Drug reference
Clindamycin is active against Gram-positive cocci, including streptococci and penicillin-resistant staphylococci, and also against many anaerobes, especially Bacteroides fragilis. It is well concentrated in bone and excreted in bile and urine.
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Staphylococcal bone and joint infections such as osteomyelitis | Peritonitis | Intra-abdominal sepsis | Meticillin-resistant Staphylococcus aureus (MRSA) in bronchiectasis, bone and joint infections, and skin and soft-tissue infections ▶BY MOUTH ▶Child: 3–6 mg/kg 4 times a day (max. per dose 450 mg) ▶Adult: 150–300 mg every 6 hours; increased if necessary up to 450 mg every 6 hours if required, increased dose used in severe infection ▶BY DEEP INTRAMUSCULAR INJECTION, OR BY INTRAVENOUS INFUSION ▶Adult: 0.6–2.7 g daily in 2–4 divided doses; increased if necessary up to 4.8 g daily, increased dose used in life- threatening infection, single doses above 600 mg to be administered by intravenous infusion only, single doses by intravenous infusion not to exceed 1.2 g Moderate diabetic foot infection | Severe diabetic foot infection ▶BY MOUTH ▶Adult: 150–300 mg every 6 hours; increased if necessary up to 450 mg every 6 hours ▶BY INTRAVENOUS INFUSION ▶Adult: 0.6–2.7 g daily in 2–4 divided doses; increased if necessary up to 4.8 g daily, increased dose used in life- threatening infection, single doses not to exceed 1.2 g Cellulitis | Erysipelas ▶BY MOUTH ▶Child: 3–6 mg/kg 4 times a day (max. per dose 450 mg) for 7 days then review ▶Adult: 150–300 mg every 6 hours; increased if necessary up to 450 mg every 6 hours for 7 days then review ▶BY INTRAVENOUS INFUSION ▶Adult: 0.6–2.7 g daily in 2–4 divided doses; increased if necessary to 1.2 g 4 times a day, increased dose used in life-threatening infection Treatment of mild to moderate pneumocystis pneumonia (in combination with primaquine) ▶BY MOUTH ▶Adult: 600 mg every 8 hours Treatment of falciparum malaria (to be given with or following quinine) ▶BY MOUTH ▶Child: 7–13 mg/kg every 8 hours (max. per dose 450 mg) for 7 days ▶Adult: 450 mg every 8 hours for 7 days l UNLICENSED USE Not licensed for treatment of mild to moderate pneumocystis infection. Not licensed for treatment of falciparum malaria.
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Diarrhoeal states
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Avoid in Acute porphyrias p. 1120 ▶With intravenous use or oral use electrolyte disturbances (predisposition to QT interval prolongation). may aggravate myasthenia gravis. predisposition to QT interval prolongation
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For choice of antibacterial therapy, see Diabetic foot infections, antibacterial therapy p. 533, Gastro-intestinal system infections, antibacterial therapy p. 535, Genital system infections, antibacterial therapy p. 536, Malaria, treatment p. 649, MRSA p. 612, Musculoskeletal system infections, antibacterial therapy p. 536, Pneumocystis pneumonia p. 637, Skin infections, antibacterial therapy p. 540.
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→Appendix 1: clindamycin
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GENERAL SIDE-EFFECTS ▶Common or very common Skin reactions SPECIFIC SIDE-EFFECTS ▶Common or very common ▶With oral use Abdominal pain. antibiotic associated colitis. diarrhoea (discontinue) ▶Uncommon ▶With oral use Nausea. vomiting ▶Frequency not known ▶With oral use Agranulocytosis. angioedema. eosinophilia. gastrointestinal disorders. jaundice. leucopenia. neutropenia. severe cutaneous adverse reactions (SCARs). taste altered. thrombocytopenia. vulvovaginal infection ▶With parenteral use Abdominal pain. agranulocytosis. antibiotic associated colitis. cardiac arrest. diarrhoea (discontinue). eosinophilia. hypotension. jaundice. leucopenia. nausea. neutropenia. severe cutaneous adverse reactions (SCARs). taste altered. thrombocytopenia. thrombophlebitis. vomiting. vulvovaginal infection SIDE-EFFECTS, FURTHER INFORMATION Antibiotic- associated colitis Clindamycin has been associated with antibiotic-associated colitis, which may be fatal. Although antibiotic-associated colitis can occur with most antibacterials, it occurs more frequently with clindamycin. If C difficile infection is suspected or confirmed, discontinue the antibiotic if appropriate. Seek specialist advice if the antibiotic cannot be stopped and the diarrhoea is severe. ▶Common or very common Appetite decreased. diarrhoea. dizziness. gastrointestinal discomfort. gastrointestinal disorders. headache. hearing impairment. insomnia. nausea. pancreatitis. paraesthesia. skin reactions. taste altered. vasodilation. vision disorders. vomiting ▶Uncommon Angioedema. anxiety. arrhythmias. candida infection. chest pain. constipation. drowsiness. eosinophilia. hepatic disorders. leucopenia. neutropenia. palpitations. QT interval prolongation. severe cutaneous adverse reactions (SCARs). tinnitus. vertigo ▶Rare or very rare Antibiotic associated colitis. myasthenia gravis. nephritis tubulointerstitial ▶Frequency not known Hallucination. hypotension. seizure . smell altered. thrombocytopenia. tongue discolouration eiiii F 565
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Manufacturer advises not known to be harmful in the second and third trimesters; use with caution in the first trimester—limited data.
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g Specialist sources indicate use with caution—present in milk. Monitor infant for effects on the gastrointestinal flora such as diarrhoea, candidiasis, or rarely, blood in the stool indicating possible antibiotic- associated colitis. k
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Monitor liver and renal function if treatment exceeds 10 days. ▶In children Monitor liver and renal function in neonates and infants.
