The active substance clindamycin is an antibiotic that belongs to the pharmacological category of lincosamides. Clindamycin is a so-called semisynthetic derivative of the substance lincomycin.
What is clindamycin?
Clindamycin belongs to the subgroup of lincosamide antibiotics. The active ingredient is obtained from lincomycin and is then present in chlorinated form. In this process, the substance is produced in a semisynthetic manner. In the usual doses, the drug clindamycin usually shows a bacteriostatic effect. In higher doses, however, the drug has a bactericidal effect, i.e. it kills bacteria. The active ingredient clindamycin is primarily effective against gram-positive aerobic pathogens. These include, for example, staphylococci or streptococci. In addition, the substance clindamycin is also effective against anaerobes, in particular gram-negative germs and chlamydia. If the substance clindamycin is used together with the substance pyrimethamine, the compound is also effective against Toxoplasma gondii.
Pharmacological action
The substance clindamycin inhibits the synthesis of proteins in bacteria. In this process, the substance acts similarly to macrolides, which bind to a specific subunit of ribosomes. Since the mechanism of action is the same, cross-resistance occurs in some cases. When the drug clindamycin is administered orally, approximately 90 percent of the active substance is absorbed. At the same time, binding to plasma proteins occurs at 92 to 94 percent. In principle, the plasma half-life of the substance clindamycin is approximately 2.4 hours. The substance reaches internal organs as well as bone marrow, pleural fluid, skin and breast milk. The drug is also able to cross the placental barrier. In the liver, a conversion of the active substance takes place. Finally, the drug clindamycin is excreted through urine and stool. By inhibiting bacterial synthesis of proteins, an enzyme called peptidyltransferase is stopped. The spectrum of action of the drug clindamycin is relatively broad. For example, it is effective against Gram-positive cocci, such as Streptococcus pyogenes or pneumoniae. With regard to anaerobes, the drug is effective, for example, against Actinomyces, Peptostreptococcus, Fusobacterium and Bacteroides. In contrast, the antibiotic clindamycin shows little to no effect on aerobic gram-negative rod bacteria, enterococci, species of Haemophilus or Neisseria. In principle, it is possible that secondary resistance to antibiotics may also form as a result of taking the drug clindamycin, by altering certain structures on ribosomes. While taking the drug, meals hardly affect the absorption of the active substance. The substance clindamycin is well absorbed by tissues and accumulates in bones. In the liver, there is a strong metabolism of the active substance. About one-third of the ingested amount of active substance is excreted unchanged by the kidneys.
Medical use and application
The drug clindamycin is used in a variety of infections. In particular, clindamycin is frequently used in the treatment of abscessing inflammation of the lung, chronic osteomyelitis, osteomyelitis in a diabetic foot, or infections of the oral cavity. In addition, the drug is used for infections of joints and bones or female reproductive organs. Clindamycin can also be administered for the treatment of acne vulgaris. The possible areas of application are similar to those of other well-tolerated macrolides. One exception is infections caused by staphylococci. Macrolides are generally ineffective against these. Clindamycin is also used as a substitute in patients who are allergic to penicillin. In veterinary medicine, clindamycin is also used for serious infections of the skin, eyes or respiratory tract. In principle, clindamycin is a reserve antibiotic, so it is not always used as a first-choice agent for potential indications. As a rule, the active ingredient clindamycin is taken orally, depending on the indication. Both tablets and capsules are available. In addition, parenteral administration of the active substance as an infusion solution or local application by means of gels or ointments is possible.
Risks and side effects
In the course of therapy with the drug clindamycin, a number of undesirable side effects are possible, which vary depending on the individual case. Primarily, gastrointestinal symptoms such as diarrhea, vomiting, or cramps in the stomach area occur as a result of the drug. In addition, pseudomembranous colitis is possible, which in some cases forms as a result of antibiotic use. This makes complications possible, which occur more often with clindamycin than with other types of antibiotics. In such a case, treatment with the drug should be stopped immediately. Rare side effects of the drug include itching, inflammation of the skin, and vaginal catarrh. Clindamycin is not indicated during breastfeeding because the active substance passes into breast milk. Other potential side effects include damage to the liver associated with an increased concentration of transaminases. At the same time, the risk of allergies as well as leukocytopenia increases. In principle, the drug clindamycin must not be taken if the patient has an allergy to lincosamide antibiotics. If side effects or other symptoms occur, a physician should be consulted immediately.
