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clindamycin

clindamycin

Pronunciation Generic Name: clindamycin (klin da MYE sin)

Brand Name: Cleocin HCl, Cleocin Pediatric, Cleocin Phosphate, Cleocin Phosphate ADD-Vantage

OverviewSide EffectsInteractionsFor ProfessionalsMore…

What is clindamycin?

Clindamycin is an antibiotic that fights bacteria in the body.

Clindamycin is used to treat serious infections caused by bacteria.

Clindamycin may also be used for purposes not listed in this medication guide.

What is the most important information I should know about clindamycin?

You should not use this medication if you are allergic to clindamycin or lincomycin (Bactramycin, L-Mycin, Lincocin).

Do not take clindamycin together with erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin, Pediazole, and others).

Before using clindamycin, tell your doctor if you have kidney disease, liver disease, an intestinal disorder such as colitis or Crohn’s disease, or a history of asthma, eczema, or allergic skin reaction.

Take this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Clindamycin will not treat a viral infection such as the common cold or flu.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, stop taking clindamycin and call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

To be sure this medication is not causing harmful effects, your blood may need to be tested often. Your kidney or liver function may also need to be tested. Visit your doctor regularly.

If you need surgery, tell the surgeon ahead of time that you are using clindamycin. You may need to stop using the medicine for a short time.

What should I discuss with my healthcare provider before taking clindamycin?

You should not use this medication if you are:

  • allergic to clindamycin or lincomycin (Bactramycin, L-Mycin, Lincocin); or

  • if you are also taking erythromycin (E.E.S., EryPed, Ery-Tab, Erythrocin, Pediazole, and others).

To make sure you can safely take clindamycin, tell your doctor if you have any of these other conditions:

  • colitis, Crohn’s disease, or other intestinal disorder;

  • kidney disease;
  • liver disease; or
  • a history of asthma, eczema, or allergic skin reaction.

FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment.

Clindamycin can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take clindamycin?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Follow the directions on your prescription label.

Take this medicine with a full glass of water to keep it from irritating your throat.

Measure liquid medicine with a special dose-measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one.

Take this medicine for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Clindamycin will not treat a viral infection such as the common cold or flu.

To be sure this medication is not causing harmful effects, your blood may need to be tested often. Your kidney or liver function may also need to be tested. Visit your doctor regularly.

If you need surgery, tell the surgeon ahead of time that you are using clindamycin. You may need to stop using the medicine for a short time.

Store at room temperature away from moisture and heat. Do not store clindamycin liquid in the refrigerator.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

What should I avoid while taking clindamycin?

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or bloody, stop taking clindamycin and call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to.

Clindamycin side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat.

Stop using clindamycin and call your doctor at once if you have any of these serious side effects:

  • diarrhea that is watery or bloody;

  • jaundice (yellowing of the skin or eyes);
  • urinating less than usual or not at all;
  • fever, chills, body aches, flu symptoms, sores in your mouth and throat;
  • easy bruising, unusual bleeding (nose, mouth, vagina, or rectum), purple or red pinpoint spots under your skin; or
  • severe skin reaction — fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

Less serious side effects may include:

  • change in bowel habits (especially in older adults);

  • mild nausea, vomiting, or stomach pain;
  • joint pain;
  • vaginal itching or discharge;
  • mild rash or itching; or
  • heartburn, irritation in your throat.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: clindamycin side effects (in more detail)

Clindamycin Dosing Information

Usual Adult Dose for Babesiosis:

600 mg orally every 6 to 8 hours or 1.2 grams IV twice daily, plus quinine sulfate 650 mg 3 times daily for 7 to 10 days.

Usual Adult Dose for Bacteremia:

450 to 900 mg IV every 8 hours. Once the patient is stable and able to tolerate oral medications, oral clindamycin may be substituted according to the microbiology sensitivity data. An appropriate oral dosage for this patient may be 450 mg orally every 6 hours.

Clindamycin is not commonly used for bacteremia and is specifically not recommended for Staphylococcus aureus bacteremia/endocarditis.

Duration: 14 days, depending on the nature and severity of the infection

Usual Adult Dose for Bacterial Endocarditis Prophylaxis:

600 mg orally 1 hour prior to the procedure. A single dose of clindamycin is appropriate for prophylaxis prior to dental, oral, upper respiratory tract and esophageal procedures in at-risk, penicillin-allergic patients. Alternatively, clindamycin may be administered intravenously in those patients unable to take clindamycin by mouth. The intravenous dosage is the same as the oral dosage but should be given 30 minutes before the procedure.

Patients who are already taking clindamycin for an infection should preferably be given another antibiotic, such as clarithromycin or azithromycin, for endocarditis prophylaxis. Alternatively, the procedure may be delayed, if possible, until 9 to 14 days after completion of therapy for infection.

Usual Adult Dose for Bacterial Vaginosis:

300 mg orally twice daily. The vaginal form of clindamycin may also be appropriate.

If trichomoniasis is suspected, treatment of this patient’s male sexual partner(s) is necessary if balanitis is present. Suspicion of trichomoniasis indicates metronidazole therapy for both the patient (provided the patient is not in the first trimester of pregnancy) and her male sexual partner(s).

