- Discussion:
- for serious infections with Gram Neg anaerobes (B. fragilis) or staph / streptococcus infections in patients allergic to penicillin;
- not good for gm neg aerobes;
- clindamycin binds exclusively to the 50 S subunit of bacterial ribosomes and suppresses protein synthesis; (bacterostatic not bacterocidal);
- although clindamycin, chloramphenicol, and erythromycin are not structurally related, they all act at this site;
- clindamycin is almost completly absorbed orally;
- Cautions:
- beware diarrhea w/ pseudomembranous colitis by C. difficile
- this infectious diarrhea treated with vancomycin or metronidazole PO;
- inducible resistance with MRSA infections;
- inducible resistance (appears sensitive on petri dish but is not)
- D-test: an erythromycin disk is placed near a clindamycin disk on a Kirby-Bauer plate;
- if inducible resistance is present then, zone of inhibition around clindamycin will be flattened in direction of erythromycin disc and will resemble letter D;
- decrease dose with severe renal or hepatic dz;
- 10-15 % of dose will be excreted in urine (w/ nl renal f(x))
- dosing regimens for patients w/ renal insufficiency:
- dose for 70kg Adult (gm/dosing interval in hours):
- CrCl: > 80 0.6/8;
- CrCl: 50-79 0.6/8;
- CrCl: 30-49 0.6/8;
- CrCl: 10-29 0.6/8;
- caution with patients with GI dz (colitis), atopic individuals, patients receiving neuromuscular blocking drugs, patients with ASA hypersensitivity;
- note diffusion from blood into CSF is NIL even w/ inflammation;
- will interact w/ neuromuscular blocking agents, and with theophylline (to incr serum levels, seizures, and apnea)
- for serious infections with Gram Neg anaerobes (B. fragilis) or staph / streptococcus infections in patients allergic to penicillin;
- not good for gm neg aerobes;
- clindamycin binds exclusively to the 50 S subunit of bacterial ribosomes and suppresses protein synthesis; (bacterostatic not bacterocidal);
- although clindamycin, chloramphenicol, and erythromycin are not structurally related, they all act at this site;
- clindamycin is almost completly absorbed orally;
- Dosing:
- adult:150-450mg PO qid; 300-600mg IV q6hr; 900mg IV q8hr
- w/ severe infections: 300-450mg PO q6hr or 1200-1700 mg/day IM/IV in 2-4 divided dose;
- w/ life threatening infections may use up to 4800mg qd max dose;
- peds: 25 mg/kg/24 hrs;
- > 1 month: 15-40 mg/kg/24hr IM or IV divided q6-8hr; 8-25 mg/kg/24hr PO in 3-4 DD;
- Cautions:
- beware diarrhea w/ pseudomembranous colitis by C. difficile
- this infectious diarrhea treated with vancomycin or metronidazole PO;
- inducible resistance with MRSA infections;
- inducible resistance (appears sensitive on petri dish but is not)
- D-test: an erythromycin disk is placed near a clindamycin disk on a Kirby-Bauer plate;
- if inducible resistance is present then, zone of inhibition around clindamycin will be flattened in direction of erythromycin disc and will resemble letter D;
- decrease dose with severe renal or hepatic dz;
- 10-15 % of dose will be excreted in urine (w/ nl renal f(x))
- dosing regimens for patients w/ renal insufficiency:
- dose for 70kg Adult (gm/dosing interval in hours):
- CrCl: > 80 0.6/8;
- CrCl: 50-79 0.6/8;
- CrCl: 30-49 0.6/8;
- CrCl: 10-29 0.6/8;
- caution with patients with GI dz (colitis), atopic individuals, patients receiving neuromuscular blocking drugs, patients with ASA hypersensitivity;
- note diffusion from blood into CSF is NIL even w/ inflammation;
- will interact w/ neuromuscular blocking agents, and with theophylline (to incr serum levels, seizures, and apnea)
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