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Clindamycin is a semi-synthetic derivative of lincomycin. Its action is referred to as bacteriostatic. Clindamycin is mainly used to treat severe infections that do not respond to treatment with other antibiotics.

Action of clindamycin

Clindamycin shows concentration-dependent activity. In the majority of cases, clindamycin has a bacteriostatic effect, i.e. it limits the growth and multiplication of bacteria. In higher concentration, it has a bactericidal effect on more sensitive strains.

The mechanism of action of clindamycinis to inhibit the synthesis of bacterial proteins. This antibiotic already works at the level of the cytoplasm in the bacterial cell. It binds to the 50S subunit of the bacterial ribosome and, as a result, blocks the formation of peptide chains (this is due to blocking the function of ribosomes in the cell).

The same mechanism of action is shown by macrolide antibiotics, e.g. erythromycin or chloramphenicol.

It is therefore not advisable to administer clindamycin simultaneously with these antibiotics, because it does not increase their action and improve the therapeutic effect, and even reduces their effectiveness.

This is due to the fact that these substances compete with each other for a binding site on the bacterial 50S ribosome, so their interaction is described as antagonistic.

As the bacterium is no longer able to produce the structurally appropriate protein, its cell wall becomes weaker. Additionally, the ability of bacteria to bind to host cells decreases. The secretion of toxins by the bacteria is reduced and its multiplication is inhibited, and thus - the attack on the host cells and their colonization.

Among specialists, there is talk of the stimulating effect of clindamycin on the immune system. This is probably related to the fact that clindamycin induces immune processes such as:

  • opsonization (covering the pathogen by molecules to facilitate its phagocytosis),
  • complement binding,
  • phagocytosis
  • and the intracellular destruction of bacteria.

Clindamycin also has favorable pharmacological parameters because it penetrates well into tissues and even bones. Does not penetrate into the cerebralspinal cord but its penetration into the toughest tissue of the body is especially appreciated by dentists-implantologists.

Indications for the use of clindamycin

Clindamycin is only recommended for use in severe infections that do not respond to treatment with other antibiotics . Gram-positive aerobic and anaerobic gram-positive bacteria react to this antibiotic.

Activity against gram-negative bacteria is limited to anaerobes only.

Clindamycin is given in the case of :

  • respiratory tract infections caused by anaerobic bacteria, Streptococcus pneumoniae and other streptococci and Staphylococcus aureus,
  • skin and soft tissue infections caused by Streptococcus pyogenes, Staphylococcus aureus and anaerobic bacteria,
  • bone and joint infections caused by Staphylococcus aureus,
  • sepsis caused by Staphyloccocus aureus,
  • intra-abdominal infections caused by anaerobic bacteria,
  • infection of the female genital organs caused by anaerobic bacteria.

There is an intravenous version of clindamycin that is recommended for very severe infections including sepsis. When venous circulation is disturbed within the infected area, as in the case of a diabetic foot, intravenous administration of the antibiotic is recommended.

Clindamycin is also often used by dentists . It is especially recommended to use clindamycin during oral infections and exacerbation of periodontal diseases, especially in patients with reduced immunity.

Infection of peri-implant tissues (in the case of implant implantation) leads to an excessive growth of pathological bacterial flora, and even the formation of a biofilm, which further hinders the penetration of the antibiotic to the site of infection.

Chronic inflammation around the implant contributes to the loss of alveolar bone and causes gingival recession around implants. Such an untreated condition can lead to the gradual exposure of the implant, and even to its mobility, or in the worst case to its loss.

Implantologists agree that the most effective method of treating such a complication is to mechanically clean the infected area and get rid of the bacterial plaque formed around the implant, and then start antibiotic therapy.

Since it is extremely difficult to pinpoint the inflammatory strain accurately and it cannot be determined by the culture method, the selected antibiotic must have a broad spectrum,especially including anaerobic bacteria. Clindamycin is recommended in this case, especially in advanced lesions in the course of which an abscess has formed.

The fact that this substance penetrates well into tissues, including bones, is its additional advantage. In mild superinfections and in the initial phase of treatment, beta-lactam antibiotics are usually recommended.

Clindamycin in the form of a gel or emulsionis also used in the treatment of acne,especially in the comedone-maculopapular form.