Duration: 7 days

Usual Adult Dose for Diverticulitis:

450 mg orally every 6 hours. This dosage regimen is generally appropriate for the outpatient management of diverticulitis and should be given in conjunction with trimethoprim-sulfamethoxazole. For more acutely ill patients in the inpatient setting, clindamycin 450 to 900 mg intravenously every 8 hours may be administered in conjunction with other agents (often an aminoglycoside, a 3rd generation cephalosporin, an antipseudomonal penicillin or aztreonam).

Duration: Approximately one week in the outpatient setting. For more acutely ill patients, the total duration of therapy may be 10 to 14 days.

Usual Adult Dose for Deep Neck Infection:

600 mg IV every 6 to 8 hours. Once the patient is stable and able to tolerate oral medications, oral clindamycin may be substituted according to the microbiology sensitivity data. An appropriate oral dosage for this patient may be 450 mg orally every 6 hours.

Duration: 3 to 4 weeks, depending on the nature and severity of the infection

Usual Adult Dose for Intraabdominal Infection:

450 to 900 mg IV every 8 hours. Once the patient is stable and able to tolerate oral medications, oral clindamycin may be substituted according to the microbiology sensitivity data. An appropriate oral dosage for this patient may be 450 mg orally every 6 hours.

For intraabdominal infections, clindamycin is almost always used with one or more additional drugs.

Duration: 7 to 14 days, depending on the nature and severity of the infection

Usual Adult Dose for Joint Infection:

450 to 900 mg IV every 8 hours. Once the patient is stable and able to tolerate oral medications, oral clindamycin may be substituted according to the microbiology sensitivity data. An appropriate oral dosage for this patient may be 450 mg orally every 6 hours.

Duration: 3 to 4 weeks, depending on the nature and severity of the infection. Longer therapy, 6 weeks or more, may be required for prosthetic joint infections. In addition, removal of the involved prosthesis is usually required.

Usual Adult Dose for Malaria:

Chloroquine-resistant Plasmodium falciparum: 900 mg orally every 8 hours for 5 days plus quinine sulfate 650 mg every 8 hours for 3 to 7 days.

Usual Adult Dose for Osteomyelitis:

450 to 900 mg IV every 8 hours. Once the patient is stable and able to tolerate oral medications, oral clindamycin may be substituted according to the microbiology sensitivity data. An appropriate oral dosage for this patient may be 450 mg orally every 6 hours.

Duration: 4 to 6 weeks, sometimes longer, depending on the nature and severity of the infection. Chronic osteomyelitis may require an additional one to two months of oral antibiotic therapy and may benefit from surgical debridement.

The key to successful management of osteomyelitis is identification of the offending organism. If blood cultures are negative and no source of infection is obvious, bone biopsy or aspiration may be helpful in directing antibiotic therapy.

Usual Adult Dose for Pelvic Inflammatory Disease:

900 mg IV every 8 hours. Once the patient is stable and able to tolerate oral medications, oral clindamycin may be substituted according to the microbiology sensitivity data. An appropriate oral dosage for this patient may be 450 mg orally every 6 hours.

When used for the treatment of pelvic inflammatory disease in acutely ill women in the inpatient setting, clindamycin is generally given in conjunction with gentamicin. The combination of clindamycin and gentamicin should be continued for at least 48 hours after the patient has demonstrated clinical improvement. Thereafter, either oral clindamycin at a dosage of 450 mg every 6 hours or oral doxycycline (provided that the patient is not pregnant) may be started.

For less acutely ill women in the outpatient setting, ofloxacin in combination with clindamycin at a dosage of 450 mg orally every 6 hours may be used.

The patient’s sexual partner(s) should also be evaluated.

The total recommended duration of antimicrobial therapy is 14 days.

Usual Adult Dose for Peritonitis:

450 to 900 mg IV every 8 hours. In patients undergoing peritoneal dialysis, clindamycin should be administered intraperitoneally. A dosage of 300 mg should be added to each 2 liters of peritoneal dialysate.

Once the patient is stable and able to tolerate oral medications, oral clindamycin may be substituted according to the microbiology sensitivity data. An appropriate oral dosage for this patient may be 450 mg orally every 6 hours. For peritonitis, clindamycin is almost always used in conjunction with one or more additional drugs to cover aerobic Gram negative rods.

Usual Adult Dose for Pneumocystis Pneumonia:

450 to 600 mg orally every 6 hours. Clindamycin is effective in combination with primaquine for the treatment of mild to moderately severe PCP in AIDS patients. Seriously ill patients should receive intravenous trimethoprim-sulfamethoxazole or pentamidine, the drugs of choice for PCP. Alternative therapies for severe cases include intravenous trimetrexate or clindamycin given in a dosage of 900 mg intravenously every 8 hours.

Duration: Therapy should be continued for approximately 21 days, depending on the nature and severity of the infection. Once treatment for PCP is completed, AIDS patients should be administered lifelong suppressive therapy. Sulfamethoxazole-trimethoprim is the agent of choice for this purpose. Alternative therapies include dapsone with or without pyrimethamine and monotherapy with aerosolized pentamidine.

