clindamycin (klin da mye' sin) clindamycin hydrochloride Oral: Cleocin, Cleocin Suppository, Dalacin C (CAN) clindamycin palmitate hydrochloride

Oral: Cleocin Pediatric clindamycin phosphate Oral, parenteral, topical dermatologic solution for acne, vaginal preparation: Cleocin Phosphate, Cleocin T, Cleocin Vaginal Ovules, Clinda-Derm (CAN), Dalacin C (CAN) Pregnancy Category B Drug class Lincosamide antibiotic Therapeutic actions Inhibits protein synthesis in susceptible bacteria, causing cell death. Indications Systemic administration: Serious infections caused by susceptible strains of anaerobes, streptococci, staphylococci, pneumococci; reserve use for penicillin-allergic patients or when penicillin is inappropriate; less toxic antibiotics (erythromycin) should be considered Parenteral: Treatment of septicemia caused by staphylococci, streptococci; acute hematogenous osteomyelitis; adjunct to surgical treatment of chronic bone and joint infections due to susceptible organisms; do not use to treat meningitis; does not cross the bloodbrain barrier. Topical dermatologic solution: Treatment of acne vulgaris Vaginal preparation: Treatment of bacterial vaginosis

Use cautiously in newborns and infants due to benzyl alcohol content; associated with gasping syndrome. Topical dermatologic solution, vaginal preparation Contraindicated with allergy to clindamycin or lincomycin. Use cautiously with history of regional enteritis or ulcerative colitis; history of antibioticassociated colitis. Available forms Capsules75, 150, 300 mg; granules for oral solution75 mg/5 mL; injection150 mg/mL; topical gel10 mg; topical lotion10 mg; topical solution10 mg; vaginal cream2%; vaginal suppository100 mg Dosages ADULTS Oral 150300 mg q 6 hr, up to 300450 mg q 6 hr in more severe infections. Parenteral 6002,700 mg/day in two to four equal doses; up to 4.8 g/day IV or IM may be used for lifethreatening situations. Vaginal One applicator (100 mg clindamycin phosphate) intravaginally, preferably at hs for 7 consecutive days; or insert vaginal suppository, preferably at hs for 7 consecutive days, 3 days for Cleocin Vaginal Ovules. Topical Apply a thin film to affected area bid. PEDIATRIC PATIENTS
Oral For clindamycin HCl, 820 mg/kg/day in three or four equal doses. For clindamycin palmitate HCl, 8 25 mg/kg/day in three or four equal doses; for children weighing < 10 kg, use 37.5 mg tid as the minimum dose. Parenteral Neonates: 1520 mg/kg/day in three or four equal doses. > 1 mo: 1540 mg/kg/day in three or four equal doses or 300 mg/m2/day to 400 mg/m2/day; in severe infections, give 300 mg/day regardless of weight.

systemic absorption Metabolism: Hepatic; T1/2: 23 hr Distribution: Crosses placenta; enters breast milk Excretion: Urine and feces
IV facts Preparation: Store unreconstituted product at room temperature. Reconstitute by adding 75 mL of water to 100-mL bottle of palmitate in two portions. Shake well; do not refrigerate reconstituted solution. Reconstituted solution is stable for 2 wk at room temperature. Dilute reconstituted solution to a concentration of 300 mg/50 mL or more of diluent using 0.9% sodium chloride injection, 5% dextrose injection, or lactated Ringer's solution. Solution is stable for 16 days at room temperature. Infusion: Do not administer more than 1,200 mg in a single 1-hr infusion. Infusion rates: 300 mg in 50 mL diluent, 10 min; 600 mg in 50 mL diluent, 20 min; 900 mg in 50100 mL diluent, 30 min; 1,200 mg in 100 mL diluent, 40 min. Incompatibilities: Do not mix with calcium gluconate, ampicillin, phenytoin, barbiturates, aminophylline, and magnesium sulfate. May be mixed with sodium chloride, dextrose, calcium, potassium, vitamin B complex, kanamycin, gentamicin, penicillin, carbencillin. Incompatible in syringe with tobramycin.

GU: Cervicitis, vaginitis, vulvar irritation

Interactions Systemic administration Drug-drug Increased neuromuscular blockade with neuromuscular blocking agents Decreased GI absorption with kaolin, aluminum salts Nursing considerations Assessment

History: Allergy to clindamycin, history of asthma or other allergies, allergy to tartrazine (in 75- and 150-mg capsules); hepatic or renal dysfunction; lactation; history of regional enteritis or ulcerative colitis; history of antibiotic associated colitis Physical: Site of infection or acne; skin color, lesions; BP; R, adventitious sounds; bowel sounds, output, liver evaluation; complete blood count, renal and liver function tests

Adverse effects
Systemic administration

CV: Hypotension, cardiac arrest (with rapid IV infusion) GI: Severe colitis, including pseudomembranous colitis, nausea, vomiting, diarrhea, abdominal pain, esophagitis, anorexia, jaundice, liver function changes Hematologic: Neutropenia, leukopenia, agranulocytosis, eosinophilia Hypersensitivity: Rashes, urticaria to anaphylactoid reactions

Local: Pain following injection, induration and sterile abscess after IM injection, thrombophlebitis after IV use Topical dermatologic solution

Contraindications and cautions Systemic administration Contraindicated with allergy to clindamycin, history of asthma or other allergies, tartrazine (in 75and 150-mg capsules); hepatic or renal dysfunction; lactation.

GERIATRIC PATIENTS OR PATIENTS WITH RENAL FAILURE Reduce dose, and monitor patient's serum levels carefully. Pharmacokinetics Route Onset Oral Varies IM 2030 min IV Immediate Topical Minimal Peak 12 hr 13 hr Minutes Duration 812 hr 812 hr 812 hr

CNS: Fatigue, headache Dermatologic: Contact dermatitis, dryness, gram-negative folliculitis GI: Pseudomembranous colitis, diarrhea, bloody diarrhea; abdominal pain, sore throat

Interventions Systemic administration Culture infection before therapy. Administer oral drug with a full glass of water or with food to prevent esophageal irritation. Do not give IM injections of more than 600 mg; inject deep into large muscle to avoid serious problems. Do not use for minor bacterial or viral infections. Monitor renal and liver function tests, and blood counts with prolonged therapy. Topical dermatologic administration Keep solution away from eyes, mouth and abraded skin or mucous membranes; alcohol base will cause stinging. Shake well before use. Keep cool tap water available to bathe eye, mucous membranes, abraded skin inadvertently contacted by drug solution. Vaginal preparation Give intravaginally, preferably at hs. Teaching points Systemic administration

GU: Urinary frequency Vaginal preparation

Take oral drug with a full glass of water or with food. Take full prescribed course of oral drug. Do not stop taking without notifying health care provider. These side effects may occur: Nausea, vomiting (eat small, frequent meals); superinfections in the mouth, vagina (use frequent hygiene measures; request treatment if severe). Report severe or watery diarrhea, abdominal pain, inflamed mouth or vagina, skin rash or lesions. Topical dermatologic administration Apply thin film of acne solution to affected area twice daily, being careful to avoid eyes, mucous membranes, abraded skin; if solution contacts one of these areas, flush with copious amounts of cool water. Report abdominal pain, diarrhea. Vaginal preparation Use vaginal preparation for 7 or 3 consecutive days, preferably at bedtime. Refrain from sexual intercourse during treatment with this product. Report vaginal irritation, itching; diarrhea, no improvement in complaint being treated.