2010/06/09

Clindamycin

International name:
Clindamycin (Clindamycin)

Group Affiliation:
Antibiotic Lincosamides

Description of the active substance (INN):
Clindamycin

Dosage form:
granules for syrup, capsule, solution for intravenous and intramuscular

Mode of action:
Antibiotic group Lincosamides. It has a wide spectrum of activity, bakteriostatik, binds to the 50S ribosomal subunit of the membrane and inhibits protein synthesis in the microbial cell. In a number of gram-positive cocci may bactericidal action. It is active against Staphylococcus spp. (Including Staphylococcus epidermidis, penicillinase-producing), Streptococcus spp. (Except Enterococcus spp), Streptococcus pneumoniae, Corynebacterium diphtheriae, spore and asporogenous anaerobes and microaerophilic gram positive cocci (including Peptococcus spp. And Peptostreptococcus spp.), Clostridium perfringens, Clostridium tetani, Mycoplasma spp., Bacteroides spp. (Including Bacteroides fragilis and Prevotella melaninogenica), Fusobacterium spp., Propionibacterium spp., Eubacter spp., Actinomyces spp. Most strains of Clostridium perfringens susceptible to clindamycin, however, since other types of clostridia (Clostridium sporogenes, Clostridium tertium) resistant to clindamycin , then with infections caused by Clostridium spp., recommended definition antibiotikogrammy. Clinically ineffective against Mycoplasma pneumoniae, Haemophilus influenzae, Helibacter pylori, Neisseria meningitidis, Neisseria gonorrhoeae, Ureaplasma urealyticum. between clindamycin and lincomycin there cross-resistance. It is effective for the treatment of asymptomatic carriers of diphtheria (one-week course of therapy, oral).

Indications:
Bacterial infections caused by susceptible organisms: infections of the ENT organs (including tonsillitis, pharyngitis, sinusitis, otitis media), infections of the respiratory system (bronchitis, pneumonia, lung abscess, empyema, fibrosing alveolitis), infections of bones and joints ( osteomyelitis, septic arthritis), abscesses of skin and soft tissue (including acne, boils, abscess, impetigo, whitlow, infected wounds, abscesses, erysipelas), sepsis (especially anaerobic) infections of the pelvic organs, and intraabdominal infection ( including peritonitis, abscesses of the abdominal cavity with the simultaneous use of drugs, active against gram-negative aerobic microbes), gynecological diseases (endometritis, adnexitis, colpitis, abscesses of the fallopian tubes and ovaries, salpingitis, pelvioperitonit) infection of oral cavity (in including periodontal abscess), Toxoplasma encephalitis, malaria (caused by Plasmodium falciparum), pneumonia (caused by Pneumocystis carinii), sepsis, endocarditis, chlamydia, scarlet fever, diphtheria.

Contraindications:
Hypersensitivity, children's age (up to 1 month). C care. Myasthenia gravis, asthma, ulcerative colitis (in history), severe renal and / or hepatic insufficiency, pregnancy, lactation.

Side effects:
Of the nervous system: rarely - a violation of neuromuscular conduction. On the part of the digestive system: stomach pain, nausea, diarrhea, vomiting, esophagitis, pseudomembranous enterocolitis, hepatotoxicity, hyperbilirubinemia, jaundice, dysbacteriosis. From the side of hematopoiesis: leukopenia, neutropenia, agranulocytosis, thrombocytopenia. On the part of the SSA: the rapid i / v administration - lowering blood pressure, until the collapse. Allergic reactions: seldom - maculopapular rash, urticaria, pruritus, and in some cases - and exfoliative dermatitis vezikulobullezny, eosinophilia, anaphylactoid reactions. Local reaction : pain (in place of i / m injection), thrombophlebitis (where i / v injection). Other: the development of superinfection.

Dosage and administration:
Inside, adults: 150 mg every 6 hours, in severe infections single dose may be increased to 300-450 mg. Children: 8-25 mg / kg / day (depending on the severity of infection), divided into 3-4 reception. When treating obesity, caused by Chlamydia trachomatis, appoint 450 mg 4 times daily for 10-14 days. / m or / v: adults - 300 mg 2 times a day. In moderate infections - 150-300 mg 2-4 times a day, in severe infections - 1.2-2.7 g / day for 2-4 introduction. In life-threatening infections in / dose may be increased to 4.8 g / day. Children appoint 10-40 mg / kg / day, divided into 3-4 reception. For iv administration to throw until the concentration no higher than 6 mg / ml diluted solution is introduced in / infusion over 10-60 min. dilution scheme and the duration of infusion: dose, volume of solvent and the duration of infusion (respectively): 300 mg - 50 ml - 10 min, 600 mg - 100 ml - 20 min , 900 mg - 150 ml - 30 min, 1200 mg - 200 ml - 45 min. We do not recommend the introduction of more than 1.2 g for 1 h infusion. The solution is used within 24 hours after cooking. In the treatment of colitis caused by Clostridium difficile, once appropriate to combine assignment with vancomycin for 10 days at 500 mg - 2 g per day, divided into 3 or 4 equal doses. Patients with severe renal / hepatic failure require dosage adjustment.

Cautions:
Pseudomembranous colitis may occur against the background of receiving clindamycin, and 2-3 weeks after cessation of treatment (3-15% of cases) manifested by diarrhea, leukocytosis, fever, abdominal pain (sometimes accompanied with the release of faecal mass of blood and mucus). If you experience these effects in mild cases rather discontinuation of treatment and application of ion exchange resins (kolestiramin, colestipol), in severe cases showed recovery of loss of fluid, electrolytes and protein, the appointment of vancomycin at a dose of 125-500 mg 4 times per day, or bacitracin in a dose of 25 tys.ED 4 times / day for 7-10 days, or metronidazole 500 mg 3 times / day. Do not use drugs which inhibit intestinal motility. Safety of the drug in neonates is not established. Solution contains benzyl alcohol, which can lead to asphyxiation syndrome in preterm infants. In "real life" testimony newborn appoint a dose of 15-20 mg / kg / day in 3-4 receiving, in some cases it may be efficient and smaller dose. During prolonged therapy of children requires periodic monitoring of the blood and liver functional state. In the appointment of the drug in high doses is necessary to monitor the concentration of clindamycin in plasma. There should be appointed for the treatment of meningitis. Quick to / in the introduction may lead to the development of acute left ventricular failure and lower blood pressure.

Interaction:
Incompatible with solutions containing a complex of vitamins B, aminoglycosides, ampicillin, phenytoin, barbiturates, aminophylline, calcium gluconate and magnesium sulfate. Shows antagonism with erythromycin and chloramphenicol. Enhances the action of competitive muscle relaxants. With simultaneous use of opioid (narcotic) analgesics may be caused by increased of respiratory depression (up to apnea). Simultaneous with the appointment of antidiarrhoeal drugs that reduce gastrointestinal motility, increases the risk of pseudomembranous colitis. Aminoglycosides broaden the spectrum of antimicrobial action; increases (relatively) the effect of rifampicin.