Clindamycin

·        Chemistry.

·        Pharmacokinetics.

·        Spectrum of activity.

Chemistry

1.       Structurally a lincosamide.

2.       Inhibits protein synthesis by binding to 50S subunit of bacterial ribosomes.

3.       Primarily bacteriostatic.

Pharmacokinetics

1.    Half-life: 3h.

2.       Preparations:

a.       Oral: clindamycin hydrochloride or palmitate hydrochloride.

b.       Parenteral: clindamycin phosphate.

3.       Widely distributed in the body; penetrates well into saliva, sputum, pleural fluid, but not in brain, CSF and eye.

4.    Most of the drug is metabolized to N-desmethylclindamycin and clindamycin sulphoxide.

5.       Excreted in the bile and urine (10% unchanged).

Adverse reactions

1.       Diarrhea: 7% of patients treated with clindamycin.

2.    Skin rashes: 10% of patients treated with clindamycin.

3.       Pseudomembranous colitis:

a.       Characterized by: diarrhoea, abdominal pain, fever, blood and mucus in stool.

b.    Due to the exotoxin produced by Clostridium difficile.

c.    This complication may be potentially fatal if not treated.

d.       Treatment: discontinuation of drug and treat with vancomycin orally or metronidazole.

Spectrum of antimicrobial activity

Therapeutic indications

1.       Staphylococcal bone and joint infections.

2.       Dental infections.

3.       Abdominal sepsis.

4.    Non-sexually transmitted infection of the genital tract in women.