My watch list
my.chemeurope.com  
Login  

Clindamycin



Clindamycin
Systematic (IUPAC) name
(2S,4R)-N-((1R)-2-chloro-
1-((3R,4R,5S,6R)-3,4,5-trihydroxy-
6-(methylthio)-tetrahydro-2H-pyran-2-yl)propyl)-
1-methyl-4-propylpyrrolidine-2-carboxamide
Identifiers
CAS number 18323-44-9
ATC code J01FF01 D10AF01 G01AA10
PubChem 29029
DrugBank APRD00566
Chemical data
Formula C18H33ClN2O5S 
Mol. mass 424.98 g/mol
Synonyms 7-chloro-lincomycin
7-chloro-7-deoxylincomycin
Pharmacokinetic data
Bioavailability 90% (oral)
4–5% (topical)
Protein binding 90%
Metabolism Hepatic
Half life 2–3 hours
Excretion Biliary and renal (around 20%)
Therapeutic considerations
Pregnancy cat.

A(AU) B(US)

Legal status

Prescription Only (S4)(AU) POM(UK) -only(US)

Routes Oral, topical, IV, intravaginal

Clindamycin (rINN; pronounced /klɪndəˈmaɪsɨn/) is a lincosamide antibiotic. It is usually used to treat infections with anaerobic bacteria but can also be used to treat some protozoal diseases, such as malaria. It is a common topical treatment for acne, and can be useful against some methicillin-resistant Staphylococcus aureus (MRSA) infections.[1]

The most severe common adverse effect of clindamycin is Clostridium difficile-associated diarrhea (the most frequent cause of pseudomembranous colitis). Although this side-effect occurs with almost all antibiotics, including beta-lactam antibiotics, it is classically linked to clindamycin use.[2]

Clindamycin is marketed alone and in combination with other drugs under various trade names, including Dalacin and Cleocin (manufactured by Pfizer), and in a foam as Evoclin (Connetics) and Duac (with benzoyl peroxide, made by Stiefel). It is also available as a generic drug.

Contents

Indications

Clindamycin is used primarily to treat infections caused by susceptible anaerobic bacteria, including infections of the respiratory tract, septicemia and peritonitis.[3] In patients with hypersensitivity to penicillins, clindamycin may be used to treat infections caused by susceptible aerobic bacteria as well. It is also used to treat bone and joint infections, particularly those caused by Staphylococcus aureus.[4][3] Topical application of clindamycin phosphate can be used to treat mild to moderate acne.[5]

Combination therapy in acne

Multiple studies have shown the use of clindamycin in conjunction with benzoyl peroxide, which is available both through prescription or over-the-counter, to be more effective in the treatment of acne than the use of either product by itself.[6][7][8] A single-blind study comparing this combination to adapalene, a retinoid, also found it to work faster and be significantly better tolerated than adapalene, as well as more effective.[9]

Clindamycin and adapalene in combination are also more effective than either drug alone, although adverse effects are more frequent;[10] a single study found pretreatment with adapalene (application of adapalene 3–5 minutes before clindamycin) to significantly increase the penetration of clindamycin into the skin, which may enhance efficacy.[11]

Malaria

Given with chloroquine or quinine, clindamycin is effective and well-tolerated in treating Plasmodium falciparum malaria; the latter combination is particularly useful for children, and is the treatment of choice for pregnant women who become infected in areas where resistance to chloroquine is common.[12][13] Clindamycin should not be used as an antimalarial by itself, although it appears to be very effective as such, because of its slow action.[12][13]

Other uses

Clindamycin is used in cases of suspected toxic shock syndrome,[14] often in combination with a bactericidal agent such as vancomycin. The rationale for this approach is a presumed synergy between the bactericidal antibiotic, which causes the death of the bacteria by breakdown of the cell membrane, and clindamycin, which is a powerful inhibitor of toxin synthesis. Both in vitro and in vivo studies have shown that clindamycin reduces the production of exotoxins by staphylococci;[15] it may also induce changes in the surface structure of bacteria that make them more sensitive to immune system attack (opsonization and phagocytosis).[16][17]

It can also be useful in skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus (MRSA);[1] many strains of MRSA are still susceptible to clindamycin.

