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Clindamycin is an antiprotozoal and antibacterial drug substance, the effect of which is due to the ability to bind to the ribosome of microbial cells and inhibit the synthesis of proteins in cells of sensitive bacteria.

Active Ingredient: Сlindamycin, Hydrochloride

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What is Clindamycin?

For most strains in therapeutic doses, clindamycin has a bacteriostatic effect, but when using high doses, as well as in the treatment of infections associated with highly sensitive strains, bactericidal activity is possible. The mechanism of action of clindamycin is similar to that of lincomycin, but clindamycin has a more pronounced activity (2-10 times higher in relation to individual strains).

With oral administration of clindamycin, the active substance is rapidly and completely absorbed in the gastrointestinal tract with a bioavailability index of about 90%. There is a decrease in the rate of absorption of the active substance when taken with food. The time to reach peak serum levels is from 0.75 to 1 hour when taken orally, from 1 to 3 hours when injected into the muscle (depending on the age of the patient) and by the end of the infusion with the appropriate method of administration.

Up to 94% of clindamycin in serum is bound by serum proteins, the substance penetrates well into organs and tissues, creating high levels in the pleural fluid, lungs and bronchi (from 50 to 90% of the serum level), bone and muscle tissue (up to 40% of the serum level), as well as the appendix, bile ducts, prostate, fallopian tubes and synovial fluid (up to 50% serum level), saliva and sputum (up to 75% serum level). Through the intact blood-brain barrier practically does not penetrate, however, with inflammation of the meninges, penetration through the BBB increases.

The distribution volume reaches 0.66 l / kg in adults and 0.86 l / kg in children. Significantly crosses the placenta (in the fetal blood, the level of clindamycin reaches 40% of maternal serum levels) and breast milk (up to 100% of serum level).

Clindamycin is converted to form inactive derivatives and active metabolites in the liver. Excreted over 4 days by the kidneys and intestines (in active form, not more than 10% is excreted by the kidneys and 3.6% by the intestines). The average elimination half-life with preserved renal activity is 2.4–3 hours; in premature infants, the elimination half-life can increase to 6.3–8.6 hours. In patients with end-stage renal failure, the elimination half-life may increase to 5 hours. Clindamycin does not cumulate in the body.

With intravaginal use of clindamycin in the form of a gel for 7 consecutive days, systemic absorption was no more than 2-8%, the peak level of clindamycin in serum on day 7 was 16 ng / ml. With intravaginal use of clindamycin phosphate in the form of suppositories for 3 consecutive days, systemic absorption was about 6–70%.

With external use of clindamycin in the form of a gel, significant systemic absorption and the development of systemic effects are possible.

Indications for use of Clindamycin

Clindamycin is used in the treatment of patients with inflammatory infectious diseases caused by sensitive pathogens, including infectious diseases of the ENT organs (sinusitis, pharyngitis, otitis media), bone tissue and joints (septic arthritis, osteomyelitis), and the respiratory system (fibrosing alveolitis, bronchitis , lung abscess, pneumonia, empyema), skin and soft tissues (acne, phlegmon, abscesses, boils, panaritium, impetigo, infected wounds and erysipelas).

Clindamycin systemic drugs can be used in the treatment of infections of the organs of the abdominal infections and pelvis (peritonitis, abscesses), as well as infectious diseases in gynecological practice (including endometritis, adnexitis, abscesses of the ovaries and fallopian tubes, salpingitis) and dental practice (periodontal abscess).

Clindamycin for systemic use can be used in patients with tropical malaria (resistant to chloroquine), sepsis, toxoplasmosis encephalitis, pneumocystis pneumonia, diphtheria and scarlet fever, bacterial endocarditis.

Intravaginal clindamycin preparations are used for topical treatment of patients with vaginosis, which is associated with sensitive flora.

External clindamycin preparations are used in the local treatment of acne.