Usual Adult Dose for Pneumonia:

450 to 900 mg IV every 8 hours. Once the patient is stable and able to tolerate oral medications, oral clindamycin may be substituted according to the microbiology sensitivity data. An appropriate oral dosage for this patient may be 450 mg orally every 6 hours.

Duration: 10 to 21 days, depending on the nature and severity of the infection

Usual Adult Dose for Aspiration Pneumonia:

450 to 900 mg IV every 8 hours. Once the patient is stable and able to tolerate oral medications, oral clindamycin may be substituted according to the microbiology sensitivity data. An appropriate oral dosage for this patient may be 450 mg orally every 6 hours.

Duration: Therapy of anaerobic lung abscess should be continued until a residual scar forms, which may take as long as 2 to 4 months. A shorter duration of therapy may be appropriate for nonnecrotizing anaerobic pneumonia.

Usual Adult Dose for Prevention of Perinatal Group B Streptococcal Disease:

In patients with immediate penicillin hypersensitivity and clindamycin-susceptible isolates:

900 mg IV every 8 hours until delivery.

Usual Adult Dose for Sinusitis:

150 to 300 mg orally every 6 hours. Clindamycin is generally reserved for chronic bacterial sinusitis in which anaerobic bacteria may play a role.

Duration: 2 to 4 weeks

Usual Adult Dose for Skin or Soft Tissue Infection:

450 to 900 mg IV every 8 hours. Once the patient is stable and able to tolerate oral medications, oral clindamycin may be substituted according to the microbiology sensitivity data. An appropriate oral dosage for this patient may be 450 mg orally every 6 hours.

Duration: 7 to 10 days, or for 3 days after acute inflammation disappears, depending on the nature and severity of the infection. For more severe infections, such as diabetic soft tissue infections, 14 to 21 days of therapy may be required.

Usual Adult Dose for Surgical Prophylaxis:

600 mg IV given once within 1 hour of incision time. This regimen is appropriate for prophylaxis prior to gastrointestinal surgery.

Usual Adult Dose for Toxoplasmosis — Prophylaxis:

300 to 450 mg orally every 6 to 8 hours. This dosage of clindamycin should be given with pyrimethamine 25 to 75 mg orally once a day and leucovorin 10 mg orally once a day.

Clindamycin is recommended by the USPHS/IDSA (U.S. Public Health Service/Infectious Diseases Society of America) Prevention of Opportunistic Infections Working Group as an alternative to sulfadiazine for prophylaxis against recurrent toxoplasmosis in patients who do not tolerate sulfa drugs. Clindamycin is not recommended for prophylaxis against the first episode of toxoplasmosis gondii.

Duration: Maintenance therapy should be lifelong for AIDS patients.

Usual Adult Dose for Toxoplasmosis:

600 mg orally or IV every 6 hours. Adjunctive therapy with pyrimethamine should be given in a dosage of 200 mg orally once, followed by 50 to 100 mg orally once a day. Folinic acid (leucovorin) 10 mg orally once a day should be administered to prevent pyrimethamine-induced bone marrow toxicity.

The optimal dosage of clindamycin for CNS toxoplasmosis has not been determined. A regimen of 900 to 1200 mg every 8 hours has been used in some studies.

Clindamycin has no established role in the systemic treatment of toxoplasmosis and is most often used in patients intolerant of sulfadiazine or other sulfa medications and in the treatment of HIV-related central nervous system toxoplasmosis.

Duration: 3 to 6 weeks, depending on the nature and severity of the infection. Once treatment is completed, AIDS patients should be administered lifelong suppressive therapy.

Usual Adult Dose for Bacterial Infection:

300 to 900 mg IV every 8 hours. Once the patient is stable and able to tolerate oral medications, oral clindamycin may be substituted according to the microbiology sensitivity data. An appropriate oral dosage for this patient may be 300 to 450 mg orally every 6 hours.

Duration: 7 to 14 days, depending on the nature and severity of the infection

Usual Pediatric Dose for Babesiosis:

5 mg/kg (maximum dose 600 mg) every 6 hours plus quinine 8.3 mg/kg (maximum dose 650 mg) every 8 hours for 7 to 10 days.

Usual Pediatric Dose for Bacterial Endocarditis Prophylaxis:

1 year or older: As an alternative in penicillin-allergic patients, 20 mg/kg (maximum 600 mg) IV once within 30 minutes before procedure, or orally within 1 hour before procedure.

Usual Pediatric Dose for Surgical Prophylaxis:

1 year or older: As an alternative in penicillin-allergic patients, 20 mg/kg (maximum 600 mg) IV once within 30 minutes before procedure, or orally within 1 hour before procedure.

What other drugs will affect clindamycin?

