Clindamycin (Systemic) (Skilled Affected person Recommendation)

Clindamycin (Systemic) (Professional Patient Advice)
December 27, 2020 0 Comments

Medically reviewed by Medication.com. Final up to date on Jul 7, 2020.

Pronunciation

(klin da MYE sin)

Index Phrases

  • Clindamycin HCl
  • Clindamycin Hydrochloride
  • Clindamycin Palmitate
  • Clindamycin Palmitate HCl

Dosage Kinds

Excipient data introduced when obtainable (restricted, notably for generics); seek the advice of particular product labeling. [DSC] = Discontinued product

Capsule, Oral, as hydrochloride [strength expressed as base]:

Cleocin: 75 mg, 150 mg [contains brilliant blue fcf (fd&c blue #1), tartrazine (fd&c yellow #5)]

Cleocin: 300 mg [contains brilliant blue fcf (fd&c blue #1)]

Generic: 75 mg, 150 mg, 300 mg

Equipment, Injection, as phosphate [strength expressed as base]:

CLIN Single Use: 300 mg/2 mL [DSC] [contains benzyl alcohol, edetate disodium]

Answer, Injection, as phosphate [strength expressed as base]:

Cleocin Phosphate: 300 mg/2 mL (2 mL); 600 mg/4 mL (4 mL); 900 mg/6 mL (6 mL); 9 g/60 mL (60 mL) [contains benzyl alcohol, edetate disodium]

Generic: 300 mg/2 mL (2 mL); 600 mg/4 mL (4 mL); 900 mg/6 mL (6 mL); 9000 mg/60 mL (60 mL); 9 g/60 mL (60 mL)

Answer, Intravenous, as phosphate [strength expressed as base]:

Cleocin in D5W: 600 mg/50 mL (50 mL [DSC]) [contains benzyl alcohol, edetate disodium]

Cleocin Phosphate: 300 mg/2 mL (2 mL [DSC]); 600 mg/4 mL (4 mL [DSC]); 900 mg/6 mL (6 mL [DSC]) [contains benzyl alcohol, edetate disodium]

Generic: 600 mg/50 mL (50 mL); 900 mg/50 mL (50 mL); 300 mg/2 mL (2 mL [DSC]); 600 mg/4 mL (4 mL [DSC]); 900 mg/6 mL (6 mL [DSC])

Answer, Intravenous, as phosphate [strength expressed as base, preservative free]:

Cleocin in D5W: 300 mg/50 mL (50 mL [DSC]) [contains benzyl alcohol, edetate disodium]

Cleocin in D5W: 300 mg/50 mL (50 mL [DSC]); 600 mg/50 mL (50 mL [DSC]) [contains edetate disodium]

Cleocin in D5W: 900 mg/50 mL (50 mL [DSC]) [contains benzyl alcohol, edetate disodium]

Cleocin in D5W: 900 mg/50 mL (50 mL [DSC]) [contains edetate disodium]

Generic: 300 mg/50 mL (50 mL); 600 mg/50 mL (50 mL); 900 mg/50 mL (50 mL); 300 mg/50 mL in NaCl 0.9% (50 mL); 600 mg/50 mL in NaCl 0.9% (50 mL); 900 mg/50 mL in NaCl 0.9% (50 mL)

Answer Reconstituted, Oral, as palmitate hydrochloride [strength expressed as base]:

Cleocin: 75 mg/5 mL (100 mL) [contains ethylparaben]

Generic: 75 mg/5 mL (100 mL)

Model Names: U.S.

  • Cleocin
  • Cleocin in D5W [DSC]
  • Cleocin Phosphate
  • CLIN Single Use [DSC]

Pharmacologic Class

Pharmacology

Reversibly binds to 50S ribosomal subunits stopping peptide bond formation thus inhibiting bacterial protein synthesis; bacteriostatic or bactericidal relying on drug focus, an infection web site, and organism

Absorption

Oral, hydrochloride: Speedy (90%); clindamycin palmitate have to be hydrolyzed within the GI tract earlier than it’s energetic

Distribution

Distributed in physique fluids and tissues; no vital ranges in CSF, even with infected meninges.

Neonates (Gonzalez 2016):

PMA ≤28 weeks: Median: 1.2 L/kg (vary: 0.87 to 2.26 L/kg).

PMA >28 to 32 weeks: Median: 1.3 L/kg (vary: 0.74 to 1.88 L/kg).

PMA >32 to 40 weeks: Median: 1.03 L/kg (vary: 0.7 to 2.12 L/kg).

Neonates and Infants ≤5 months (PMA >40 to 60 weeks): Median: 0.99 L/kg (vary: 0.64 to 1.27 L/kg) (Gonzalez 2016).

Infants >5 months: Median: 0.83 L/kg (vary: 0.7 to 1.17 L/kg) (Gonzalez 2016).

Kids ≥2 years and Adolescents (Smith 2017):

Non-obese: Median vary: 0.81 to 0.9 L/kg.

Overweight: Median vary: 0.86 to 1.03 L/kg.

Metabolism

Biologically inactive clindamycin phosphate (intravenous formulation) is quickly transformed to energetic clindamycin. Clindamycin is metabolized predominantly by CYP3A4, with minor contribution by CYP3A5, to kind clindamycin sulfoxide (main metabolite) and N-desmethylclindamycin (minor metabolite)

Excretion

Urine (~10%) and feces (3.6%) as energetic drug and metabolites

Time to Peak

Serum: Oral: Inside 60 minutes; IM: 1 to three hours

Half-Life Elimination

Neonates (Gonzalez 2016):

PMA ≤28 weeks: Median: 5.89 hours (vary: 2.42 to 12.9 hours).

PMA >28 to 32 weeks: Median: 5.25 hours (vary: 2.34 to eight.87 hours).

PMA >32 to 40 weeks: Median: 3.96 hours (vary: 1.3 to eight.83 hours).

Neonates and Infants ≤5 months (Gonzalez 2016): PMA >40 to 60 weeks: Median: 2.35 hours (vary: 0.94 to six.44 hours).

Infants >5 months to 1 yr (Gonzalez 2016): Median: 2.05 hours (vary: 1.26 to three.47 hours).

Kids ≥2 years and Adolescents (Smith 2017):

Non-obese: Median vary: 2.15 to 2.84 hours.

Overweight: Median vary: 2.15 to three.55 hours.

Adults: 3 hours.

Aged (oral) ~4 hours (vary: 3.4 to five.1 hours).

Protein Binding

94%

Use: Labeled Indications

Bone and joint infections: Remedy of bone and joint infections, together with acute hematogenous osteomyelitis brought on by Staphylococcus aureus and as adjunctive remedy within the surgical remedy of continual bone and joint infections brought on by prone organisms.

Gynecological infections: Remedy of gynecologic infections, together with endometritis, nongonococcal tubo-ovarian abscess, pelvic cellulitis, and postsurgical vaginal cuff an infection brought on by prone anaerobes.