Clindamycin has been proven to decrease the risk of premature births in women diagnosed with bacterial vaginosis during early pregnancy to about a third of the risk of untreated women.[18]

The combination of clindamycin and quinine is the standard treatment for severe babesiosis.[19] Clindamycin may also be used to treat toxoplasmosis,[20][21][22] and, in combination with primaquine, is effective in treating mild to moderate Pneumocystis jirovecii pneumonia.[23]

Susceptible bacteria

It is most effective against infections involving the following types of organisms:

  • Aerobic gram-positive cocci, including some members of the Staphylococcus and Streptococcus (eg. pneumococcus) genera.
  • Anaerobic, gram-negative rod-shaped bacteria, including some species of Bacteroides and Fusobacterium.

Most aerobic gram-negative bacteria (such as Pseudomonas, Legionella, Haemophilus influenzae and Moraxella), as well as the facultative anaerobic Enterobacteriaceae, are resistant to clindamycin.[20][24]

Available forms

Clindamycin preparations for oral administration include capsules (containing clindamycin hydrochloride) and oral suspensions (containing clindamycin palmitate hydrochloride). It is also available for topical administration, in gel form and in a foam delivery system (both containing clindamycin phosphate), primarily as a prescription acne treatment. It is also available in the form of vaginal suppositories, in combination with Clotrimazole IP, as in India, sold as "Clinsup-V" and is manufactured by Olive Health Care. The combination of clindamycin and benzoyl peroxide in a single product is also available, as is (in the United States) a combination of clindamycin and tretinoin, sold as Ziana.[25]

Clindamycin is available as a generic drug, for both systemic (oral and intravenous) and topical use.

Adverse effects

Common adverse drug reactions (ADRs) associated with clindamycin therapy—found in over 1% of patients—include: diarrhea, pseudomembranous colitis, nausea, vomiting, abdominal pain or cramps, rash, and/or itch. High intravenous doses may cause a metallic taste, and topical application may cause contact dermatitis.[26]

Pseudomembranous colitis is a potentially-lethal condition commonly associated with clindamycin, but which also occurs with other antibiotics.[27][2] Overgrowth of Clostridium difficile, which is inherently resistant to clindamycin, results in the production of a toxin that causes a range of adverse effects, from diarrhea to colitis and toxic megacolon.[26]

Rarely—in less than 0.1% of patients—clindamycin therapy has been associated with anaphylaxis, blood dyscrasias, polyarthritis, jaundice, raised liver enzyme levels and/or hepatotoxicity.[26]

Chemistry

Clindamycin is a semisynthetic derivative of lincomycin, a natural antibiotic produced by the actinobacterium Streptomyces lincolnensis. It is obtained by 7(S)-chloro-substitution of the 7(R)-hydroxyl group of lincomycin.[28]

Pharmacology

Pharmacokinetics

Approximately 90% of an oral dose of clindamycin is absorbed from the gastrointestinal tract and it is widely distributed throughout the body, excluding the central nervous system. Adequate therapeutic concentrations can be achieved in bone. There is also active uptake into white blood cells, most importantly neutrophils.[29]

Clindamycin is extensively metabolised in the liver, probably by CYP3A4;[30][31] some of its metabolites are active, such as N-dimethyl clindamycin and clindamycin sulfoxide. The elimination half-life is 1.5 to 5 hours. Clindamycin is primarily eliminated by hepatic metabolism; after an intravenous dose of clindamycin phosphate, about 4.5% of the dose is excreted in urine as clindamycin and about 0.35% as the phosphate salt.[32] The metabolites are excreted primarily in the urine.[33]

Mechanism of action

Clindamycin has a bacteriostatic effect. It interferes with bacterial protein synthesis (in a similar way to erythromycin, azithromycin and chloramphenicol), by binding preferentially to the 50S subunit of the bacterial ribosome.[20]

The structures of the complexes between several antibiotics (including clindamycin) and a Deinococcus radiodurans ribosome have been solved by X-ray crystallography by a team from the Max Planck Working Groups for Structural Molecular Biology, and published in the journal Nature.[34]

Interactions

Clindamycin may prolong the effects of neuromuscular-blocking drugs.[35][36][37][38] Its similarity to the mechanism of action of macrolides and chloramphenicol means they should not be given simultaneously, as this causes antagonism[24] and possible cross-resistance.

