Clindamycin

Lincosamide. Semi-synthetically modified analogue of lincosamide which is no longer used today. It is a weak base with lipophilic properties.

Clindamycin binds to the 50S subunit of bacterial ribosomes and inhibits protein synthesis. This results in a bacteriostatic effect. Clindamycin is the most effective antibiotic against anerobes.

• Systemic:
• 0.6-1.8 g/day p.o. in 3-4 ED or 0.9-1.8 g/day i.v. in 3-4 ED For severe infections 2.4-2.7 g in 2-4 cycles/day.
• Children < 10 kg: 3 times/day 0.38 g/kg bw/day and higher.
• Children > 4 weeks: 20-40 mg/kg bw/day distributed over four cycles.
• Topical: Apply 1-2 times/day after thorough skin cleansing to the diseased areas.

Gastrointestinal side effects:

• Symptoms of diarrhoea
• Stomatitis
• Oesophagitis

immune reactions:

• Maculo-papular exanthema (Papakonstantinou E et al. 2018)
• Contact dermatitis (Veraldi S et al. 2019)
• Rare are:
  • Sore throat
  • Headaches
  • Skin dryness
  • Reports on the occurrence of a"Symmetrical drug-related intertriginous and flexural exanthema" (Cabrera Hernandez V et al. 2019)
  • Urge to urinate

Use for max. 10-12 weeks due to development of resistance. Do not use together with alcoholic benzoyl peroxide solutions.

Very good tissue penetration, hardly liqourgable, strong accumulation in macrophages.

Inducible MLSB (macrolide lincosamide B-streptogramin) resistance, which may develop in the presence of erythromycin resistance, prohibits the use of clindamycin despite sensitive in vitro testing in the antibiogram.

1. Cabrera Hernandez V et al (2019) Symmetrical drug-related intertriginous and flexural exanthema due to clindamycin. BMJ Case Rep 12:e230077.

2. Garcia-Lechuz JM et al (2007) Spanish Pneumococcal Study Network. Streptococcus pneumoniae skin and soft tissue infections: characterization of causative strains and clinical illness. Eur J Clin Microbiol Infect Dis 26: 247-253

3. Monteagudo B et al (2018) Clindamycin-induced Maculopapular Exanthema with Preferential Involvement of Striae Distensae: A Koebner phenomenon? Acta Dermatovenerol Croat. 26:61-63

   Papakonstantinou E et al (2018) Generalized reactions during skin testing with clindamycin in drug hypersensitivity: a report of 3 cases and review of the literature. Contact Dermatitis 78:274-280

4. Rostetter C et al (2017) Amoxicillin with clavulanic acid. Standard antibiotic in general dentistry. Swiss Dent J 127:654-655.
5. Veraldi S et al. (2019) Allergic contact dermatitis caused by clindamycin. Contact dermatitis 80:68-69.