Intraabdominal infections: Remedy of intraabdominal infections, together with peritonitis and intraabdominal abscess brought on by prone anaerobic organisms.

Decrease respiratory tract infections: Remedy of decrease respiratory tract infections, together with pneumonia, empyema, and lung abscess brought on by prone anaerobes, Streptococcus pneumoniae, different streptococci (besides Enterococcus faecalis), and S. aureus.

Septicemia: Remedy of septicemia brought on by S. aureus, streptococci (besides E. faecalis), and prone anaerobes.

Pores and skin and smooth tissue an infection: Remedy of pores and skin and smooth tissue an infection brought on by Streptococcus pyogenes, S. aureus, and prone anaerobes.

Off Label Makes use of

Anthrax

Based mostly on the Facilities for Illness Management and Prevention (CDC) skilled panel conferences on prevention and remedy of anthrax in adults, clindamycin is an efficient and acceptable various for postexposure prophylaxis or remedy of cutaneous anthrax; it’s also a first-line choice, together with different antimicrobials, for the remedy of systemic anthrax. Different regimens have additionally been instructed for different affected person populations with anthrax, together with injectable drug customers who develop injectional anthrax [Hicks 2012].

Babesiosis

Based mostly on the Infectious Ailments Society of America (IDSA) pointers for the scientific evaluation, remedy, and prevention of Lyme illness, human granulocytic anaplasmosis, and babesiosis, clindamycin (together with quinine) is an efficient and advisable choice for the remedy of babesiosis.

Bacterial vaginosis

Based mostly on the CDC sexually transmitted ailments remedy pointers, oral clindamycin is an efficient and advisable various agent for sufferers with bacterial vaginosis.

Chunk wound, prophylaxis or remedy, animal or human chunk

Based mostly on the IDSA pointers for the analysis and administration of pores and skin and smooth tissue infections, clindamycin, together with a second- or third-generation cephalosporin, levofloxacin, or sulfamethoxazole and trimethoprim, is an efficient and advisable various for remedy of animal or human chunk wounds.

Diabetic foot an infection, gentle to average

Based mostly on the IDSA pointers for the analysis and remedy of diabetic foot infections, clindamycin is an efficient and advisable various remedy choice for gentle diabetic foot an infection as a consequence of S. aureus or Streptococcus spp and, together with ciprofloxacin or levofloxacin, for average diabetic foot an infection

Endocarditis, prophylaxis (dental or invasive respiratory tract procedures) (various agent for penicillin-allergic sufferers)

Based mostly on the American Coronary heart Affiliation (AHA) pointers for the prevention of infective endocarditis, clindamycin is an efficient and advisable various agent for the prevention of infective endocarditis related to dental or respiratory tract procedures in sufferers with sure cardiac situations who’re allergic to penicillins or ampicillin.

Group B streptococci, maternal prophylaxis for prevention of neonatal illness

Based mostly on the American Faculty of Obstetricians and Gynecologists (ACOG) Prevention of Group B Streptococcal Early-Onset Illness in Newborns guideline, the usage of intravenous clindamycin is efficient and advisable in sufferers at excessive threat for anaphylaxis as a consequence of penicillin allergy if the GBS isolate is delicate to clindamycin.

Hidradenitis suppurativa

Information from a potential, observational cohort examine and a retrospective cohort examine counsel that clindamycin, together with rifampin, could also be useful for the remedy of hidradenitis suppurativa [Dessinioti 2016], [Gener 2009]. Based mostly on the European S1 guideline on hidradenitis suppurativa/pimples inversa, clindamycin, together with rifampin, is an efficient and advisable agent for the remedy of hidradenitis suppurativa.

Malaria

Based mostly on the CDC Remedy of Malaria: Tips for Clinicians (United States), clindamycin, together with quinine, is an efficient and advisable various choice for the remedy of malaria (CDC 2020).

Neutropenic fever, empiric remedy for low-risk most cancers sufferers (various agent for penicillin-allergic sufferers)

Information from a potential, randomized, open-label examine assist the usage of clindamycin (together with ciprofloxacin) for the outpatient administration of neutropenic fever in low-risk most cancers sufferers [Rubenstein 1993]. Based mostly on the IDSA pointers for the usage of antimicrobial brokers in neutropenic sufferers with most cancers and the American Society of Medical Oncology (ASCO) and IDSA pointers for the outpatient administration of fever and neutropenia in adults handled for malignancy, clindamycin (together with ciprofloxacin) is an efficient and advisable agent for the administration of neutropenic fever in low-risk most cancers sufferers.

Odontogenic an infection

Information from two randomized, potential, blinded (one single-blind, one double-blind) research assist the usage of clindamycin for the remedy of odontogenic infections [Cachovan 2011], [Tancawan 2015].

Pneumocystis jirovecii pneumonia, remedy

Based mostly on the US Division of Well being and Human Providers (HHS) pointers for the prevention and remedy of opportunistic infections in adults and adolescents with HIV, clindamycin (with primaquine) is an efficient and advisable various routine for the remedy of Pneumocystis jirovecii pneumonia in adolescents and adults with HIV.

Pneumonia as a consequence of methicillin-resistant Staphylococcus aureus

Based mostly on the IDSA pointers for the remedy of methicillin-resistant S. aureus infections in adults, clindamycin is efficient and advisable within the remedy of community-acquired methicillin-resistant S. aureus pneumonia.

Prosthetic joint an infection

Based mostly on the IDSA pointers for the administration of prosthetic joint an infection, clindamycin is an efficient and advisable various agent for the remedy of prosthetic joint an infection as a consequence of Cutibacterium acnes.

Medical expertise suggests the utility of clindamycin as continual suppressive remedy of prosthetic joint an infection brought on by methicillin-resistant staphylococci [Berbari 2019].

Rhinosinusitis, acute bacterial

Based mostly on the IDSA pointers for acute bacterial rhinosinusitis (ABRS) in youngsters and adults, clindamycin (together with cefixime or cefpodoxime) is an efficient and advisable remedy for the remedy of ABRS.

Medical expertise suggests the utility of clindamycin (together with cefixime or cefpodoxime) for the remedy of ABRS [Patel 2018].

Streptococcal (group A) pharyngitis and continual carriage

Based mostly on the IDSA pointers for the analysis and administration of group A streptococcal pharyngitis, clindamycin is an efficient and advisable various agent for the remedy of streptococcal pharyngitis and an choice for remedy of continual group A streptococcal carriage.

Surgical prophylaxis

Based mostly on the American Society of Well being-System Pharmacists (ASHP) scientific observe pointers for antimicrobial prophylaxis in surgical procedure, clindamycin, given in its place antibiotic in sufferers with beta-lactam allergy requiring surgical prophylaxis, is efficient and advisable for quite a lot of surgical procedures.

