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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, it is available as:

• Topicil™ topical solution
• Dalacin C™ capsule
• Dalacin C™ phosphate injection solution

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

When do dermatologists use clindamycin?

Clindamycin is prescribed by dermatologists for a variety of skin conditions.

Indications for clindamycin solution, gel or lotion include:

• Acne
• Rosacea

Together with rifampicin, uses for oral clindamycin include:

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

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

Side Effects

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

Gastrointestinal

Clindamycin has been associated with colitis (inflammation of the bowel); this is caused by a toxin produced from an overgrowth of a bacterium, Clostridium difficile. Symptoms can range from mild watery diarrhoea to severe, persistent diarrhoea with fever, abdominal cramps and the passage of blood and mucus. It may be potentially serious. If significant diarrhoea develops whilst taking clindamycin, the drug should be stopped. A stool test may show the presence of the toxin. Treatment depends on the severity of symptoms. Stopping the drug may be enough; however, more severe cases may require hospitalisation for intravenous fluid and antibiotic treatment.

Allergic rashes

Hives, rarely erythema multiforme and anaphylactoid reactions have been reported.

Liver

Jaundice (dark urine, yellow eyes and skin).

Musculoskeletal

Rarely polyarthritis (inflammation of several joints) has been reported.

Precautions

• The safety of use in pregnancy has not been established.
• Clindamycin has been reported to appear in breast milk.
• If therapy is prolonged, liver and renal function tests may be monitored periodically.
• May enhance the action of neuromuscular blocking agents.
• May counteract the effects of erythromycin.