ADMINISTRATION ROUTES:
IV, PO, NG
ALTERNATIVE NAMES:
Dalacin, Clinda
ICU INDICATIONS:
- Treatment of infections caused by susceptible organisms (particularly Streptococcal or Staphylococcal toxic shock syndrome)
PRESENTATION AND ADMINISTRATION:
IV:
Vial of 600 mg in 4 mL solution. Add required dose to compatible IV fluid as shown in the table and administer over the stated time:
| Dose | Volume of IV fluid | Time for administration |
|---|---|---|
| 300 mg | 50 mL | 10 minutes |
| 600 mg | 50 mL | 20 minutes |
| 900 mg | 100 mL | 30 minutes |
| 1200 mg | 100 mL | 40 minutes |
Infusion rate not to exceed 30 mg/min. Administration of more than 1200 mg in one hour is not recommended. Stable at room temperature for 24 hours after dilution.
Compatible with the following IV fluids: Normal saline, 5% dextrose, 10% dextrose, Glucose and Sodium chloride, Hartmanns
IM:
Not used by this route in ICU patients
PO::
Dalacin C 150 mg tablets
To avoid oesophageal irritation, should be taken with a full glass of water
DOSAGE:
IV:
600 mg QID
PO:
300-450 mg QID
DOSAGE IN RENAL FAILURE AND RENAL REPLACEMENT THERAPY:
Dose as in normal renal function
DOSAGE IN PAEDIATRICS: IV:
10-20 mg/kg TDS
PO:
5-8 mg/kg TDS
CLINICAL PHARMACOLOGY:
Clindamycin inhibits bacterial protein synthesis by binding to the 50S subunit of the ribosome. It has activity against Gram-positive aerobes and anaerobes as well as the Gram-negative anaerobes. Clindamycin is bacteriostatic. Clindamycin has been shown to be active against most of the isolates of the following microorganisms, both in vitro and in clinical infections
Gram-Positive Aerobes
- Staphylococcus aureus (methicillin-susceptible strains)
- Streptococcus pneumoniae (penicillin-susceptible strains)
- Streptococcus pyogenes
Anaerobes
- Prevotella melaninogenica
- Fusobacterium necrophorum
- Fusobacterium nucleatum
- Peptostreptococcus anaerobius
- Clostridium perfringens
CONTRAINDICATIONS:
- Hypersensitivity to preparations containing clindamycin or lincomycin
WARNINGS:
Anaphylaxis:
Clindamycin may cause serious allergic reactions including anaphylaxis
Pseudomembranous colitis:
Pseudomembranous colitis has been reported with nearly all antibacterial agents, including clindamycin, and may range in severity from mild to life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhoea subsequent to the administration of antibacterial agents. Because clindamycin therapy has been associated with severe colitis which may end fatally, it should be reserved for serious infections where less toxic antimicrobial agents are inappropriate
Usage in Meningitis:
Since clindamycin does not diffuse adequately into the cerebrospinal fluid, the drug should not be used in the treatment of meningitis
PRECAUTIONS:
General:
Prescribing clindamycin in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria
Laboratory Tests:
No tests in addition to routine ICU tests are indicated
Drug/Laboratory Test Interactions:
None noted
IMPORTANT DRUG INTERACTIONS IN ICU:
Clindamycin has been shown to have neuromuscular blocking properties that may enhance the action of other neuromuscular blocking agents. Therefore, it should be used with caution in patients receiving such agents.
Antagonism has been demonstrated between clindamycin and erythromycin in vitro. Because of possible clinical significance, the two drugs should not be administered concurrently
ADVERSE REACTIONS:
Body as a whole:
Anaphylaxis
Gastrointestinal system:
Metallic taste, jaundice and abnormalities in liver function tests, oesophageal irritation, diarrhoea
Haematological system:
Transient neutropaenia (leukopaenia), eosinophilia, agranulocytosis and thrombocytopaenia
Cardiovascular system:
Rare instances of cardiopulmonary arrest and hypotension have been reported following too rapid intravenous administration