Clindamycin

Clindamycin

[1 vial $19.29]

ADMINISTRATION ROUTES:

  • IV, IM

ALTERNATIVE NAMES:

  • Dalacin, Clinda

ICU INDICATIONS:

  1. treatment of infections caused by susceptible organisms (particularly Streptococcal or Staphylococcal toxic shock syndrome)

PRESENTATION AND ADMINISTRATION:

  • IV:
    Ampoule of 600mg in 4 ml (solution) Add required dose to compatible IV fluid as shown in the table and administer over the stated time:

Infusion rate not to exceed 30mg/min
Administration of more than 1200mg in one hour is not recommended
Stable at room temperature for 24 hours after dilution in compatible IV fluid
Compatible with the following IV fluids:
Normal saline, 5% and 10% dextrose, Glucose and Sodium chloride, Hartmanns

  • IM:
    Not used by this route in ICU patients.

DOSAGE:

  • IV:
    600mg 6 hourly

DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:

  • Dose as in normal renal function

DOSAGE IN PAEDIATRICS:

  • IV:
    10-20mg/kg 8 hourly

CLINICAL PHARMACOLOGY:

  • Clindamycin inhibits bacterial protein synthesis by binding to the 50S subunit of the ribosome. It has activity against Gram-positive aerobes and anaerobes as well as the Gram-negative anaerobes. Clindamycin is bacteriostatic. Clindamycin has been shown to be active against most of the isolates of the following microorganisms, both in vitro and in clinical infections
  • Gram-Positive Aerobes:
    Staphylococcus aureus (methicillin-susceptible strains)
    Streptococcus
    pneumoniae (penicillin-susceptible strains)
    Streptococcus pyogenes
  • Anaerobes:
    Prevotella melaninogenica
    Fusobacterium necrophorum
    Fusobacterium nucleatum
    Peptostreptococcus anaerobius
    Clostridium perfringens

CONTRAINDICATIONS:

  1. hypersensitivity to preparations containing clindamycin or lincomycin.

WARNINGS

  • Anaphylaxis
    Clindamycin may cause serious allergic reactions including anaphylaxis
  • Pseudomembranous colitis
    Pseudomembranous colitis has been reported with nearly all antibacterial agents, including clindamycin, and may range in severity from mild to life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea subsequent to the administration of antibacterial agents. Because clindamycin therapy has been associated with severe colitis which may end fatally, it should be reserved for serious infections where less toxic antimicrobial agents are inappropriate
  • Usage in Meningitis:
    Since clindamycin does not diffuse adequately into the cerebrospinal fluid, the drug should not be used in the treatment of meningitis.

PRECAUTIONS

  • General:
    Prescribing clindamycin in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria.
  • Laboratory Tests:
    No tests in addition to routine ICU tests are indicated
  • Drug/Laboratory Test Interactions:
    None noted

IMPORTANT DRUG INTERACTIONS FOR THE ICU

  • Clindamycin has been shown to have neuromuscular blocking properties that may enhance the action of other neuromuscular blocking agents. Therefore, it should be used with caution in patients receiving such agents. Antagonism has been demonstrated between clindamycin and erythromycin in vitro. Because of possible clinical significance, the two drugs should not be administered concurrently.

ADVERSE REACTIONS

  • Body as a whole:
    Anaphylaxis
  • Gastrointestinal system:
    Metallic taste, Jaundice and abnormalities in liver function tests
  • Haematological system:
    Transient neutropenia (leukopenia), eosinophilia, agranulocytosis and thrombocytopenia
  • Cardiovascular system:
    Rare instances of cardiopulmonary arrest and hypotension have been reported following too rapid intravenous administration

Critical Care Drug Manual

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