Clindamycin is one of the most commonly prescribed antibiotics for topical therapy. There are many advantages of such therapy, e.g. it causes less irritation than the therapy with retinoids or azelaic acid alone.

Additionally, in the case of clindamycin, in addition to its antibacterial effect, an anti-inflammatory effect is also observed. These include inhibition of neutrophil chemotaxis and cytokinin production.

The effectiveness of the therapy combining several anti-acne preparations has been confirmed. Therefore, drugs containing a combination of clindamycin with tretinoin or clindamycin with benzoyl peroxide are gaining popularity. This solution reduces the risk of side effects and reduces the likelihood of bacterial resistance to the antibiotic used.

Clindamycin is also used to treat diseases such as malaria . This drug has an antiprotozoal effect as it impairs protein synthesis in these organisms. Of course, clindamycin is one of the components of malaria polytherapy.

There are situations whereclindamycin is used to treat toxoplasmosis and bacterial vaginosis in women .

Clindamycin dosage

Clindamycin can be taken by children from 1 month of age, and its dose depends on the child's weight. However, the administration of clindamycin in solution for infusion to premature babies is very risky as benzyl alcohol is present in the solution for injection.

This compound can cause fatal breathing problems in premature babies and infants. When it comes to oral administration, children under the age of 5 may have difficulty swallowing the film-coated tablet.

In adults and children over 14 years of age, the dose is 800 mg to 1.8 g of clindamycin daily in divided doses.

You should always follow your doctor's instructions, never end the therapy too early or extend it.

Contraindications to the use of clindamycin

Do not administer clindamycin to patients who are allergic to clindamycin or lincomycin.

For patients who are hypersensitive to penicillins, clindamycin may be the optimal alternative. Clindamycin differs in chemical structure from penicillin.

Caution should be exercised when administering clindamycin, but the chance of an anaphylactic shock in such a patient is very small.

Precautions and interactions

Clindamycin should be used with caution in patients with hepatic impairment. Dose reduction is usually not necessary when clindamycin is administered within 8 hours. However, in severe liver failure, it may be necessary to monitor the drug concentration in the patient's blood.

The drug should be carefully administered to a patient who suffers from neuromuscular conduction disorders, e.g. Parkinson's disease or myasthenia gravis.

Clindamycin has an inhibitory effect on neuromuscular conduction. Muscle relaxants should not be used in parallel with clindamycin. If you are undergoing any surgery you should notify the anesthetist that you are taking climamycin.

If you suffer from gastro-intestinal disease, your doctor should prescribe clindamycin with caution. The use of antibiotics increases the risk of inflammation of the gastrointestinal tract, the growth of abnormal bacterial flora in the gut, and pseudomembranous enteritis caused by infection with overgrown bacteria of the species Clostridium difficile.

If symptoms such as bloody diarrhea, fever or abdominal pain occur, the patient should notify the doctor immediately.

Long-term antibiotic therapy, not only in the case of clindamycin, may lead to infections with resistant strains or yeasts. The patient should not make independent decisions about treatment with clindamycin.

If there is no improvement after the recommended treatment time, the physician should make a culture swab in order to establish a targeted therapy.

Clindamycin should not be used to treat viral infections such as influenza or viral pneumonia.

The effectiveness of clindamycin may be reduced when you use clindamycin together with contraceptives. In this case, use additional protection such as a condom during sexual intercourse.

Clindamycin and pregnancy and breastfeeding

When it comes to the use of clindamycin during pregnancy, the FDA classifies clindamycin as a B drug, so if necessary, a pregnant woman can be treated with clindamycin under the supervision of a specialist doctor.

Womenbreastfeeding mothers should wean their baby from the breast in case of treatment with clindamycin. This substance passes into breast milk and may cause diarrhea in the infant.

Side effects of clindamycin

Common side effects include:

  • stomach pains,
  • nausea,
  • vomiting
  • or diarrhea.

Other side effects include:

  • metallic taste in the mouth,
  • joint pain,
  • heartburn,
  • white coating on the tongue, which may suggest a fungal infection in the mouth,
  • rash,
  • itching,
  • difficulty breathing.

The latter may indicate an allergic reaction to the drug and the patient should consult a doctor immediately.

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