There may be other drugs that can interact with clindamycin. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Next Page → Side Effects

More clindamycin resources

  • Side Effects
  • Pregnancy Warnings
  • Drug Images
  • Drug Interactions
  • Support Group
  • 102 Reviews - Add your own review/rating
  • clindamycin MedFacts Consumer Leaflet (Wolters Kluwer)
  • clindamycin Oral, Injection, Intravenous Advanced Consumer (Micromedex) – Includes Dosage Information
  • Clindamycin Professional Patient Advice (Wolters Kluwer)
  • Cleocin Pediatric Prescribing Information (FDA)
  • Cleocin Pediatric suspension MedFacts Consumer Leaflet (Wolters Kluwer)
  • Cleocin Phosphate Prescribing Information (FDA)
  • Clindamycin Hydrochloride Monograph (AHFS DI)

Compare clindamycin with other medications

  • Aspiration Pneumonia
  • Babesiosis
  • Bacteremia
  • Bacterial Endocarditis Prevention
  • Bacterial Infection
  • Bacterial Vaginitis
  • Bone infection
  • Deep Neck Infection
  • Diverticulitis
  • Intraabdominal Infection
  • Joint Infection
  • Malaria
  • Pelvic Inflammatory Disease
  • Peritonitis
  • Pneumocystis Pneumonia
  • Pneumonia
  • Prevention of Perinatal Group B Streptococcal Disease
  • Sinusitis
  • Skin Infection
  • Surgical Prophylaxis
  • Toxoplasmosis
  • Toxoplasmosis, Prophylaxis

Where can I get more information?

  • Your pharmacist can provide more information about clindamycin.

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Clindamycin

Clindamycin

Pronunciation: KLIN-da-MYE-sin

Class: Antibiotic, Anti-infective, Lincosamide Clindamycin Hydrochloride

Trade Names

Cleocin

– Capsules 75 mg

– Capsules 150 mg

– Capsules 300 mg

Dalacin C (Canada)

Clindamycin Palmitate Hydrochloride

Cleocin Pediatric

– Granules for oral solution 75 mg per 5 mL

Clindamycin Phosphate

Cleocin

– Vaginal ovules 100 mg

– Vaginal cream 2%

Cleocin Phosphate

– Injection 150 mg/mL

Cleocin Phosphate IV

– Injection 300 mg

– Injection 600 mg

– Injection 900 mg

Cleocin T

– Gel 1%

– Lotion 1%

– Solution, topical 1%

Clindagel

– Gel 1%

ClindaMax

– Gel 1%

– Lotion, topical 1%

ClindaReach

– Solution, topical 1%

Clindesse

– Vaginal cream 2%

Clindets

– Pledget 1%

Evoclin

– Foam 1%

Apo-Clindamycin (Canada)

Clindasol (Canada)

Clinda-T (Canada)

Dalacin C Flavored Granules (Canada)

Dalacin C Phosphate Sterile Solution (Canada)

Dalacin T Topical Solution (Canada)

Dalacin Vaginal Cream (Canada)

Gen-Clindamycin (Canada)

ratio-Clindamycin (Canada)

Taro-Clindamycin (Canada)

Pharmacology

Suppresses bacterial protein synthesis.

Pharmacokinetics

Absorption

Oral Rapidly absorbed. C max is 2.5 mcg/mL. T max is 45 min. Bioavailability is 90%.

IM T max is 3 h (adults) and 1 h (children).

IV C max is 7 to 14 mcg/mL.

Topical Very low levels present in the serum (0 to 3 ng/mL) after multiple applications.

Vaginal Approximately 5% is absorbed (cream); 30% absorbed (suppositories).

Distribution

Widely distributed (including bones); no significant levels attained in CSF. Excreted in breast milk.

Metabolism

Rapidly converted to active clindamycin.

Elimination

The average biological half-life is 2.4 to 3.2 h. Approximately 10% of bioactivity is excreted in the urine (0.2% for topical administration) and 3.6% in the feces; the remainder is excreted as inactive metabolites.

Special Populations

Renal Function Impairment

The serum half-life is increased slightly. Dosage adjustment is not usually needed.

Hepatic Function Impairment

The serum half-life is increased slightly. Dosage adjustment is not usually needed.

Indications and Usage

Treatment of serious infections caused by susceptible strains of anaerobic bacteria staphylococci, streptococci, and pneumococci in conditions such as lower respiratory tract infections, skin and skin structure infections, gynecological infections, intra-abdominal infections, septicemia, and bone and joint infections (PO/IV/IM). Treatment of acne vulgaris (topical use). Treatment of bacterial vaginosis (vaginal use) in nonpregnant women and second or third trimester pregnant women ( Cleocin and ClindaMax only).

Unlabeled Uses

Alternative to sulfonamides in combination with pyrimethamine in the acute treatment of CNS toxoplasmosis in AIDS patients; treatment of Chlamydia trachomatis infections in women; alternative to metronidazole in the treatment of bacterial vaginosis caused by Gardnerella vaginalis .

Contraindications

Hypersensitivity to lincosamides or any product component; history of regional enteritis, ulcerative colitis, or antibiotic-associated colitis.

Dosage and Administration

Adults PO 150 to 450 mg every 6 h.

Children Clindamycin hydrochloride PO 8 to 20 mg/kg/day divided into 3 to 4 doses.

