BMA Concise Guide to Medicine & Drugs

Clindamycin

Brand names Dalacin, Dalacin C, Dalacin T, Zindaclin

Used in the following combined preparation Duac Once Daily

QUICK REFERENCE

Drug group Antibiotic

Overdose danger rating Low

Dependence rating Low

Prescription needed Yes

Available as generic Yes

GENERAL INFORMATION

Clindamycin is an antibiotic that is effective against a broad range of bacteria. This, combined with the fact that the drug reaches good concentrations in the bones and skin, makes it especially useful for treating diseases such as the bone infection osteomyelitis and the skin infections erysipelas and cellulitis. Clindamycin is also effective against protozoa, such as those causing toxoplasmosis and falciparum malaria. However, clindamycin may cause proliferation of other bacteria such as Clostridium difficile, especially in the intestines when the drug is used in oral or intravenous forms. Clindamycin-induced Clostridium difficile diarrhoea is a serious, and sometimes life-threatening side effect, which limits the use of this antibiotic. For this reason the drug should be used under specialist supervision and avoided in the elderly. Clindamycin may also be used topically for acne as well as vulval and vaginal infections.

INFORMATION FOR USERS

Your drug prescription is tailored for you. Do not alter dosage without checking with your doctor.

How taken/used Capsules, injection, topical solution, vaginal cream.

Frequency and timing of doses 4 x daily with plenty of water (capsules); 2–4 x times daily (injection); 1–2 x daily (topical solution or vaginal cream).

Adult dosage range 600mg–1.8g daily (capsules); 0.6–4.8g daily in divided doses (injection); 5g daily (vaginal cream): 1 pre-prepared applicator daily (topical solution).

Onset of effect 1 hour.

Duration of action 6 hours.

Diet advice None.

Storage Keep in original container at room temperature out of the reach of children.

Missed dose Take as soon as you remember, and take your next dose as usual.

Stopping the drug Take the full course. Even if you feel better the original infection may still be present, and symptoms may recur if treatment is stopped too soon.

Exceeding the dose An occasional unintended extra dose is unlikely to cause problems. Large overdoses may cause nausea or, in rare cases, seizures. Notify your doctor immediately.

POSSIBLE ADVERSE EFFECTS

Most side effects are rare. A rash and/or itching are the only likely adverse reactions to the topical solution or vaginal cream; if either of these does occur, discuss with your doctor. You should also consult your doctor if you are taking the drug in oral or injected form and it causes severe nausea or a hypersensitivity reaction (which may produce a range of allergy-like symptoms). Rarely, clindamycin may cause jaundice; if so, stop taking the drug and consult your doctor. The most serious side effect of the drug is Clostridium difficile diarrhoea, which may be life-threatening. You should therefore report any diarrhoea to your doctor immediately and stop taking the drug.

INTERACTIONS

General note Interactions are unlikely with the topical solution and vaginal cream.

Warfarin Clindamycin may alter the effectiveness of warfarin.

Pyridostigmine and neostigmine Clindamycin reduces the effectiveness of these drugs.

Oral typhoid vaccine Clindamycin may make this vaccine less effective if taken at the time of vaccination.

SPECIAL PRECAUTIONS

Be sure to tell your doctor if:

· You have a history of antibiotic-associated or Clostridium difficile diarrhoea.

Pregnancy Not known to be harmful unless taken within 48 hours of delivery. Discuss with your doctor.

Breast-feeding The drug passes into the breast milk, but at normal doses adverse effects on the baby are unlikely. Discuss with your doctor.

Infants and children Reduced dose necessary.

Over 60 Not recommended.

Driving and hazardous work No special problems.

Alcohol No special problems.

PROLONGED USE

No major problems with the topical solution or vaginal cream. Oral and injected forms of the drug carry an ongoing risk of Clostridium difficile diarrhoea.