Toxoplasma gondii encephalitis and pneumonitis (remedy/long-term upkeep)

Based mostly on the US Division of Well being and Human Providers pointers for the prevention and remedy of opportunistic infections in adults and adolescents with HIV and the American Society of Transplantation Infectious Ailments Neighborhood of Follow pointers on parasitic infections in stable organ transplantation, clindamycin (with pyrimethamine and leucovorin) is an efficient and advisable various routine for the remedy and long-term upkeep remedy of Toxoplasma gondii encephalitis and pneumonitis.

Contraindications

Hypersensitivity to clindamycin, lincomycin, or any element of the formulation.

Canadian labeling: Further contraindications (not in US labeling): Oral clindamycin: Infants <30 days of age.

Dosing: Grownup

Regular dose:

Oral: 600 to 1,800 mg/day in 2 to 4 divided doses; as much as 2,400 mg/day in 4 divided doses could also be given for extreme infections.

IM, IV: 600 to 2,700 mg/day in 2 to 4 divided doses; in response to the producer, as much as 4,800 mg/day IV (in divided doses) has been utilized in life-threatening infections; nonetheless, knowledge supporting this dose are missing; most: 600 mg/dose IM.

Anthrax (off-label use): Word: Seek the advice of public well being officers for event-specific suggestions.

Inhalational publicity postexposure prophylaxis (PEP) (various agent): Oral: 600 mg each 8 hours for 42 to 60 days.

Word: Anthrax vaccine also needs to be administered to uncovered people (CDC [Bower 2019]; CDC [Hendricks 2014]). Period of remedy: If the PEP anthrax vaccine sequence is run on schedule (for all regimens), antibiotics could also be discontinued in immunocompetent adults 18 to 65 years of age at 42 days after initiation of vaccine or 2 weeks after the final dose of the vaccine (whichever comes final and to not exceed 60 days); if the vaccination sequence can’t be accomplished, antibiotics ought to proceed for 60 days (CDC [Bower 2019]). As well as, adults with immunocompromising situations or receiving immunosuppressive remedy, sufferers >65 years of age, and sufferers who’re pregnant or breastfeeding ought to obtain antibiotics for 60 days (CDC [Bower 2019]).

Cutaneous, with out systemic involvement, empiric remedy (various agent): Oral: 600 mg each 8 hours for 60 days following organic weapon-related occasion; length is 7 to 10 days after naturally acquired an infection. Word: Sufferers with cutaneous lesions of the pinnacle or neck or in depth edema needs to be handled for systemic involvement (CDC [Hendricks 2014]).

Systemic, meningitis excluded: IV: 900 mg each 8 hours together with different acceptable brokers for not less than 2 weeks or till clinically steady, whichever is longer (CDC [Hendricks 2014]).

Meningitis (various agent): IV: 900 mg each 8 hours together with different acceptable brokers for not less than 2 to three weeks or till clinically steady, whichever is longer (CDC [Hendricks 2014]).

Word: Antitoxin also needs to be administered for systemic anthrax. Following the course of IV mixture remedy for systemic anthrax an infection (together with meningitis), sufferers uncovered to aerosolized spores require oral monotherapy to finish a complete antimicrobial course of 60 days (CDC [Hendricks 2014]).

Babesiosis (off-label use):

Gentle to average illness: Oral: 600 mg each 8 hours together with quinine for 7 to 10 days (IDSA [Wormser 2006]).

Extreme illness: IV: 600 mg each 6 hours for 7 to 10 days together with quinine (IDSA [Wormser 2006]; Krause 2019); an extended length is required for these at excessive threat for relapse (Krause 2008; Sanchez 2016; Vannier 2020). Clindamycin could be given orally as soon as signs have abated and parasitemia is lowered (Krause 2019; Sanchez 2016).

Bacterial vaginosis (various agent) (off-label use): Oral: 300 mg twice each day for 7 days (CDC [Workowski 2015]).

Chunk wound, prophylaxis or remedy, animal or human chunk (various agent) (off-label use): Word: For animal chunk, use together with an acceptable agent for Pasteurella multocida. For human chunk, use together with an acceptable agent for Eikenella corrodens (IDSA [Stevens 2014]).

Oral: 300 to 450 mg 3 occasions each day (Baddour 2019a; Baddour 2019b; IDSA [Stevens 2014]).

IV: 600 mg each 6 to eight hours (IDSA [Stevens 2014]). Word: In chosen sufferers with high-risk wounds, some consultants advocate parenteral remedy be given initially till an infection is resolving, adopted by oral remedy (Baddour 2019a; Baddour 2019b).

Word: For prophylaxis, length is 3 to five days (IDSA [Stevens 2014]); for remedy of established an infection, length is usually 5 to 14 days and varies based mostly on patient-specific components, together with scientific response (Baddour 2019a; Baddour 2019b).

Diabetic foot an infection, gentle to average (various agent) (off-label use): Oral: 300 to 450 mg each 6 to eight hours (Bader 2008; IDSA [Lipsky 2012]; Lipsky 1990; Weintrob 2018). Word: Could also be used alone for empiric remedy of gentle infections; if there are threat components for gram-negative bacilli, have to be utilized in mixture with different acceptable brokers. Period of remedy needs to be tailor-made to particular person scientific circumstances; most sufferers reply to 1 to 2 weeks of remedy (IDSA [Lipsky 2012]; Weintrob 2018).

Endocarditis, prophylaxis (dental or invasive respiratory tract procedures) (various agent for penicillin-allergic sufferers) (off-label use):

Oral: 600 mg as a single dose 30 to 60 minutes previous to process (AHA [Wilson 2007]).

IM, IV: 600 mg as a single dose 30 to 60 minutes earlier than process (provided that unable to tolerate or take in oral remedy) (AHA [Wilson 2007]).

Word: Solely advisable for sufferers with cardiac situations related to the best threat of an adversarial end result from endocarditis and who’re present process a process more likely to end in bacteremia with an organism that has the potential means to trigger endocarditis (AHA [Wilson 2007]).

Hidradenitis suppurativa (off-label use): Oral: 300 mg twice each day together with rifampin for 10 to 12 weeks (Dessinioti 2016; Gener 2009; Gulliver 2016; Zouboulis 2015).

Malaria, remedy (various agent) (off-label use): Oral: 20 mg/kg/day in divided doses each 8 hours for 7 days together with quinine sulfate (quinine sulfate length is area particular). Word: If used for P. vivax or P. ovale, use together with primaquine. If used for extreme malaria (after completion of IV remedy), use full 7-day schedule of clindamycin. (CDC 2020).

Neutropenic fever, empiric remedy for low-risk most cancers sufferers (various agent for penicillin-allergic sufferers) (off-label use): Oral: 600 mg each 8 hours (Rubenstein 1993); some consultants advocate 300 mg each 6 hours (Bow 2018) (knowledge on acceptable dose are restricted). Use together with oral ciprofloxacin; proceed till afebrile and neutropenia has resolved. Word: Keep away from in sufferers who’ve obtained fluoroquinolone prophylaxis. Administer first dose within the well being care setting (after blood cultures are drawn); observe affected person for ≥4 hours earlier than discharge (ASCO/IDSA [Taplitz 2018]; IDSA [Freifeld 2011]).