Dosage and Method of using Clindamycin

Clindamycin for oral administration should be taken orally as a whole and washed down with a significant amount of water (if the capsule or tablet shell is damaged, the active substance can irritate the esophagus).

Adult patients are usually prescribed 600–1800 mg, which are divided into 3-4 doses. In some cases, including infections associated with beta-hemolytic streptococcus, it is allowed to take 300 mg of clindamycin twice a day for at least 10 days.

With cervicitis associated with chlamydia, a dose of 1800 mg / day is recommended, which is divided into several doses for at least 10-14 days.

Patients from 6 years of age are recommended to take 8–25 mg / kg / day, which are divided into several doses. The use of clindamycin in the form of capsules is not recommended for younger patients (aspiration is possible), patients of this age group are recommended to take other oral forms of clindamycin.

In case of impaired renal activity, dose titration is not required. There is no decrease in serum clindamycin levels during dialysis.

In patients with reduced activity of the hepatobiliary system, an increase in the half-life of clindamycin is possible, which requires a dose reduction, however, when using average therapeutic doses with an interval of 8 hours, no significant cumulation was recorded (the specialist should decide on a reduction in the dose of clindamycin).

Clindamycin must be taken strictly according to the recommendation of a specialist, interruption of the course of therapy is not allowed, including treatment, it is important to continue if the patient has an improvement in the clinical condition and there are no symptoms of the disease (with the premature completion of the course of therapy, a relapse of the disease may develop).

Side effects of Clindamycin

During clindamycin therapy in patients, the appearance of systemic undesirable effects was recorded (the likelihood of systemic effects is also high when local and intravaginal forms of clindamycin are used), including:

  • central nervous system: decreased neuromuscular conduction;
  • blood system: insufficiency of the cardiovascular system (with the rapid introduction of the active substance into a vein), leukopenia, thrombocytopenia, eosinophilia, agranulocytosis, arterial hypotension;
  • gastrointestinal tract: esophagitis, abdominal pain, nausea, pseudomembranous colitis, diarrhea, jaundice, disturbance of intestinal microflora, hyperbilirubinemia, decreased liver activity. With a quick introduction into the vein, a metallic taste in the mouth may appear;
  • hypersensitivity: measles-like rash, urticaria, maculopapular rash, itching, exfoliative dermatitis, vesiculo-bullous dermatitis, toxic epidermal necrolysis, anaphylactoid reactions, erythema multiforme;
  • other: oliguria, azotemia, polyarthritis, proteinemia, superinfection, candidiasis, nosebleeds, hyperthyroidism.

With parenteral administration (into the muscle), pain at the injection site and the appearance of an abscess are possible. When administered intravenously, thrombophlebitis may occur.

When used intravaginally, the appearance of symptomatic or vaginitis or cervicitis caused by insensitive flora, vulvovaginitis, irritation of the vaginal mucosa, menstrual irregularities, endometriosis, vaginal pain, uncharacteristic vaginal discharge, dysuria, uterine bleeding, proteinuria and glucosuria, as well as abnormal.

When using external forms of clindamycin, the appearance of contact dermatitis, folliculitis associated with gram-negative flora, increased secretory activity of the sebaceous glands, dryness and skin irritation at the site of application of the drug are also possible.

Clindamycin Contraindications

Clindamycin is not used in the treatment of people with hypersensitivity to lincomycin.

Clindamycin is not used in the treatment of patients with a history of ulcerative colitis, regional enteritis, and colitis associated with the use of antimicrobials.

Relative contraindications to the use of clindamycin are myasthenia gravis (due to the high risk of impaired neuromuscular transmission), breast age (up to 1 month), and marked decreases in kidney and liver activity.

Clindamycin Overdose

With clindamycin intoxication, an increase in the severity of characteristic side effects is possible.

In case of an overdose of clindamycin, symptomatic treatment is performed. Hemodialysis to reduce clindamycin is ineffective.