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▶With intravenous use Avoid rapid intravenous administration. For intravenous infusion (Dalacin ® C Phosphate), give continuously or intermittently in Glucose 5% or Sodium Chloride 0.9%; dilute to not more than 18 mg/mL and give over 10–60 minutes at a rate not exceeding 30 mg/minute (1.2 g over at least 60 minutes; higher doses by continuous infusion).
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There can be variation in the licensing of different medicines containing the same drug. Forms available from special-order manufacturers include: oral suspension, oral solution Solution for injection EXCIPIENTS: May contain Benzyl alcohol ▶Clindamycin (Non-proprietary) Clindamycin (as Clindamycin phosphate) 150 mg per 1 ml Clindamycin 600mg/4ml solution for injection ampoules | 5 ampoule P £59.00 (Hospital only) | 5 ampoule P £61.75 Clindamycin 300mg/2ml solution for injection ampoules | 5 ampoule P £29.50 (Hospital only) | 5 ampoule P £31.01 ▶Dalacin C (Pfizer Ltd) Clindamycin (as Clindamycin phosphate) 150 mg per 1 ml Dalacin C Phosphate 300mg/2ml solution for injection ampoules | 5 ampoule P £31.01 (Hospital only) Dalacin C Phosphate 600mg/4ml solution for injection ampoules | 5 ampoule P £61.75 (Hospital only) Capsule CAUTIONARY AND ADVISORY LABELS 9, 27 ▶Clindamycin (Non-proprietary) Clindamycin (as Clindamycin hydrochloride) 75 mg Clindamycin 75mg capsules | 24 capsule P £7.45 DT = £7.45 Clindamycin (as Clindamycin hydrochloride) 150 mg Clindamycin 150mg capsules | 24 capsule P £13.72 DT = £2.51 | 100 capsule P £4.26–£55.08 Clindamycin (as Clindamycin hydrochloride) 300 mg Clindamycin 300mg capsules | 30 capsule P £42.00 DT = £38.23 ▶Dalacin C (Pfizer Ltd) Clindamycin (as Clindamycin hydrochloride) 75 mg Dalacin C 75mg capsules | 24 capsule P £7.45 DT = £7.45 Clindamycin (as Clindamycin hydrochloride) 150 mg Dalacin C 150mg capsules | 24 capsule P £13.72 DT = £2.51 | 100 capsule P £55.08 ANTIBACTERIALS › MACROLIDES Infection Macrolides Overview The macrolides have an antibacterial spectrum that is similar but not identical to that of penicillin; they are thus an alternative in penicillin-allergic patients. They are active against many-penicillin-resistant staphylococci, but some are now also resistant to the macrolides. Indications for the macrolides include campylobacter enteritis, respiratory infections (including pneumonia, whooping cough, Legionella, chlamydia, and mycoplasma infection), and skin infections. Erythromycin p. 569 is also used in the treatment of early syphilis, uncomplicated genital chlamydial infection, and non-gonococcal urethritis. Erythromycin has poor activity against Haemophilus influenzae. Erythromycin causes nausea, vomiting, and diarrhoea in some patients; in mild to moderate infections this can be avoided by giving a lower dose, but if a more serious infection, such as Legionella pneumonia, is suspected higher doses are needed. Azithromycin p. 566 is a macrolide with slightly less activity than erythromycin against Gram-positive bacteria, but enhanced activity against some Gram-negative organisms including H. influenzae. Plasma concentrations are very low, but tissue concentrations are much higher. It has a long tissue half-life and once daily dosage is recommended. Azithromycin is also used in the treatment of uncomplicated genital chlamydial infection, non-gonococcal urethritis, uncomplicated gonorrhoea, typhoid [unlicensed indication], trachoma [unlicensed indication], and Lyme disease [unlicensed indication]. Clarithromycin p. 567 is an erythromycin derivative with slightly greater activity than the parent compound. Tissue concentrations are higher than with erythromycin. Clarithromycin is also used in regimens for Helicobacter pylori eradication. Spiramycin is also a macrolide which is used for the treatment of toxoplasmosis. Macrolides f
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Patients and their carers should be advised to discontinue and contact a doctor immediately if severe, prolonged or bloody diarrhoea develops. ▶With oral use Capsules should be swallowed with a glass of water. l PROFESSION SPECIFIC INFORMATION Dental practitioners’ formulary ▶With oral use Clindamycin capsules may be prescribed.
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3–6 mg/kg 4 times a day (max. per dose 450 mg)
First-line fragment. Read the complete Indications and Dose section above.
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150–300 mg every 6 hours; increased if
First-line fragment. Read the complete Indications and Dose section above.
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0.6–2.7 g daily in 2–4 divided doses; increased if
First-line fragment. Read the complete Indications and Dose section above.
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150–300 mg every 6 hours; increased if
First-line fragment. Read the complete Indications and Dose section above.
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0.6–2.7 g daily in 2–4 divided doses; increased if
First-line fragment. Read the complete Indications and Dose section above.
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3–6 mg/kg 4 times a day (max. per dose 450 mg)
First-line fragment. Read the complete Indications and Dose section above.
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150–300 mg every 6 hours; increased if
First-line fragment. Read the complete Indications and Dose section above.
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0.6–2.7 g daily in 2–4 divided doses; increased if
First-line fragment. Read the complete Indications and Dose section above.
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600 mg every 8 hours
First-line fragment. Read the complete Indications and Dose section above.
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7–13 mg/kg every 8 hours (max. per dose
First-line fragment. Read the complete Indications and Dose section above.
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450 mg every 8 hours for 7 days
First-line fragment. Read the complete Indications and Dose section above.
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