Odontogenic an infection (various agent for penicillin-allergic sufferers) (off-label use):

IV: 600 mg each 8 hours till improved, then transition to oral clindamycin (Bhagania 2018; Chow 2018).

Oral (preliminary remedy for gentle an infection or step-down after parenteral remedy): 450 mg each 8 hours to finish a 7- to 14-day course (Chow 2018); doses within the literature diverse from 150 mg each 6 hours (Tancawan 2015) to 300 mg each 6 hours (Cachovan 2011) to 600 mg each 8 hours (Bhagania 2018).

Osteomyelitis:

Osteomyelitis as a consequence of methicillin-resistant Staphylococcus aureus (MRSA) (various agent): IV, Oral: 600 mg 3 occasions each day for at least 8 weeks; some consultants mix with rifampin (IDSA [Liu 2011]).

Osteomyelitis, native vertebral as a consequence of staphylococci, methicillin-susceptible (various agent):

IV: 600 to 900 mg each 8 hours for six weeks (IDSA [Berbari 2015]).

Oral: 300 to 450 mg 4 occasions each day (IDSA [Berbari 2015]) or 600 mg 3 occasions each day (IDSA [Liu 2011]) for six weeks (IDSA [Berbari 2015]). Word: Clindamycin may be used as suppressive remedy in chosen sufferers (Osmon 2019).

Osteomyelitis, native vertebral as a consequence of Cutibacterium acnes (various agent): IV: 600 to 900 mg each 8 hours for six weeks (IDSA [Berbari 2015]).

Pelvic inflammatory illness, extreme: IV: 900 mg each 8 hours with gentamicin; after 24 to 48 hours of sustained scientific enchancment, transition to clindamycin 450 mg orally 4 occasions each day (or oral doxycycline) to finish 14 days of remedy. Word: If tubo-ovarian abscess is current, oral clindamycin needs to be given together with doxycycline to finish not less than 14 days of remedy slightly than giving doxycycline alone (CDC [Workowski 2015]).

Pneumocystis jirovecii pneumonia (PCP), remedy (various agent) (off-label use):

Gentle to average illness: Oral: 450 mg each 6 hours or 600 mg each 8 hours with primaquine for 21 days (HHS [OI adult 2020]).

Extreme illness: IV: 600 mg each 6 hours or 900 mg each 8 hours with primaquine for 21 days; following scientific enchancment, clindamycin could be given orally at 450 mg each 6 hours or 600 mg each 8 hours (HHS [OI adult 2020]; Thomas 2018).

Word: Sufferers with average or extreme an infection (PaO2 <70 mm Hg at room air or alveolar-arterial oxygen gradient ≥35 mm Hg) ought to obtain adjunctive glucocorticoids (HHS [OI adult 2020]).

Pneumonia as a consequence of MRSA (various agent) (off-label use): Oral, IV: 600 mg 3 occasions each day; length is for at least 7 days and varies based mostly on illness severity and response to remedy (IDSA [Liu 2011]).

Postpartum endometritis: IV: 900 mg each 8 hours plus gentamicin; deal with till the affected person is clinically improved (no fundal tenderness) and afebrile for twenty-four to 48 hours (Chen 2018; Gall 1996).

Prosthetic joint an infection (off-label use):

Cutibacterium acnes, remedy (various agent for penicillin allergy):

IV: 600 to 900 mg each 8 hours for 4 to six weeks (IDSA [Osmon 2013]).

Oral: 300 to 450 mg each 6 hours (IDSA [Osmon 2013]), following not less than 2 weeks of parenteral remedy (Kanafani 2018).

Methicillin-resistant staphylococci, remedy (continual suppression): Oral: 600 mg each 8 hours (Berbari 2019).

Rhinosinusitis, acute bacterial (various agent for penicillin-allergic sufferers in a position to tolerate cephalosporins with concern for pneumococcal resistance) (off-label use): Oral: 300 mg each 6 to eight hours together with a third-generation cephalosporin (eg, cefixime or cefpodoxime) for five to 7 days (IDSA [Chow 2012]; Patel 2018; Rosenfeld 2016). Word: In uncomplicated acute bacterial rhinosinusitis, preliminary remark and symptom administration with out antibiotic remedy is suitable in most sufferers (AAO-HNS [Rosenfeld 2015]; Harris 2016).

Septic arthritis as a consequence of Staphylococcus aureus (together with MRSA) (various agent): Oral, IV: 600 mg 3 occasions each day for 3 to 4 weeks (Goldenberg 2018; IDSA [Liu 2011]). Word: An extended course of parenteral remedy (4 weeks) could also be required for sufferers with concomitant bacteremia (within the absence of endocarditis) (Goldenberg 2019).

Pores and skin and smooth tissue an infection:

Impetigo or ecthyma if MRSA is suspected or confirmed (various agent): Oral: 300 mg 4 occasions each day or 450 mg 3 occasions each day for 7 days (Baddour 2020; IDSA [Stevens 2014]).

Nonpurulent cellulitis or erysipelas as a consequence of beta-hemolytic streptococci or Staphylococcus aureus (together with MRSA), empiric or pathogen-directed remedy (various agent):

Oral: 300 mg 4 occasions each day or 450 mg 3 occasions each day.

IV: 600 mg to 900 mg each 8 hours.

Word: Transition to oral remedy as soon as bettering; deal with for not less than 5 days however could prolong to 14 days relying on severity and scientific response (IDSA [Stevens 2014]; Spelman 2020).

Purulent cellulitis or abscess as a consequence of S. aureus (together with MRSA) or beta-hemolytic streptococci (various agent):

Oral: 300 mg 4 occasions each day or 450 mg 3 occasions each day. Deal with for five to 14 days relying on severity and scientific response.

Word: Systemic antibiotics solely indicated for sure cases (eg, immunocompromised sufferers, indicators of systemic an infection, massive or a number of abscess, indwelling gadget, excessive threat for adversarial end result with endocarditis). If in danger for gram-negative bacilli, use together with an acceptable agent (IDSA [Stevens 2014]; Spelman 2020).

Necrotizing smooth tissue an infection (various agent): IV: 600 to 900 mg each 8 hours as a part of an acceptable mixture routine. Word: Antibiotic remedy have to be used at the side of early and aggressive surgical exploration and debridement of necrotic tissue (IDSA [Stevens 2014]; Stevens 2018).

Streptococcus (group A):

Bloodstream an infection: IV: 900 mg each 8 hours together with IV penicillin G; length is individualized, however clindamycin could also be discontinued inside 48 hours for sufferers with out septic shock, organ failure, or necrotizing an infection. Proceed penicillin G to finish ≥14 days of remedy (Stevens 2019).

Pharyngitis (various agent for penicillin-allergic sufferers) (off-label use): Oral: 300 mg 3 occasions each day for 10 days (IDSA [Shulman 2012]).

