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 blood–brain barrier.
• Topical dermatologic solution: Treatment of acne vulgaris
• Vaginal preparation: Treatment of bacterial vaginosis

Contraindications and cautions

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

Available forms
Capsules—75, 150, 300 mg; granules for oral solution—75 mg/5 mL; injection—
150 mg/mL; topical gel—10 mg; topical lotion—10 mg; topical solution—10 mg;
vaginal cream—2%; vaginal suppository—100 mg

Dosages
ADULTS
Oral
150–300 mg q 6 hr, up to 300–450 mg q 6 hr in more severe infections.
Parenteral
600–2,700 mg/day in two to four equal doses; up to 4.8 g/day IV or IM may be used for
life-threatening 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, 8–20 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: 15–20 mg/kg/day in three or four equal doses.
> 1 mo: 15–40 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.
GERIATRIC PATIENTS OR PATIENTS WITH RENAL FAILURE
Reduce dose, and monitor patient's serum levels carefully.

Pharmacokinetics
Route Onset Peak Duration
Oral Varies 1–2 hr 8–12 hr
IM 20–30 min 1–3 hr 8–12 hr
IV Immediate Minutes 8–12 hr
Topical Minimal systemic absorption

Metabolism: Hepatic; T1/2: 2–3 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 50–100
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.

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
• CNS: Fatigue, headache
• Dermatologic: Contact dermatitis, dryness, gram-negative folliculitis
• GI: Pseudomembranous colitis, diarrhea, bloody diarrhea; abdominal pain, sore
throat
• GU: Urinary frequency
Vaginal preparation
• 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

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
• 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.

Adverse effects in Italic are most common; those in Bold are life-threatening.