Macrolide-resistant isolates of these organisms should be screened for clindamycin inducible resistance using the D-zone test.Ĭlindamycin has been shown to be active against most of the isolates of the following microorganisms, both in vitro and in clinical infections, as described in the Clindamycin inducible resistance has been identified in macrolide-resistant staphylococci and beta-hemolytic streptococci. Antagonism in vitro has been demonstrated between clindamycin and erythromycin. Cross-resistance between clindamycin and lincomycin is complete. It has activity against Gram-positive aerobes and anaerobes as well as some Gram-negative anaerobes. ![]() The extent of absorption, however, is not different between age groups and no dosage alteration is necessary for the elderly with normal hepatic function and normal (age-adjusted) renal function.Ĭlindamycin inhibits bacterial protein synthesis by binding to the 50S subunit of the ribosome. After oral administration of clindamycin hydrochloride, elimination half-life is increased to approximately 4 hours (range 3.4 to 5.1 h) in the elderly compared to 3.2 hours (range 2.1 to 4.2 h) in younger adults. Pharmacokinetic studies in elderly volunteers (61 to 79 years) and younger adults (18 to 39 years) indicate that age alone does not alter clindamycin pharmacokinetics (clearance, elimination half-life, volume of distribution, and area under the serum concentration-time curve) after IV administration of clindamycin phosphate. Hemodialysis and peritoneal dialysis are not effective in removing clindamycin from the serum. Serum half-life of clindamycin is increased slightly in patients with markedly reduced renal function. Approximately 10% of the bioactivity is excreted in the urine and 3.6% in the feces the remainder is excreted as bioinactive metabolites. The average biological half-life is 2.4 hours. No significant levels of clindamycin are attained in the cerebrospinal fluid, even in the presence of inflamed meninges. Clindamycin is widely distributed in body fluids and tissues (including bones). ![]() Serum levels exceed the MIC (minimum inhibitory concentration) for most indicated organisms for at least six hours following administration of the usually recommended doses. Doses of up to 2 grams of clindamycin per day for 14 days have been well tolerated by healthy volunteers, except that the incidence of gastrointestinal side effects is greater with the higher doses.Ĭoncentrations of clindamycin in the serum increased linearly with increased dose. Serum level studies following multiple doses of clindamycin hydrochloride for up to 14 days show no evidence of accumulation or altered metabolism of drug. Absorption of an oral dose is virtually complete (90%), and the concomitant administration of food does not appreciably modify the serum concentrations serum levels have been uniform and predictable from person to person and dose to dose. An average peak serum level of 2.50 mcg/mL was reached in 45 minutes serum levels averaged 1.51 mcg/mL at 3 hours and 0.70 mcg/mL at 6 hours. ![]() Serum level studies with a 150 mg oral dose of clindamycin hydrochloride in 24 normal adult volunteers showed that clindamycin was rapidly absorbed after oral administration. difficile, and surgical evaluation should be instituted as clinically indicated. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents. CDAD must be considered in all patients who present with diarrhea following antibiotic use. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. difficile produces toxins A and B, which contribute to the development of CDAD. It should not be used in patients with nonbacterial infections such as most upper respiratory tract infections.Ĭ. ![]() difficile.īecause clindamycin hydrochloride therapy has been associated with severe colitis which may end fatally, it should be reserved for serious infections where less toxic antimicrobial agents are inappropriate, as described in the Treatment with antibacterial agents alters the normal flora of the colon, leading to overgrowth of C. To reduce the development of drug-resistant bacteria and maintain the effectiveness of clindamycin hydrochloride capsules and other antibacterial drugs, clindamycin hydrochloride capsules should be used only to treat or prevent infections that are proven or strongly suspected to be caused by bacteria.Ĭlostridium difficile associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including clindamycin hydrochloride and may range in severity from mild diarrhea to fatal colitis.
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