Power carriage (off-label use): Oral: 300 mg 3 occasions each day for 10 days. Word: Most people with continual carriage don’t require antimicrobial remedy (IDSA [Shulman 2012]).

Streptococcus (group B), maternal prophylaxis for prevention of neonatal illness (various agent) (off-label use):

Word: Prophylaxis is reserved for pregnant girls with a optimistic group B streptococci (GBS) vaginal or rectal screening in late gestation or GBS bacteriuria through the present being pregnant, historical past of delivery of an toddler with early-onset GBS illness, and unknown GBS tradition standing with any of the next: delivery <37 0/7 weeks gestation, intrapartum fever, extended rupture of membranes, recognized GBS optimistic in a earlier being pregnant, or intrapartum nucleic acid amplification testing optimistic for GBS (ACOG 2019).

IV: 900 mg at onset of labor or prelabor rupture of membranes, then each 8 hours till supply. Word: Clindamycin needs to be reserved for penicillin-allergic sufferers at excessive threat for anaphylaxis (ACOG 2019).

Surgical prophylaxis (together with different acceptable brokers when protection for MRSA is indicated or for gram-positive protection in sufferers unable to tolerate cephalosporins) (off-label use): IV: 900 mg began inside 60 minutes previous to preliminary surgical incision. Clindamycin doses could also be repeated intraoperatively at 6-hour intervals if process is prolonged or if there may be extreme blood loss (ASHP/IDSA/SIS/SHEA [Bratzler 2013]). In circumstances the place an extension of prophylaxis is warranted postoperatively, whole length needs to be ≤24 hours (Anderson 2014; ASHP/IDSA/SIS/SHEA [Bratzler 2013]). For clear and clean-contaminated procedures, continued prophylactic antibiotics past surgical incision closure is just not advisable, even within the presence of a drain (CDC [Berríos-Torres 2017]).

Poisonous shock syndrome, toxin manufacturing suppression (empiric remedy): IV: 900 mg each 8 hours as a part of an acceptable mixture routine (Lappin 2009; Wong 2013). Period is till clinically and hemodynamically steady for not less than 48 to 72 hours; then discontinue clindamycin and provides monotherapy with an acceptable agent (Chu 2019; Stevens 2019).

Toxoplasma gondii encephalitis and pneumonitis (various agent) (off-label use):

Preliminary remedy: Oral, IV: 600 mg each 6 hours together with pyrimethamine and leucovorin. Proceed remedy for not less than 6 weeks; longer length could also be required if incomplete response or in depth illness; after completion of acute remedy, all sufferers ought to obtain long-term upkeep remedy (HHS [OI adult 2020]; Schwartz 2013).

Lengthy-term upkeep remedy: Oral: 600 mg each 8 hours together with pyrimethamine and leucovorin (HHS [OI adult 2020]; Schwartz 2013); in sufferers with HIV, could discontinue when asymptomatic with a CD4 depend >200 cells/mm3 and an undetectable HIV viral load for >6 months in response to ART (HHS [OI adult 2020]).

Dosage adjustment for concomitant remedy: Vital drug interactions exist, requiring dose/frequency adjustment or avoidance. Seek the advice of drug interactions database for extra data.

Dosing: Geriatric

Confer with grownup dosing.

Dosing: Pediatric

Word: Dosage needs to be based mostly on whole physique weight for overweight youngsters ≥2 years of age and adolescents (Smith 2017; producer’s labeling).

Basic dosing, prone an infection:

IM, IV:

Producer’s labeling: Infants, Kids, and Adolescents 1 month to 16 years:

Weight-directed dosing: 20 to 40 mg/kg/day divided each 6 to eight hours.

BSA-directed dosing: 350 to 450 mg/m2/day divided each 6 to eight hours.

Alternate dosing (Pink Guide [AAP] 2012): Infants, Kids, and Adolescents:

Gentle to average infections: 20 mg/kg/day divided each 8 hours; most each day dose: 1,800 mg/day.

Extreme infections: 40 mg/kg/day divided each 6 to eight hours; most each day dose: 2,700 mg/day.

Oral:

Producer’s labeling: Infants, Kids, and Adolescents:

Hydrochloride salt (capsule): 8 to twenty mg/kg/day divided each 6 to eight hours.

Palmitate salt (resolution): 8 to 25 mg/kg/day divided each 6 to eight hours; minimal dose: 37.5 mg 3 occasions each day.

Alternate dosing (Pink Guide [AAP]; 2012): Infants, Kids, and Adolescents:

Gentle to average infections: 10 to 25 mg/kg/day divided each 8 hours; most each day dose: 1,800 mg/day.

Extreme infections: 30 to 40 mg/kg/day divided each 6 to eight hours; most each day dose: 1,800 mg/day.

Babesiosis: Infants, Kids, and Adolescents: Oral: 20 to 40 mg/kg/day divided each 8 hours for 7 to 10 days plus quinine; most single dose: 600 mg (Pink Guide [AAP] 2012).

Bacterial endocarditis prophylaxis for dental and higher respiratory procedures in penicillin-allergic sufferers (Pink Guide [AAP] 2012; Wilson 2007): Infants, Kids, and Adolescents:

IM, IV: 20 mg/kg half-hour earlier than process; most single dose: 600 mg.

Oral: 20 mg/kg 1 hour earlier than process; most single dose: 600 mg.

Word: American Coronary heart Affiliation (AHA) pointers now advocate prophylaxis solely in sufferers present process invasive procedures and in whom underlying cardiac situations could predispose to the next threat of adversarial outcomes ought to an infection happen. As of April 2007, routine prophylaxis for GI/GU procedures is now not advisable by the AHA.

Catheter (peritoneal dialysis); exit-site or tunnel an infection: Toddler, Kids, and Adolescents: Oral: 10 mg/kg/dose 3 occasions each day; most dose: 600 mg/dose (Warady [ISPD 2012]).

Intra-abdominal an infection, difficult: Infants, Kids, and Adolescents: IV: Word: Not advisable for community-acquired infections as a consequence of rising Bacteroides fragilis resistance: 20 to 40 mg/kg/day divided each 6 to eight hours together with gentamicin or tobramycin (Solomkin 2010).

Malaria, remedy: Infants, Kids, and Adolescents:

Uncomplicated: Oral: 20 mg/kg/day divided each 8 hours for 7 days plus quinine (CDC 2011; Pink Guide [AAP] 2012).

Extreme: IV: Loading dose: 10 mg/kg as soon as adopted by 15 mg/kg/day divided each 8 hours plus IV quinidine gluconate; change to oral remedy (clindamycin and quinine, see above) when in a position for whole remedy length of seven days. Word: Quinine length is area particular; seek the advice of CDC for present suggestions (CDC 2011).