Clindamycin palmitate hydrochloride PO 8 to 25 mg/kg/day divided into 3 to 4 doses. In children weighing 10 kg or less, 37.5 mg 3 times daily should be considered the minimum recommended dosage.

Acne

Adults Topical Apply thin film to affected area once daily ( Clindagel , Evoclin ) or twice daily ( Clindets ). More than 1 pledget may be used if necessary.

Acute Pelvic Inflammatory Disease

Adults IV 900 mg every 8 h with gentamicin loading dose of 2 mg/kg IV or IM, followed by 1.5 mg/kg every 8 h. Parenteral therapy may be discontinued after 24 h. After discharge from hospital, continue with doxycycline 100 mg twice daily for 10 to 14 days or oral clindamycin 450 mg 4 times daily for 10 to 14 days.

Serious Infections

Adults PO 150 to 300 mg every 6 hours.

More severe infections PO 300 to 450 mg every 6 h.

IV/IM 600 to 1,200 mg/day in 2 to 4 equally divided doses. For more serious infections, 1,200 to 2,700 mg/day in 2 to 4 equally divided doses may be administered. For severe or life-threatening infections, the dose may be increased. Doses as high as 4,800 mg daily have been given IV. Single IM injections of more than 600 mg are not recommended. Administration of more than 1,200 mg in a single 1-h infusion is not recommended. Alternative dosing may be administered in the form of a single rapid infusion of the first dose followed by continuous IV infusions.

To maintain serum levels above 4 mcg/mL Rapid infusion rate is 10 mg/min for 30 min followed by a maintenance dose of 0.75 mg/min.

To maintain serum levels above 5 mcg/mL Rapid infusion rate is 15 mg/min for 30 min followed by a maintenance dose of 1 mg/min.

To maintain serum levels above 6 mcg/mL Rapid infusion rate is 20 mg/min for 30 min followed by a maintenance dose of 1.25 mg/min.

Children 1 mo to 16 y of age IV/IM 20 to 40 mg/kg daily in 3 or 4 equally divided doses with the higher doses being given for severe infections. Alternative dosing based on BSA may be considered. 350 mg/m 2 daily for serious infections and 450 mg/m 2 daily for more severe infections.

Newborns younger than 1 mo of age IV/IM 15 to 20 mg/kg daily in 3 or 4 equally divided doses; the lower dose may be adequate for small premature infants.

Vaginosis

Adults Intravaginal cream 1 applicatorful, preferably at bedtime, for 3 or 7 consecutive days in nonpregnant patients and 7 consecutive days in pregnant patients. Clindesse : 1 applicatorful any time of the day for 1 day. Intravaginal suppositories Insert 1 suppository/day, preferably at bedtime, for 3 consecutive days.

General Advice

  • Capsules and oral solution
  • Administer without regard to meals, but administer with food if GI upset occurs.
  • Administer capsules with a full glass of water to reduce esophageal irritation.
  • Administer prescribed dose of oral solution using dosing spoon or dosing syringe.
  • Injection
  • For IV infusion or IM administration only. Not for intradermal, subcutaneous, or intra-arterial administration.
  • To minimize injection-site reactions, administer by deep IM injection and avoid prolonged use of indwelling IV catheters.
  • Do not administer undiluted solution by IV bolus. Infuse over at least 10 to 60 min. Follow manufacturer’s guidelines for recommended dilutions and infusion rates.
  • Follow manufacturer’s recommendations for reconstituting clindamycin when using the ADD-Vantage system.
  • Do not add other drugs to the clindamycin infusion bag.
  • Do not use plastic IV containers in series connections because of risk of air embolism.
  • Topical gel, solution, and lotion
  • For topical use only. Not for ophthalmic, vaginal, or oral administration.
  • Cleanse areas to be treated before applying medication.
  • Shake lotion well just before use.
  • If using topical solution pledget, remove pledget from foil just before use. Do not use if seal is broken. Discard pledget after single use.
  • Topical solution contains an alcohol base and will cause burning and irritation if applied to sensitive surfaces. Avoid contact with the eyes, mucous membranes, and abraded skin. If accidental contact occurs, rinse with large amounts of cool tap water.
  • Do not use any other topical acne medication unless directed by health care provider.
  • Do not dispense foam directly onto hands or face; foam will melt on contact with warm skin. Dispense amount directly onto cap or on a cool surface. If the can seems warm or the foam seems runny, run the can under cold water.
  • Vaginal cream and ovules
  • For intravaginal use only. Not for ophthalmic, dermal, or oral administration.
  • Administer Cleocin and ClindaMax vaginal cream using the disposable applicator provided with medication.
  • Administer Clindesse vaginal cream using the prefilled disposable applicator.
  • Administer suppository using reusable applicator.
  • If accidental contact of vaginal cream with the eye(s) occurs, rinse the eye(s) with large amounts of cool tap water.

Storage/Stability

Capsules, oral solution, and injection Store between 68° and 77°F. Do not refrigerate oral solution (causes thickening). Discard any unused oral solution after 14 days.

Topical gel, lotion, foam, and solution Store between 68° and 77°F. Store ClindaReach , Clindets pledgets, and ClindaMax gel and lotion between 59° and 86°F. Protect from freezing.

