Clindamycin

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The antibiotic clindamycin inhibits the growth and reproduction of bacteria. It is therefore used to treat certain bacterial infections. The active ingredient is produced semi-synthetically and belongs to the so-called lincosamide antibiotics. It is suitable for patients with a penicillin allergy. Here you can read everything you need to know about clindamycin.

This is how clindamycin works

Clindamycin inhibits the ability of bacteria to produce proteins. Since proteins are extremely important for the construction of bacterial cells, the antibiotic prevents the growth and reproduction of the bacteria.

Clindamycin works well against staphylococci (gram-positive bacteria) and anaerobes (germs that grow in an oxygen-free environment).

Uptake, breakdown and excretion

Clindamycin is well absorbed into the body through the gastrointestinal tract when given by mouth. Administration into a venous blood vessel or into a skeletal muscle using a syringe and cannula is also possible.

Most of the active ingredient is metabolized by the liver and then excreted in the stool. A small part leaves the body unchanged with the urine.

Clindamycin can also be used externally. In the form of a vaginal cream or gel, the antibiotic inhibits bacterial growth at the site of application.

When is clindamycin used?

Since clindamycin is well tissue-permeable and, among other things, accumulates in bone tissue, it is used for infections of the bones and joints (e.g. osteomyelitis, septic arthritis) and infections of the tooth and jaw area.

Further areas of application (indications) of the antibiotic are:

• Ear, nose and throat infections (e.g. acute otitis media, sinus infections, tonsillitis and throat infections)
• Infections of the pelvic and abdominal area and the female genital organs (e.g. vaginal inflammation)
• Soft tissue infections

This is how clindamycin is used

Internal application

Clindamycin tablets or capsules are taken with plenty of fluids with or without food. A ready-to-use suspension (liquid with partially insoluble components) must be prepared from a clindamycin dry juice before the first use. This is usually done at the pharmacy. If the dry juice is not needed immediately (e.g.because you take it with you on vacation), you can also make the suspension yourself:

To do this, cold, previously boiled water is added to below the mark on the bottle. The bottle is closed and gently shaken until the granules have completely dissolved. As soon as the foam has completely settled, you fill up again exactly up to the mark. The ready-to-use suspension should be shaken well before each use and should not be stored above 25 degrees.

The daily dose depends on the type and severity of the infection. Generally between 0.6 and 1.8 grams of clindamycin - divided into three to four doses. The duration of use also depends on the type of infection and the course of the disease and is therefore determined by the doctor.

External use

A clindamycin vaginal cream is placed in the vagina with an applicator. Treatment should be given at bedtime and not started during menstruation.

Clindamycin gel is applied thinly to the diseased skin areas and should not come into contact with the eyes or mucous membranes.

What are the side effects of clindamycin?

Clindamycin can cause diarrhea, especially when taken by mouth. The reason is that the antibiotic promotes the multiplication of a certain bacterium in the intestine, which produces a toxin that damages the intestinal lining.

In some patients, this can lead to colon inflammation, which is accompanied by fever, severe diarrhea with blood build-up, abdominal cramps and nausea. If diarrhea occurs, the antibiotic should therefore be discontinued as a precaution and a doctor should be consulted.

More than one percent of patients using clindamycin have a slight, temporary increase in certain liver enzymes (serum transaminases). After administration through a venous blood vessel, pain and inflammation of the veins with subsequent blood clots (thrombophlebitis) may occur.

When applied to the skin, clindamycin can cause side effects such as dry skin, reddening of the skin, burning sensation and itching.

What should be considered when using clindamycin?

Contraindications

Clindamycin must not be used in case of hypersensitivity to clindamycin or lincomycin.

In patients with impaired liver function, disorders of the signal transmission from nerves to muscles (e.g. myasthenia gravis, Parkinson's disease) and with a history of gastrointestinal diseases (e.g. inflammation of the colon), particular caution is required when using the antibiotic.

Interactions

The antibiotic can make the contraceptive pill less effective. As a precaution, mechanical contraception should therefore be used during treatment (e.g. with condoms).

Simultaneous intake of clindamycin and macrolide antibiotics (such as erythromycin, clarithromycin, azithromycin or roxithromycin) does not make sense, as both active ingredients work in the same way and thus weaken each other's effects.

Due to the similar mechanism of action, there may also be cross-resistance with macrolide antibiotics. Cross-resistance means that (resistant) germs that are insensitive to macrolide antibiotics are also insensitive to clindamycin and vice versa.

Clindamycin may increase the effects of muscle relaxants (medicines that cause the skeletal muscles to relax temporarily) because the antibiotic also relaxes muscles. Therefore, the dosage of the muscle relaxants may be adjusted accordingly by the doctor.

Clindamycin is broken down by the enzyme CYP3A4. Other drugs that strongly stimulate the enzyme activity of CYP3A4 (including rifampicin, phenytoin, phenobarbital, some HIV drugs) can thus limit the effectiveness of clindamycin.

pregnancy and breast feeding period

Clindamycin is a reserve antibiotic used in pregnancy. It should only be used when more suitable alternatives are out of the question.

If possible, other antibiotics such as penicillins, cephalosporins and macrolides should also be preferred during breastfeeding. If clindamycin is absolutely indicated, the patient can continue to breastfeed.

This is how you get drugs with the active ingredient clindamycin

Preparations with clindamycin require a prescription in Germany, Austria and Switzerland and are only available with a prescription in pharmacies.

How long has clindamycin been known?

Clindamycin is chemically closely related to lincomycin, which is produced by certain bacteria (Streptomyces lincolnensis) is produced and was discovered in the 1950s. The discovery was made in soil cultures near the city of Lincoln, Nebraska (hence the name lincomycin).

Clindamycin is obtained from lincomycin through a chemical reaction. Compared to this, it is more effective and is better absorbed into the body. Clindamycin has been on the market since 1968.

What else you should know about clindamycin

Since clindamycin changes the natural colonization of germs in the intestine, diarrhea can occur. As a preventive measure, preparations with special medicinal yeast (e.g. Saccharomyces cerevisiae) can be taken.

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