Osteomyelitis, septic arthritis, as a consequence of MRSA: Infants, Kids, and Adolescents: IV, Oral: 40 mg/kg/day divided each 6 to eight hours for not less than 4 to six weeks (osteomyelitis) or 3 to 4 weeks (septic arthritis) (IDSA [Liu 2011]).

Otitis media, acute: Infants ≥6 months, Kids, and Adolescents: Oral: 30 to 40 mg/kg/day divided each 8 hours; administer with or and not using a third era cephalosporin (AAP [Lieberthal 2013]).

Peritonitis (peritoneal dialysis):

Prophylaxis (Warady [ISPD 2012]):

Invasive dental procedures: Oral: 20 mg/kg administered 30 to 60 minutes earlier than process; most dose: 600 mg.

Gastrointestinal or genitourinary procedures: IV: 10 mg/kg administered 30 to 60 minutes earlier than process; most dose: 600 mg.

Remedy: Intraperitoneal, steady: Loading dose: 300 mg per liter of dialysate; upkeep dose: 150 mg per liter; Word: 125 mg/liter has additionally been advisable as a upkeep dose (Aronoff 2007; Warady [ISPD 2012]).

Pharyngitis:

AHA pointers (Gerber 2009): Kids and Adolescents: Oral: 20 mg/kg/day in divided doses 3 occasions each day for 10 days; most single dose: 600 mg.

IDSA pointers (Shulman, 2012): Kids and Adolescents: Oral:

Remedy and first prevention of rheumatic fever: 21 mg/kg/day in divided doses 3 occasions each day for 10 days; most single dose: 300 mg.

Remedy of continual carriers: 20 to 30 mg/kg/day in divided doses 3 occasions each day for 10 days; most single dose: 300 mg.

Pneumococcal illness, invasive: Infants, Kids, and Adolescents: IV: 25 to 40 mg/kg/day divided each 6 to eight hours (Pink Guide [AAP] 2012).

Pneumocystis jirovecii (previously carnii) pneumonia (PCP):

Non HIV-exposed/-positive (Pink Guide [AAP] 2012): Infants, Kids, and Adolescents:

Gentle to average illness: Oral: 10 mg/kg 3 to 4 occasions each day for 21 days; together with different brokers; most single dose: 450 mg.

Reasonable to extreme illness: IV: 15 to 25 mg/kg 3 to 4 occasions each day for 21 days; give with pentamidine or primaquine; most single dose: 600 mg. Could change to oral dose after scientific enchancment.

HIV-exposed/-positive: Adolescents (DHHS [adult] 2013):

Gentle to average illness: Oral: 300 mg each 6 hours or 450 mg each 8 hours with primaquine for 21 days.

Reasonable to extreme illness:

Oral: 300 mg each 6 hours or 450 mg each 8 hours with primaquine for 21 days.

IV: 600 mg each 6 hours or 900 mg each 8 hours with primaquine for 21 days.

Pneumonia:

Neighborhood-acquired pneumonia (CAP) (IDSA/PIDS [Bradley 2011]): Infants ≥3 months, Kids, and Adolescents: Word: In youngsters ≥5 years, a macrolide antibiotic needs to be added if atypical pneumonia can’t be dominated out.

Reasonable to extreme an infection: IV: 40 mg/kg/day divided each 6 to eight hours.

Gentle an infection, step-down remedy: Oral: 30 to 40 mg/kg/day divided each 6 to eight hours.

MRSA pneumonia: IV: 40 mg/kg/day divided each 6 to eight hours for 7 to 21 days (IDSA [Liu 2011]).

Rhinosinusitis, acute bacterial: Kids and Adolescents: Oral: 30 to 40 mg/kg/day divided each 8 hours with concomitant cefixime or cefpodoxime for 10 to 14 days. Word: Advisable in sufferers with nontype I penicillin allergy, after failure to preliminary remedy, or in sufferers in danger for antibiotic resistance (eg, daycare attendance, age <2 years, latest hospitalization, antibiotic use throughout the previous month) (Chow 2012).

Pores and skin and smooth tissue an infection: Infants, Kids, and Adolescents:

Impetigo: Oral: 20 mg/kg/day in divided doses 3 occasions each day for 7 days; most dose: 400 mg/dose (IDSA [Stevens 2014]).

MRSA an infection: Word: Remedy length based mostly on scientific response, often 7 to 14 days for classy pores and skin and smooth tissue an infection and 5 to 10 days for outpatient cellulitis (nonpurulent or purulent) (IDSA [Liu 2011]).

IV: 25 to 40 mg/kg/day in divided doses 3 occasions each day (IDSA [Stevens 2014]) or 40 mg/kg/day in divided doses each 6 to eight hours (IDSA [Liu 2011]); most dose: 600 mg/dose.

Oral: 30 to 40 mg/kg/day in divided doses 3 occasions each day (IDSA [Stevens 2014]) or 30 to 40 mg/kg/day in divided doses each 6 to eight hours (IDSA [Liu 2011]); most dose: 450 mg/dose.

MSSA an infection (IDSA [Stevens 2014]): Period of remedy dependent upon web site and severity of an infection; cellulitis and abscesses which have been drained sometimes require 5 to 10 days of remedy.

IV: 25 to 40 mg/kg/day in divided doses 3 occasions each day; most dose: 600 mg/dose.

Oral: 25 to 30 mg/kg/day in divided doses 3 occasions each day; most dose: 450 mg/dose.

Necrotizing infections: IV: 10 to 13 mg/kg/dose each 8 hours; most dose: 900 mg/dose; could use together with different antibiotics based mostly on organism. Proceed till additional debridement is just not crucial, affected person has clinically improved, and affected person is afebrile for 48 to 72 hours (IDSA [Stevens 2014]).

Surgical prophylaxis: Kids and Adolescents: IV: 10 mg/kg 30 to 60 minutes previous to the process; could repeat in 6 hours; most single dose: 900 mg (Bratzler 2013).

Toxoplasmosis (HIV-exposed/optimistic or hematopoietic cell transplantation recipients):

Infants and Kids (CDC 2009; Pink Guide [AAP] 2012; Tomblyn 2009):

Remedy, HIV-exposed/-positive: IV, Oral: 5 to 7.5 mg/kg/dose 4 occasions each day with pyrimethamine and leucovorin; most single dose: 600 mg.

Secondary prevention:

HIV-exposed/-positive: Oral: 7 to 10 mg/kg/dose each 8 hours and pyrimethamine plus leucovorin; most single dose: 600 mg (DHHS [pediatric] 2013).

Hematopoietic cell transplantation recipients: Oral: 5 to 7.5 mg/kg/dose each 6 hours and pyrimethamine plus leucovorin; most single dose: 450 mg.

Adolescents (DHHS [adult] 2013; Pink Guide [AAP] 2012; Tomblyn 2009):

Remedy: Oral, IV: 600 mg each 6 hours with pyrimethamine and leucovorin for not less than 6 weeks; longer if scientific or radiologic illness is in depth or response is incomplete.

