clindamycin

Drug Name

Generic Name : clindamycin, clindamycin hydrochloride, clindamycin palmitate hydrochloride, clindamycin phosphate

Brand Name:

  • Oral:  Cleocin, Dalacin C (CAN),Cleocin Pediatric
  • Oral, parenteral, topical dermatologic solution for acne, vaginal preparation: Cleocin Phosphate, Cleocin T, Cleocin Vaginal Ovules, Clinda-Derm (CAN), Clindagel, ClindaMax, Clindets, Dalacin C (CAN)

Classification: Lincosamide antibiotic

Pregnancy Category B

Dosage & Route
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 bedtime for 7 consecutive days; or insert vaginal suppository, preferably at bedtime for 7 consecutive days; or insert vaginal suppository, preferably at bedtime for 3 days for Cleocin Vaginal Ovules.

Topical

  • Apply a thin film to affected area bid.
Pediatric

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 350 mg/m2/day to 450 mg/m2/day.
Geriatric Patients or Patients with Renal Failure
  • Reduce dose, and monitor patient’s serum levels carefully
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
Adverse effects
  • Diarrhea, nausea, vomiting, abdominal pain; erythema multiforme, contact dermatitis, exfoliative and vesiculous dermatitis, urticaria; eosinophilia; local irritation, thrombophlebitis.
  • Potentially Fatal: Gasping syndrome (neonates); pseudomembranous colitis.
Contraindications
  • Hypersensitivity.
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; CBC, LFTs, renal 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.
  • BLACK BOX WARNING: Be aware that serious to fatal colitis can occur; reserve use, and monitor patient closely.
  • Monitor LFTs and renal 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 bedtime.
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.
  • You may experience these side effects: Nausea, vomiting (eat frequent small 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 lots 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.