Vaginal cream Store between 68° and 77°F. Store Clindesse vaginal cream between 59° and 86°F. Protect from freezing.

Vaginal suppositories Store between 59° and 86°F. Avoid high humidity and temperatures higher than 86°F. Store Clindagel at 59° to 86°F. Do not store in direct sunlight.

Consult manufacturer’s information for storage of diluted parenteral solutions.

Drug Interactions

Aluminum salts, kaolin-pectin antidiarrheals May delay absorption of clindamycin.

Erythromycin May cause antagonism.

Nondepolarizing neuromuscular blockers May enhance actions of neuromuscular-blocking agents.

Incompatibility

Aminophylline, ampicillin, barbiturates, calcium gluconate, magnesium sulfate, phenytoin sodium.

Adverse Reactions

Cardiovascular

Hypotension; cardiopulmonary arrest after too-rapid IV use (rare).

CNS

Intravaginal Headache (3%).

Dermatologic

Exfoliative dermatitis, hypersensitivity (eg, erythema multiforme; maculopapular rash; skin rash; urticaria; vesiculobullous rash, some cases resembling Stevens-Johnson syndrome [rare]), pruritus.

EENT

Intravaginal Nasopharyngitis (1%).

GI

Abdominal pain; colitis, including pseudomembranous colitis (0.01% to 10% [more frequent with oral administration]); constipation, diarrhea, esophagitis, nausea, unpleasant or metallic taste (following higher doses of IV infusion); vomiting.

Intravaginal Constipation (1%).

Genitourinary

Azotemia, oliguria, proteinuria, UTI, vaginitis.

Intravaginal Fungal vaginosis (14%); vaginal moniliasis (13%); vulvovaginal disorder (7%); vulvovaginitis (6%); vulvovaginal pruritic vaginal pain (2%); trichomonas vaginitis, UTI (1%).

Hematologic

Agranulocytosis, eosinophilia, leukopenia, neutropenia, thrombocytopenia.

Hepatic

Jaundice, LFT abnormalities.

Local

Induration, pain, sterile abscess, thrombophlebitis.

Topical Dryness (23%); oily skin (18%); erythema (16%); burning, itching, peeling (11%).

Metabolic-Nutritional

Intravaginal Back pain (2%).

Musculoskeletal

Polyarthritis.

Miscellaneous

Abnormal labor (vaginal); anaphylaxis; fungal infection.

Intravaginal Fungal infection (2%); abnormal labor, moniliasis (1%). Topical or vaginal use may theoretically produce adverse reactions seen with systemic use as a result of absorption.

Precautions

Warnings

Clostridium difficile Clostridium difficile –associated diarrhea (CDAD) can occur with clindamycin administration and may range in severity from mild diarrhea to fatal colitis. Because life-threatening colitis can occur, reserve clindamycin therapy for serious infections where less toxic antimicrobial agents are inappropriate. Clindamycin should not be used to treat nonbacterial infections such as most upper respiratory tract infections. C. difficile produces toxins that can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in patients with diarrhea following antibiotic use. CDAD has been reported to occur more than 2 months after therapy has been stopped. If CDAD is suspected or confirmed, discontinue the causative antibiotic and institute treatment (including fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile , and surgical evaluation).

Monitor

Blood cell count/renal function/liver enzymes Ensure that blood cell counts, liver enzymes, and renal function are determined periodically during prolonged therapy.

Response to therapy Monitor patient’s response to therapy.

Adverse reactions Monitor patient for GI, skin, general body adverse reactions, and signs of superinfection.

Pregnancy

Category B . Clindamycin does cross the placenta.

Lactation

Excreted in breast milk.

Children

Monitor organ system functions in newborns and children (16 y of age and younger); parenteral form may contain benzyl alcohol, which can cause gasping syndrome in premature infants.

Intravaginal Safety and efficacy not established.

Topical Safety and efficacy not established in children younger than 12 y of age.

Elderly

May not tolerate diarrhea well (dehydration).

Hypersensitivity

Use drug with caution in patients with asthma or significant allergies or who are atopic; anaphylactic/anaphylactoid reactions may occur. Use with caution in atopic patients.

Renal Function

Use drug with caution in patients with severe renal disease with severe metabolic aberrations.

Hepatic Function

Use drug with caution in patients with severe hepatic disease with severe metabolic aberrations.

Special Risk Patients

Use with caution in patients with a history of GI disease or atopic patients.

Superinfection

May result in bacterial or fungal overgrowth of nonsusceptible organisms.

Tartrazine Sensitivity

Some products contain tartrazine, which may cause allergic-type reactions in susceptible individuals.

Debilitated patients

May not tolerate diarrhea well (dehydration).

Meningitis

Drug does not diffuse into CSF. Do not use to treat meningitis.

Mineral oil

Vaginal cream contains mineral oil, which may weaken latex rubber condoms or diaphragms.

Overdosage

Symptoms

No available information.

