Clindamycin

What is clindamycin?

Clindamycin is a lincosamide antibiotic. It is used to treat infections due to susceptible bacteria.

• Skin and soft tissue infections
• Respiratory tract infections
• Bone and joint infections
• Pelvic infections
• Intra-abdominal infections
• Septicaemia and endocarditis
• Dental infections
• Multi-drug resistant Plasmodium falciparum (malaria) infection

Clindamycin can be used topically, orally or intravenously. In New Zealand (July 2017), it is available on prescription. In other countries, it may also be available as a topical foam, vaginal cream and oral suspension.

Clindamycin is quickly absorbed after oral administration, and absorption is not affected by food.

When do dermatologists use clindamycin?

Dermatologists prescribe clindamycin for a variety of skin conditions (skin and soft tissue infection).

Indications for clindamycin solution, gel or lotion include:

• Acne
• Rosacea.

Clindamycin is also available to treat acne in combination with benzoyl peroxide.

Clindamycin vaginal cream is used to treat bacterial vaginosis.

Together with rifampicin, uses for oral clindamycin include:

• Staphylococcal skin infections (cellulitis, impetigo, boils and abscesses)
• Folliculitis decalvans
• Hidradenitis suppurativa
• Folliculitis keloidalis (Acne keloidalis nuchae).

Clindamycin is active against gram-positive organisms (Staphylococcus aureus, Staphylococcus epidermidis, streptococci and Cutibacterium) and gram-negative organisms (Bacteroides species). Susceptible organisms include both aerobic and anaerobic bacteria.

What are the side effects of clindamycin?

Oral clindamycin is generally well tolerated. However, there are significant side effects that may affect some people taking the medicine orally or by injection (they are very rarely seen with the topical preparations).

Gastrointestinal effects

Clindamycin has been associated with pseudomembranous colitis (inflammation of the bowel); this adverse effect is caused by a toxin produced from an overgrowth of a bacterium, Clostridium difficile (also known as Clostridioides difficile). Symptoms can range from mild diarrhea to severe, persistent diarrhoea with fever, abdominal cramps, the passage of blood and mucus, and fatal colitis.

If significant diarrhoea develops while taking clindamycin, the drug should be stopped and medical advice sought. A stool test may show the presence of the toxin. Treatment depends on the severity of symptoms. Stopping the medication may be enough; however, more severe cases may require hospitalisation for intravenous fluid and antibiotic therapy.

Allergic rashes

Drug-induced urticaria, rarely erythema multiforme and anaphylactoid reactions have been reported.

Liver disease

• Jaundice (dark urine, yellow eyes and skin)

Musculoskeletal side effects

• Rarely, polyarthritis (inflammation of several joints) has been reported as an adverse effect.

What are the precautions when prescribed clindamycin?

• The safety of use in pregnancy has not been established.
• Clindamycin has been reported to appear in breast milk but is regarded as safe to use when breastfeeding.
• If antimicrobial therapy is prolonged, liver and renal function tests may be monitored periodically.
• Clindamycin has some known drug interactions such as:
  • may enhance the action of neuromuscular blocking agents.
  • may counteract the effects of erythromycin.

Approved datasheets are the official source of information for medicines, including approved uses, doses, and safety information. Check the individual datasheet in your country for information about medicines.

We suggest you refer to your national drug approval agency such as the Australian Therapeutic Goods Administration (TGA), US Food and Drug Administration (FDA), UK Medicines and Healthcare products regulatory agency (MHRA) / emc, and NZ Medsafe, or a national or state-approved formulary eg, the New Zealand Formulary (NZF) and New Zealand Formulary for Children (NZFC) and the British National Formulary (BNF) and British National Formulary for Children (BNFC).