Clindamycin is a drug from the group of antibiotics - lincosamides, has a broad spectrum of action, bacteriostatic, binds to the 50S ribosome subunit and inhibits protein synthesis in microorganisms. Active against Staphylococcus spp. (including Staphylococcus epidermidis, producing penicillinase), Streptococcus spp. (excluding Enterococcus spp.), Streptococcus pneumoniae,anaerobic and microaerophilic gram-positive cocci (including Peptococcus spp. and Peptostreptococcus spp.), Corynebacterium diphtheriae, Clostridium perfringens, Clostridium tetani, Mycoplasma spp., Bacteroidesspp. (including Bacteroides fragilis and Bacteroides melaningenicus), anaerobic gram-positive, non-spore-forming bacilli (including Propionibacterium spp., Eubacterium spp., Actinomyces spp.).Most strains of Clostridium perfringens are sensitive to clindamycin, however, other types of Clostridia (Clostridium sporogenes, Clostridium tertium) are resistant to the drug, therefore, antibiogram determination is recommended for infections caused by Clostridium spp.In terms of the mechanism of action and antimicrobial spectrum, it is close to lincomycin (in relation to some types of microorganisms, especially in relation to bacteroids and non-spore-forming anaerobes, it is 2-10 times more active).
It is rapidly and completely absorbed in the gastrointestinal tract, simultaneous intake of food slows down the absorption without changing the concentration of the drug in the plasma. Easily penetrates into biological fluids and tissues (tonsils, muscle and bone tissue, bronchi, lungs, pleura, bile ducts, appendix, fallopian tubes, prostate gland, synovial fluid, saliva, sputum, wound surfaces); passes through the BBB poorly (with inflammation of the meninges, the BBB permeability increases).Cmax in the blood is achieved with oral administration in 0.75-1 h, after i / m administration - after 1 h in children and 3 h in adults, with i / v - by the end of the infusion.At a therapeutic concentration circulates in the blood for 8-12 hours, T1 / 2 is about 2.4 hours; metabolized mainly in the liver (70-80%) with the formation of active (N-dimethylclindamycin and clindamycin sulfoxide) and inactive metabolites; is excreted within 4 days by the kidneys (10%) and through the intestines (3.6%) in the form of an active drug, the rest in the form of inactive metabolites.
ulcerative colitis (in history);
rare hereditary diseases, such as: galactose intolerance, lactase deficiency or glucose-galactose malabsorption (for capsules);
children under 3 years of age - for solution for i / v and i / m administration (due to the lack of data on the safety of benzyl alcohol use);
children under 8 years of age for capsules (the average weight of a child is less than 25 kg);
Clindamycin is used with caution in patients with severe hepatic and / or renal insufficiency, in elderly patients.
Pregnancy and lactation
From the digestive system: dyspepsia (abdominal pain, nausea, vomiting, diarrhea), esophagitis, jaundice, liver dysfunction, hyperbilirubinemia, dysbiosis, pseudomembranous enterocolitis.On the part of the musculoskeletal system: rarely - impaired neuromuscular conduction.
From the side of hematopoiesis: leukopenia, neutropenia, agranulocytosis, thrombocytopenia.
Allergic reactions: rarely - maculopapular rash, urticaria, itching; in some cases, exfoliative and vesiculobullous dermatitis, eosinophilia, anaphylactoid reactions.
From the side of the cardiovascular system: with rapid intravenous administration - a decrease in blood pressure, up to collapse; dizziness, weakness.
Local reactions: irritation, soreness (at the place of i / m injection), thrombophlebitis (at the place of i / v injection).
Others: development of superinfection.
Clindamycin enhances (mutually) the effect of rifampicin, aminoglycosides streptomycin, gentamicin (especially in the treatment of osteomyelitis and prevention of peritonitis after intestinal perforation).Strengthens the action of competitive muscle relaxants, and also enhances the muscle relaxation caused by n-anticholinergics.
Incompatible with ampicillin, barbiturates, aminophylline, calcium gluconate and magnesium sulfate.
Shows antagonism with erythromycin and chloramphenicol.
Simultaneous use with solutions containing a complex of B vitamins, aminoglycosides, phenytoin is not recommended.
Simultaneous administration with antidiarrheal drugs increases the risk of developing pseudomembranous colitis.
With simultaneous use with opioid (narcotic) analgesics, it is possible to increase the respiratory depression caused by them (up to apnea).
Dosage and administration
Inside, adults and children over 15 years old (average child weight 50 kg and above) with diseases of moderate severity are prescribed 1 capsule (150 mg) 4 times / day (every 6 hours).
For severe infections, adults and children over 15 years of age, a single dose can be increased to 2-3 capsules (300-450 mg).
In case of overdose, side effects may increase.
Treatment: symptomatic therapy, no specific antidote. Hemodialysis and peritoneal dialysis are ineffective.
Pseudomembranous colitis can appear both while taking clindamycin and 2-3 weeks after stopping treatment (3-15% of cases); manifested by diarrhea, leukocytosis, fever, abdominal pain (sometimes accompanied by the release of blood and mucus with feces).
If these phenomena occur in mild cases, it is sufficient to discontinue treatment and use ion-exchange resins (colestyramine, colestipol), in severe cases, it is indicated to compensate for the loss of fluid, electrolytes and protein, the appointment of vancomycin by mouth or metronidazole.
Do not use drugs that inhibit intestinal peristalsis.
The safety of using the drug in children under 3 years of age has not been established. With long-term therapy, children need periodic monitoring of the blood count and the functional state of the liver.
When prescribing the drug in high doses, it is necessary to control the concentration of clindamycin in plasma.
Patients with severe hepatic impairment need to monitor liver function (liver enzymes).