clindamycin hydrochloride: clinical use

Prescribing considerations

• Reserve for serious infections caused by organisms expected or shown to be susceptible.
• Consider local resistance and microbiology advice; inducible or constitutive macrolide-lincosamide-streptogramin B resistance can occur.
• Ask about previous gastrointestinal disease, particularly colitis.
• Ensure the patient can swallow capsules whole and understands administration precautions.
• Consider renal monitoring in pre-existing renal dysfunction or with nephrotoxic medicines.

Contraindications and cautions

• Hypersensitivity to clindamycin, lincomycin or a product excipient.

Monitoring

• Assess promptly for antibiotic-associated or Clostridioides difficile diarrhoea during and after treatment.
• During prolonged therapy, periodically monitor liver and kidney function; monitoring is also advised in neonates and infants.
• Monitor renal function where acute kidney injury risk is increased.
• Monitor PT/INR more closely with vitamin K antagonists.
• Monitor for superinfection during prolonged treatment.

Clinical pharmacology

Clindamycin is primarily bacteriostatic through reversible binding to the bacterial 50S ribosomal subunit. Oral absorption is high and is not substantially reduced by food. Distribution includes bone and many tissues, but cerebrospinal-fluid concentrations are inadequate. Metabolism is mainly through CYP3A4, with a smaller CYP3A5 contribution.

Formulation and product differences

• The selected product is a hard oral capsule containing clindamycin hydrochloride.
• Capsules must be swallowed whole and may be unsuitable for children or adults unable to do so.
• Product excipients include lactose, gelatin and soya lecithin; check the current product information when excipient allergy or intolerance matters.

Capsule

Route: Oral

Strengths: 75 mg, 150 mg, 300 mg