Patient Information

  • Reinforce to patient or caregiver the need to take exactly as prescribed and complete the entire course of therapy, even if symptoms of infection have disappeared. Caution patient or caregiver that skipping doses or not completing the full course of therapy may allow the infection to worsen and increase the possibility that the bacteria will become resistant to the antibiotic, which may cause infections that will not be treatable in the future.
  • Instruct patient to notify health care provider if infection does not appear to be improving or appears to be getting worse.
  • Advise patient to report the following signs of superinfection to health care provider: black, furry tongue; white patches in mouth; foul-smelling stools; vaginal itching or discharge.
  • Warn patient that diarrhea containing blood or pus may be a sign of a serious disorder, and to seek medical care if noted and to not treat at home. Caution patient that this may occur even weeks after completing therapy.
  • Advise patient to report any other bothersome adverse reaction to health care provider.
  • Capsules and oral solution
  • Advise patient or caregiver that capsules and oral solution can be taken without regard to meals, but to take with food if stomach upset occurs.
  • Advise patient to take capsules with a full glass of water.
  • Advise patient or caregiver that oral solution should be administered using a dosing spoon or syringe.
  • Injection
  • Advise patient, family, or caregiver that medication will be prepared and administered by a health care provider in a health care setting.
  • Advise patient to report injection-site pain or redness to health care provider.
  • Topical gel, solution, and lotion
  • Advise patient to cleanse areas to be treated before applying medication, then apply a thin film of medication once daily ( Clindagel or Evoclin ) or twice daily to entire affected areas.
  • Advise patient using lotion to shake well just before use.
  • Advise patient using topical solution pledget to remove pledget from foil just before use and then discard pledget after using. Caution patient not to use pledget if seal is broken.
  • Advise patient using topical solution that it contains an alcohol base and will cause burning and irritation if applied to sensitive surfaces. Caution patient to avoid contact with the eyes, mucous membranes, and abraded skin. Advise patient that if accidental contact occurs, to rinse with large amounts of cool tap water.
  • Advise patient that if local irritation occurs, to apply the medication less frequently. If irritation persists, advise patient to discontinue use and notify health care provider.
  • Caution patient not to use any other topical acne medication unless ordered by health care provider.
  • Advise patient to notify health care provider if acne does not improve or worsens.
  • Vaginal cream and suppositories
  • Remind patient using suppositories that they are for intravaginal use only and not to take by mouth.
  • For patient using Cleocin or ClindaMax vaginal cream, review instructions for filling applicator and administering medication. Advise patient that applicator is disposable and not to reuse.
  • For patient using Clindesse vaginal cream, review instructions for preparing the prefilled applicator and administering medication. Advise patient that applicator is disposable and not to reuse.
  • For patient using vaginal suppositories, review instructions for loading and administering applicator and cleaning applicator for reuse. Advise patient that suppository can also be inserted directly using fingers.
  • Advise patient using vaginal cream that if accidental contact with the eye(s) occurs, to rinse with large amounts of cool tap water. Advise patient to notify health care provider if eye irritation persists after rinsing.
  • Advise patient to avoid vaginal intercourse or use of other vaginal products (eg, tampons, douches) during treatment with clindamycin vaginal products.
  • Caution patient that vaginal cream contains mineral oil and vaginal suppository contains an oil-type base that can weaken latex or rubber products such as condoms and vaginal contraceptive diaphragms. Caution patient not to use such products within 72 h following treatment with Cleocin or ClindaMax vaginal cream or vaginal suppositories, or within 5 days of treatment with Clindesse vaginal cream.
  • Advise patient to discontinue use and notify health care provider if vaginal irritation develops while using the medication.

Copyright © 2009 Wolters Kluwer Health.

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Clindamycin

Clindamycin

Pronunciation Generic Name: clindamycin (KLIN-da-MYE-sin)

Brand Name: Cleocin

Infrequently, there are severe, rarely fatal, intestinal problems that can occur after use of clindamycin. Consult your doctor right away if you develop persistent diarrhea, stomach pain, or blood or mucus in your stool. These symptoms may occur weeks after stopping use of clindamycin. Do not use antidiarrhea products or narcotic pain medicines if you have these symptoms. These products may make the symptoms worse. Your doctor will monitor you closely while you are using clindamycin.

OverviewSide EffectsDosageInteractionsFor ProfessionalsMore…

Clindamycin is used for:

Treating serious infections caused by certain bacteria. It is not used to treat meningitis.

Clindamycin is a lincomycin antibiotic. Clindamycin kills sensitive bacteria by stopping the production of essential proteins needed by the bacteria to survive.

Do NOT use clindamycin if:

  • you are allergic to any ingredient in clindamycin or to lincomycin
  • you have certain intestinal problems (eg, antibiotic-associated colitis, Crohn disease, ulcerative colitis) or meningitis

Contact your doctor or health care provider right away if any of these apply to you.

