dosages; however, the following doses have been recommended based on postmenstrual age (PMA):
Neonates older than 40 weeks PMA: 9 mg/kg/dose IV/IM/PO every 8 hours.
Neonates 33 to 40 weeks PMA: 7 mg/kg/dose IV/IM/PO every 8 hours.
Neonates 32 weeks PMA and younger: 5 mg/kg/dose IV/IM/PO every 8 hours.
How supplied
clindamycin hydrochloride
capsule
- 75mg
- 150mg
- 300mg
injectable solution
- 150mg/mL
oral solution
- 75mg/5mL
intravenous ready-to-use solution
- 300 mg/50mL (5% dextrose)
- 600 mg/50mL (5% dextrose)
- 900 mg/50mL (5% dextrose)
gel/lotion/solution/foam/swab
- 1%
vaginal cream
- 2% (5g/100mg) (Clindesse Vaginal Cream, Cleocin Vaginal Cream)
vaginal suppository
- 100mg (Cleocin Vaginal Ovules)
vaginal gel
- 2% (Xaciato)