Secondary prevention:

HIV-exposed/-positive: Oral: 600 mg each 8 hours with pyrimethamine and leucovorin.

Hematopoietic cell transplantation recipients: Oral: 300 to 450 mg each 6 to eight hours with pyrimethamine and leucovorin.

Dosage adjustment for concomitant remedy: Vital drug interactions exist, requiring dose/frequency adjustment or avoidance. Seek the advice of drug interactions database for extra data.

Reconstitution

Injection: By no means administer undiluted as bolus. For IV infusion, dilute vials with 50 to 100 mL of appropriate diluent (eg, D5W, NS); focus of clindamycin for IV infusion shouldn’t exceed 18 mg/mL.

Oral resolution: Reconstitute bottles of 100 mL with 75 mL of water. Add a big portion of the water and shake vigorously; add the rest of the water and shake till the answer is uniform. When reconstituted with water, every 5 mL of resolution comprises clindamycin palmitate hydrochloride equal to clindamycin 75 mg.

Administration

IM: Deep IM websites, rotate websites; don’t exceed 600 mg in a single injection.

IV: By no means administer undiluted as bolus; administer by IV intermittent infusion over not less than 10 to 60 minutes, at a most fee of 30 mg/minute (don’t exceed 1,200 mg/hour).

Oral: Capsule needs to be taken with a full glass of water to keep away from esophageal irritation; shake oral resolution properly earlier than use; could administer with or with out meals.

Storage

Oral: Retailer at 20°C to 25°C (68°F to 77°F). Don’t refrigerate the reconstituted oral resolution (it’ll thicken); the answer is steady for two weeks at room temperature.

IV: Retailer intact vials and premixed luggage at 20°C to 25°C (68°F to 77°F). Infusion resolution in NS or D5W resolution is steady for 16 days at room temperature, 32 days refrigerated, or 8 weeks frozen. After preliminary use, discard any unused portion of vial after 24 hours.

Drug Interactions

BCG (Intravesical): Antibiotics could diminish the therapeutic impact of BCG (Intravesical). Keep away from mixture

BCG Vaccine (Immunization): Antibiotics could diminish the therapeutic impact of BCG Vaccine (Immunization). Monitor remedy

Cholera Vaccine: Antibiotics could diminish the therapeutic impact of Cholera Vaccine. Administration: Keep away from cholera vaccine in sufferers receiving systemic antibiotics, and inside 14 days following the usage of oral or parenteral antibiotics. Keep away from mixture

CYP3A4 Inducers (Sturdy): Could lower the serum focus of Clindamycin (Systemic). Confer with the precise clindamycin (systemic) – rifampin drug interplay monograph for data regarding that mixture. Monitor remedy

Kaolin: Could lower the absorption of Lincosamide Antibiotics. Monitor remedy

Lactobacillus and Estriol: Antibiotics could diminish the therapeutic impact of Lactobacillus and Estriol. Monitor remedy

Mecamylamine: Lincosamide Antibiotics could improve the neuromuscular-blocking impact of Mecamylamine. Keep away from mixture

Neuromuscular-Blocking Brokers: Lincosamide Antibiotics could improve the neuromuscular-blocking impact of Neuromuscular-Blocking Brokers. Monitor remedy

Sodium Picosulfate: Antibiotics could diminish the therapeutic impact of Sodium Picosulfate. Administration: Think about using another product for bowel cleaning previous to a colonoscopy in sufferers who’ve just lately used or are concurrently utilizing an antibiotic. Think about remedy modification

Typhoid Vaccine: Antibiotics could diminish the therapeutic impact of Typhoid Vaccine. Solely the dwell attenuated Ty21a pressure is affected. Administration: Keep away from use of dwell attenuated typhoid vaccine (Ty21a) in sufferers being handled with systemic antibacterial brokers. Postpone vaccination till 3 days after cessation of antibiotics and keep away from beginning antibiotics inside 3 days of final vaccine dose. Think about remedy modification

Opposed Reactions

The next adversarial drug reactions and incidences are derived from product labeling except in any other case specified. Frequency not outlined.

Cardiovascular: Hypotension (uncommon; IV administration), thrombophlebitis (IV)

Central nervous system: Metallic style (IV)

Dermatologic: Acute generalized exanthematous pustulosis, erythema multiforme (uncommon), exfoliative dermatitis (uncommon), maculopapular rash, pruritus, pores and skin rash, Stevens-Johnson syndrome (uncommon), poisonous epidermal necrolysis, urticaria, vesiculobullous dermatitis

Gastrointestinal: Belly ache, antibiotic-associated colitis, Clostridioides (previously Clostridium) difficile-associated diarrhea, diarrhea, esophageal ulcer, esophagitis, nausea, pseudomembranous colitis, disagreeable style (IV), vomiting

Genitourinary: Azotemia, oliguria, proteinuria, vaginitis

Hematologic & oncologic: Agranulocytosis, eosinophilia (transient), neutropenia (transient), thrombocytopenia

Hepatic: Irregular hepatic perform assessments, jaundice

Hypersensitivity: Anaphylactic shock, anaphylactoid response (uncommon), anaphylaxis, angioedema, hypersensitivity response

Immunologic: DRESS syndrome

Native: Abscess at injection web site (IM), induration at injection web site (IM), irritation at injection web site (IM), ache at injection web site (IM)

Neuromuscular & skeletal: Polyarthritis (uncommon)

Renal: Renal insufficiency (uncommon)

ALERT: U.S. Boxed Warning

Colitis:

Clostridioides (previously Clostridium) difficile-associated diarrhea (CDAD) has been reported with use of practically all antibacterial brokers, together with clindamycin, and should vary in severity from gentle diarrhea to deadly colitis. Remedy with antibacterial brokers alters the conventional flora of the colon, resulting in overgrowth of C. difficile.

As a result of clindamycin remedy has been related to extreme colitis, which can finish fatally, reserve it for severe infections for which much less poisonous antimicrobial brokers are inappropriate. Don’t use clindamycin in sufferers with nonbacterial infections, comparable to most higher respiratory tract infections.

C. difficile produces toxins A and B, which contribute to the event of CDAD. Hypertoxin-producing strains of C. difficile trigger elevated morbidity and mortality, as these infections could be refractory to antimicrobial remedy and should require colectomy. CDAD have to be thought of in all sufferers who current with diarrhea following antibiotic use. Cautious medical historical past is important as a result of CDAD has been reported to happen greater than 2 months after the administration of antibacterial brokers.

If CDAD is suspected or confirmed, ongoing antibiotic use not directed towards C. difficile could have to be discontinued. Institute acceptable fluid and electrolyte administration, protein supplementation, antibiotic remedy of C. difficile, and surgical analysis as clinically indicated.

