Clindamycin

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Clindamycin is produced by chemical modification of lincomycin, which was isolated in 1962 from Streptomyces lincolnensis. It is an antibiotic effective against gram positives (including MRSA, but see below) and anaerobes. Available in oral form.

Not really related to any other antibiotic! Blocks protein synthesis. Its particular advantages are that it is probably better than penicillin (at least in animal models) for treating Group A streptococcus (GAS), even though penicillin resistance is unknown in GAS, owing to the Eagle effect. Usual use is severe anaerobic infections.

Also has theoretical advantage in toxin mediated disease by its effect on protein synthesis (anti-exotoxin activity), so consider in toxic shock syndrome, scalded skin syndrome, scarlet fever, necrotizing Panton-Valentin leucocidin (PVL)-positive CA-MRSA-complicated pneumonia.

Contents

Administration

Oral Tastes foul, crushed tablets may be more acceptable to children than suspension. IV

Topical

Skin

Vaginal

Side effects

Associated with Clostridium difficile pseudomembranous colitis/diarrhoea, not surprisingly given its spectrum.


Interactions

Special advice

Many isolates of community acquired MRSA are sensitive to clindamycin, but inducible resistance is increasingly seen. A D-test should be done - if positive, then resistance may evolve during treatment. Further it should not usually be given alone.

Pharmacology

Binds to the 50S ribosomal subunit of rRNA so inhibiting the initiation of peptide-chain synthesis.