How clindamycin works
Clindamycin inhibits the ability of bacteria to produce proteins. However, since proteins are extremely important for building bacterial cells, the antibiotic thereby prevents the bacteria from growing and multiplying.
Clindamycin works well against staphylococci (gram-positive bacteria) and anaerobes (germs that grow in oxygen-free environments).
Absorption, degradation and excretion
Clindamycin is well absorbed into the body through the gastrointestinal tract after administration by mouth. Administration into a venous blood vessel or skeletal muscle by syringe and cannula is also possible.
Most of the drug is metabolized by the liver and then excreted in the stool. A small amount leaves the body in unchanged form in the urine.
Clindamycin can also be used externally. In the form of a vaginal cream or gel, the antibiotic inhibits bacterial growth at the site of application.
Since clindamycin is readily absorbed by tissue and accumulates in bone tissue, among other places, it is used for infections of the bones and joints (e.g., osteomyelitis, septic arthritis) and infections of the dental and jaw region.
Other areas of application (indications) of the antibiotic are:
- Infections of the ear, nose, and throat (e.g., acute otitis media, sinusitis, tonsillitis, and pharyngitis)
- Infections of the pelvic and abdominal area and the female genital organs (e.g. vaginitis, bacterial vaginosis)
- Infections of the soft tissues
How clindamycin is used
Internal use
To do this, cold, previously boiled water is added to below the mark on the bottle. The bottle is closed and carefully shaken until the granules have completely dissolved. As soon as the foam has completely settled, fill up again exactly to the mark. The now ready-to-use suspension should be shaken well before each use and should not be stored above 25 degrees.
The daily dose depends on the type and severity of the infection. Generally, it is between 0.6 and 1.8 grams of clindamycin – divided into three to four doses. The duration of application also depends on the type of infection as well as the course of the disease and is therefore determined by the physician.
External use
A clindamycin vaginal cream is applied to the vagina with an applicator. The treatment should be done before going to bed and should not be started during menstruation.
What are the side effects of clindamycin?
Clindamycin can cause diarrhea, especially when taken by mouth. This is because the antibiotic promotes the proliferation of a certain bacterium in the intestine, which produces a toxin that damages the intestinal mucosa.
In some patients, this can cause colitis, which is accompanied by fever, severe diarrhea with blood admixtures, abdominal cramps, and nausea. If diarrhea occurs, the antibiotic should therefore be discontinued as a precaution and the doctor consulted.
In more than one percent of patients, a slight, transient elevation of certain liver enzymes (serum transaminases) occurs with the use of clindamycin. After administration via a venous blood vessel, pain and phlebitis with subsequent blood clot formation (thrombophlebitis) may occur.
What should be considered when using clindamycin?
Contraindications
Clindamycin must not be used in case of hypersensitivity to clindamycin or lincomycin.
In patients with impaired liver function, disorders of signal transmission from nerves to muscles (e.g., myasthenia gravis, Parkinson’s disease) and with a history of gastrointestinal disorders (e.g., inflammation of the colon), special caution should be exercised when using the antibiotic.
Interactions
The antibiotic may reduce the effectiveness of the contraceptive pill. Therefore, as a precaution, additional mechanical contraception should be used during treatment (e.g., with condoms).
Simultaneous use of clindamycin and macrolide antibiotics (such as erythromycin, clarithromycin, azithromycin or roxithromycin) is not advisable, as both active substances act in the same way and thus weaken each other’s effect.
Clindamycin may increase the effects of muscle relaxants (medicines that cause temporary relaxation of skeletal muscles), as the antibiotic also has a muscle relaxing effect. Therefore, if necessary, the dosage of muscle relaxants is adjusted accordingly by the physician.
Clindamycin is degraded via the CYP3A4 enzyme. Other drugs that strongly stimulate CYP3A4 enzyme activity (including rifampicin, phenytoin, phenobarbital, some HIV drugs) may thus limit the effectiveness of Clindamycin.
Pregnancy and Lactation
Clindamycin is a reserve antibiotic in pregnancy. It should be used only when more suitable alternatives are not an option.
Other antibiotics such as penicillins, cephalosporins, and macrolides should also be preferred if possible during lactation. However, if clindamycin is compellingly indicated, patients may continue to breastfeed.
Preparations containing clindamycin require a prescription in Germany, Austria and Switzerland and are only available from pharmacies on prescription.
How long has clindamycin been known?
Clindamycin is chemically closely related to lincomycin, which is produced by certain bacteria (Streptomyces lincolnensis) and was discovered in the 1950s. The discovery was made in soil cultures near the city of Lincoln, Nebraska (hence the name lincomycin).
Clindamycin is obtained from lincomycin by a chemical reaction. Compared to the latter, it is more potent and is better absorbed into the body. Clindamycin has been on the market since 1968.
What you should also know about clindamycin
Because clindamycin alters the natural bacterial colonization of the intestine, diarrhea may occur. As a preventive measure, preparations containing special medicinal yeast (e.g. Saccharomyces cerevisiae) can also be taken.