Warnings/Precautions

Issues associated to adversarial results:

• Colitis: [US Boxed Warning]: Could cause extreme and presumably deadly colitis. Needs to be reserved for severe infections the place much less poisonous antimicrobial brokers are inappropriate. It shouldn’t be utilized in sufferers with nonbacterial infections comparable to most higher respiratory tract infections. Hypertoxin-producing strains of C. difficile trigger elevated morbidity and mortality, as these infections could be refractory to antimicrobial remedy and should require colectomy. C. difficile-associated diarrhea (CDAD) have to be thought of in all sufferers who current with diarrhea following antibiotic use. CDAD has been noticed >2 months postantibiotic remedy. If CDAD is suspected or confirmed, ongoing antibiotic use not directed towards C. difficile could have to be discontinued. Institute acceptable fluid and electrolyte administration, protein supplementation, antibiotic remedy of C. difficile, and surgical analysis as clinically indicated.

• Hypersensitivity: Extreme hypersensitivity reactions, together with extreme pores and skin reactions (eg, drug response with eosinophilia and systemic signs [DRESS], Stevens-Johnson syndrome [SJS], poisonous epidermal necrolysis [TEN]), some deadly, and anaphylactic reactions, together with anaphylactic shock, have been reported. Completely discontinue remedy and institute acceptable remedy if these reactions happen.

• Superinfection: Use could end in overgrowth of nonsusceptible organisms, notably yeast. Ought to superinfection happen, acceptable measures needs to be taken as indicated by the scientific scenario.

Illness-related issues:

• GI illness: Use with warning in sufferers with a historical past of GI illness, notably colitis.

• Hepatic impairment: Use with warning in sufferers with average to extreme liver illness, nonetheless, when administered at every-8-hour intervals, drug accumulation is uncommon. Monitor hepatic enzymes periodically as dosage changes could also be crucial in sufferers with extreme liver illness.

Particular populations:

• Atopic sufferers: Use with warning in atopic sufferers.

• Aged: A subgroup of older sufferers with related extreme sickness could tolerate diarrhea much less properly. Monitor rigorously for adjustments in bowel frequency.

Dosage kind particular points:

• Benzyl alcohol and derivatives: Some dosage types could include benzyl alcohol; massive quantities of benzyl alcohol (≥99 mg/kg/day) have been related to a doubtlessly deadly toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory misery, gasping respirations, CNS dysfunction (together with convulsions, intracranial hemorrhage), hypotension and cardiovascular collapse (AAP [“Inactive” 1997]; CDC 1982); some knowledge means that benzoate displaces bilirubin from protein binding websites (Ahlfors 2001); keep away from or use dosage types containing benzyl alcohol with warning in neonates. See producer’s labeling.

• Tartrazine: Some merchandise could include tartrazine (FD&C yellow no. 5), which can trigger allergic reactions in sure people. Allergy is often seen in sufferers who even have an aspirin hypersensitivity.

Different warnings/precautions:

• Administration (IV): Don’t inject IV undiluted as a bolus. Product needs to be diluted in appropriate fluid and infused over 10 to 60 minutes.

• Applicable use: Not acceptable to be used within the remedy of meningitis as a consequence of insufficient penetration into the CSF.

Monitoring Parameters

Observe for adjustments in bowel frequency. Monitor for colitis and backbone of signs. In extreme liver illness monitor liver perform assessments periodically; throughout extended remedy monitor CBC, liver and renal perform assessments periodically.

Being pregnant Concerns

Clindamycin crosses the placenta and could be detected within the twine blood and fetal tissue (Philipson 1973; Weinstein 1976). Clindamycin injection comprises benzyl alcohol, which can additionally cross the placenta.

Clindamycin pharmacokinetics usually are not affected by being pregnant (Philipson 1976; Weinstein 1976).

Clindamycin is advisable to be used in pregnant girls for the prophylaxis of group B streptococcal illness in newborns (various choice for sufferers at excessive threat for anaphylaxis to penicillin [or whose risk is unknown], and who’ve GBS prone to clindamycin) (ACOG 797 2020); prophylaxis and remedy of Toxoplasma gondii encephalitis (various remedy), or remedy of Pneumocystis pneumonia (PCP) (various remedy) (HHS [OI adult 2020]); bacterial vaginosis (CDC [Workowski 2015]); anthrax (Meaney-Delman 2014); or malaria (CDC 2020). Clindamycin can be one of many antibiotics advisable for prophylactic use previous to cesarean supply and could also be utilized in sure conditions previous to vaginal supply in girls at excessive threat for endocarditis (ACOG 199 2018).

Affected person Training

What is that this drug used for?

• It’s used to deal with or forestall bacterial infections.

All medication could trigger uncomfortable side effects. Nonetheless, many individuals don’t have any uncomfortable side effects or solely have minor uncomfortable side effects. Name your physician or get medical assist if any of those uncomfortable side effects or some other uncomfortable side effects hassle you or don’t go away:

• Belly ache

• Nausea

• Vomiting

• Dangerous style

• Diarrhea

WARNING/CAUTION: Although it might be uncommon, some individuals could have very unhealthy and typically lethal uncomfortable side effects when taking a drug. Inform your physician or get medical assist straight away if in case you have any of the next indicators or signs that could be associated to a really unhealthy facet impact:

Clostridioides (previously Clostridium) difficile-associated diarrhea like stomach ache or cramps, extreme diarrhea or watery stools, or bloody stools

• Injection web site ache, swelling, or redness

• Joint ache

• Joint swelling

• Unable to cross urine

• Change in quantity of urine handed

• Yellow pores and skin

• Swollen glands

• Vaginal ache, itching, and discharge

• Stevens-Johnson syndrome/poisonous epidermal necrolysis like pink, swollen, blistered, or peeling pores and skin (with or with out fever); pink or irritated eyes; or sores in mouth, throat, nostril, or eyes

• Indicators of an allergic response, like rash; hives; itching; pink, swollen, blistered, or peeling pores and skin with or with out fever; wheezing; tightness within the chest or throat; bother respiration, swallowing, or speaking; uncommon hoarseness; or swelling of the mouth, face, lips, tongue, or throat.

Word: This isn’t a complete listing of all uncomfortable side effects. Discuss to your physician if in case you have questions.

Client Info Use and Disclaimer: This data shouldn’t be used to resolve whether or not or to not take this medication or some other medication. Solely the healthcare supplier has the information and coaching to resolve which medicines are proper for a selected affected person. This data doesn’t endorse any medication as secure, efficient, or authorised for treating any affected person or well being situation. That is solely a restricted abstract of normal details about the drugs’s makes use of from the affected person training leaflet and isn’t meant to be complete. This restricted abstract does NOT embody all data obtainable concerning the potential makes use of, instructions, warnings, precautions, interactions, adversarial results, or dangers which will apply to this medication. This data is just not meant to offer medical recommendation, analysis or remedy and doesn’t change data you obtain from the healthcare supplier. For a extra detailed abstract of details about the dangers and advantages of utilizing this medication, please communicate together with your healthcare supplier and evaluate the whole affected person training leaflet.

Additional data

At all times seek the advice of your healthcare supplier to make sure the data displayed on this web page applies to your private circumstances.

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