Before using clindamycin:

Some medical conditions may interact with clindamycin. Tell your doctor or pharmacist if you have any medical conditions, especially if any of the following apply to you:

  • if you are pregnant, planning to become pregnant, or are breast-feeding
  • if you are taking any prescription or nonprescription medicine, herbal preparation, or dietary supplement
  • if you have allergies to medicines, foods, or other substances
  • if you have diarrhea, or a history of liver problems or stomach or bowel problems (eg, colitis)
  • if you are allergic to tartrazine

Some MEDICINES MAY INTERACT with clindamycin. Tell your health care provider if you are taking any other medicines, especially any of the following:

  • Nondepolarizing muscle relaxants (eg, vecuronium) or succinylcholine because the risk of their side effects may be increased by clindamycin
  • Erythromycin because it may decrease clindamycin’s effectiveness

This may not be a complete list of all interactions that may occur. Ask your health care provider if clindamycin may interact with other medicines that you take. Check with your health care provider before you start, stop, or change the dose of any medicine.

How to use clindamycin:

Use clindamycin as directed by your doctor. Check the label on the medicine for exact dosing instructions.

  • Take clindamycin by mouth with or without food.
  • Take clindamycin with a full glass of water (8 oz/240 mL).
  • Clindamycin works best if it is taken at the same time each day.
  • To clear up your infection completely, take clindamycin for the full course of treatment. Keep taking it even if you feel better in a few days.
  • If you miss a dose of clindamycin, take it as soon as possible. If it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not take 2 doses at once.

Ask your health care provider any questions you may have about how to use clindamycin.

Important safety information:

  • Clindamycin only works against bacteria; it does not treat viral infections (eg, the common cold).
  • Be sure to use clindamycin for the full course of treatment. If you do not, the medicine may not clear up your infection completely. The bacteria could also become less sensitive to this or other medicines. This could make the infection harder to treat in the future.
  • Long-term or repeated use of clindamycin may cause a second infection. Tell your doctor if signs of a second infection occur. Your medicine may need to be changed to treat this.
  • This product may contain tartrazine dye (FD&C Yellow No. 5). This may cause an allergic reaction in some patients. If you have ever had an allergic reaction to tartrazine, ask your pharmacist if your product has tartrazine in it.
  • Mild diarrhea is common with antibiotic use. However, a more serious form of diarrhea (pseudomembranous colitis) may rarely occur. This may develop while you use the antibiotic or within several months after you stop using it. Contact your doctor right away if stomach pain or cramps, severe diarrhea, or bloody stools occur. Do not treat diarrhea without first checking with your doctor.
  • Lab tests, including liver function, kidney function, and complete blood cell counts, may be performed while you use clindamycin. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.
  • Use clindamycin with caution in the ELDERLY; they may be more sensitive to its effects, especially diarrhea.
  • Use clindamycin with extreme caution in CHILDREN younger than 10 years old who have diarrhea or an infection of the stomach or bowel.
  • PREGNANCY and BREAST-FEEDING: If you become pregnant, contact your doctor. You will need to discuss the benefits and risks of using clindamycin while you are pregnant. Clindamycin is found in breast milk. If you are or will be breast-feeding while you use clindamycin, check with your doctor. Discuss any possible risks to your baby.

Possible side effects of clindamycin:

All medicines may cause side effects, but many people have no, or minor, side effects. Check with your doctor if any of these most COMMON side effects persist or become bothersome:

Mild diarrhea; nausea; vomiting.

Seek medical attention right away if any of these SEVERE side effects occur:

Severe allergic reactions (rash; hives; itching; difficulty breathing; tightness in the chest; swelling of the mouth, face, lips, or tongue); bloody or tarry stools; decreased urination; joint pain or swelling; red, swollen, blistered, or peeling skin; severe or persistent diarrhea; severe stomach cramps or pain; unusual vaginal discharge, itching, or odor; yellowing of the skin or eyes.

This is not a complete list of all side effects that may occur. If you have questions about side effects, contact your health care provider. Call your doctor for medical advice about side effects. To report side effects to the appropriate agency, please read the Guide to Reporting Problems to FDA.

If OVERDOSE is suspected:

Contact 1-800-222-1222 (the American Association of Poison Control Centers), your local poison control center, or emergency room immediately.

Proper storage of clindamycin: Store clindamycin at room temperature, between 68 to 77 degrees F (20 to 25 degrees C) in a tightly-closed container. Store away from heat, moisture, and light. Do not store in the bathroom. Keep clindamycin out of the reach of children and away from pets.

General information:

  • If you have any questions about clindamycin, please talk with your doctor, pharmacist, or other health care provider.
  • Clindamycin is to be used only by the patient for whom it is prescribed. Do not share it with other people.
  • If your symptoms do not improve or if they become worse, check with your doctor.
  • Check with your pharmacist about how to dispose of unused medicine.

This information should not be used to decide whether or not to take clindamycin or any other medicine. Only your health care provider has the knowledge and training to decide which medicines are right for you. This information does not endorse any medicine as safe, effective, or approved for treating any patient or health condition. This is only a brief summary of general information about clindamycin. It does NOT include all information about the possible uses, directions, warnings, precautions, interactions, adverse effects, or risks that may apply to clindamycin. This information is not specific medical advice and does not replace information you receive from your health care provider. You must talk with your healthcare provider for complete information about the risks and benefits of using clindamycin.

Issue Date: March 6, 2013 Database Edition 13.1.1.003 Copyright © 2013 Wolters Kluwer Health, Inc.

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