clindamycin phosphate: clinical use

Prescribing considerations

• Confirm that the indication matches the formulation and consider pathogen susceptibility and local resistance for systemic treatment.
• Clindamycin does not achieve therapeutic cerebrospinal-fluid concentrations and should not treat meningitis.
• Assess previous gastrointestinal disease, especially colitis, and counsel about delayed antibiotic-associated diarrhoea.
• Consider overgrowth of non-susceptible bacteria or fungi and selection of resistance during prolonged exposure.
• The injection contains benzyl alcohol; consider cumulative exposure in young children, pregnancy, breastfeeding and renal or hepatic impairment.

Contraindications and cautions

• Hypersensitivity to clindamycin, lincomycin or relevant formulation excipients.
• The injection must not be given to premature babies or neonates because it contains benzyl alcohol.
• The selected vaginal cream and topical lotion are contraindicated with inflammatory bowel disease or previous antibiotic-associated colitis; the acne gel describes these histories as cautions.

Monitoring

• Monitor for severe or persistent diarrhoea during treatment and for weeks afterwards; stop clindamycin and investigate suspected antibiotic-associated colitis.
• For prolonged systemic treatment, monitor liver and kidney function; renal monitoring is also relevant with pre-existing renal dysfunction or nephrotoxic medicines.
• Monitor coagulation tests more closely with a vitamin K antagonist.
• Assess clinical and microbiological response in serious infection.
• Monitor acne treatment for irritation, superinfection and loss of effectiveness suggesting resistance.

Clinical pharmacology

Clindamycin phosphate is hydrolysed to active clindamycin. It binds the bacterial 50S ribosomal subunit, inhibits protein synthesis and is primarily bacteriostatic. Systemic clindamycin is metabolised mainly through CYP3A4 and, to a lesser extent, CYP3A5.

Formulation and product differences

• Injection: intramuscular or intravenous preparation for serious susceptible infections; contains benzyl alcohol and requires dilution before intravenous administration.
• Vaginal cream: intravaginal treatment for bacterial vaginosis; may weaken latex barriers and commonly causes local symptoms or candidiasis.
• Gel: cutaneous acne preparation with low systemic absorption; avoid eyes and mucous membranes.
• Lotion: cutaneous acne emulsion that must be shaken; systemic absorption and antibiotic-associated colitis remain possible.

Cream

Route: Cutaneous

Strengths: 2%, 2% w/w

Gel

Route: Cutaneous

Strengths: 1%

Lotion

Route: Cutaneous

Strengths: 10 mg/mL