Veterinary use

The veterinary uses of clindamycin are quite similar to its human indications, and include treatment of osteomyelitis,[39] skin infections, and toxoplasmosis, for which it is the drug of choice in dogs and cats.[40] Toxoplasmosis rarely causes symptoms in cats, but can do so in very young or immunocompromised kittens and cats. Toxoplasmosis is contagious to humans, and therefore cat owners, particularly pregnant women, should take precautions to prevent the spread of the disease.

References

  1. ^ a b Daum RS (2007). "Clinical practice. Skin and soft-tissue infections caused by methicillin-resistant Staphylococcus aureus". N Engl J Med 357 (4): 380–90. doi:10.1056/NEJMcp070747. PMID 17652653.
  2. ^ a b Thomas C, Stevenson M, Riley TV (2003). "Antibiotics and hospital-acquired Clostridium difficile-associated diarrhoea: a systematic review". J Antimicrob Chemother 51 (6): 1339–50. doi:10.1093/jac/dkg254. PMID 12746372. Free full text
  3. ^ a b Cleocin I.V. Indications & Dosage. RxList.com (2007). Retrieved on 2007-12-01.
  4. ^ Darley ES, MacGowan AP (2004). "Antibiotic treatment of gram-positive bone and joint infections". J Antimicrob Chemother 53 (6): 928–35. doi:10.1093/jac/dkh191. PMID 15117932. Free full text
  5. ^ Feldman S, Careccia RE, Barham KL, Hancox J (2004). "Diagnosis and treatment of acne". Am Fam Physician 69 (9): 2123–30. PMID 15152959. Free full text
  6. ^ Cunliffe WJ, Holland KT, Bojar R, Levy SF (2002). "A randomized, double-blind comparison of a clindamycin phosphate/benzoyl peroxide gel formulation and a matching clindamycin gel with respect to microbiologic activity and clinical efficacy in the topical treatment of acne vulgaris". Clin Ther 24 (7): 1117–33. PMID 12182256.
  7. ^ Leyden JJ, Berger RS, Dunlap FE, Ellis CN, Connolly MA, Levy SF (2001). "Comparison of the efficacy and safety of a combination topical gel formulation of benzoyl peroxide and clindamycin with benzoyl peroxide, clindamycin and vehicle gel in the treatments of acne vulgaris". Am J Clin Dermatol 2 (1): 33–9. PMID 11702619.
  8. ^ Lookingbill DP, Chalker DK, Lindholm JS, et al (1997). "Treatment of acne with a combination clindamycin/benzoyl peroxide gel compared with clindamycin gel, benzoyl peroxide gel and vehicle gel: combined results of two double-blind investigations". J Am Acad Dermatol 37 (4): 590–5. PMID 9344199.
  9. ^ Langner A, Chu A, Goulden V, Ambroziak M (2007). "A randomized, single-blind comparison of topical clindamycin + benzoyl peroxide and adapalene in the treatment of mild to moderate facial acne vulgaris". Br J Dermatol. doi:10.1111/j.1365-2133.2007.08308.x. PMID 18047518.
  10. ^ Wolf JE, Kaplan D, Kraus SJ, et al (2003). "Efficacy and tolerability of combined topical treatment of acne vulgaris with adapalene and clindamycin: a multicenter, randomized, investigator-blinded study". J Am Acad Dermatol 49 (3 Suppl): S211–7. PMID 12963897.
  11. ^ Jain GK, Ahmed FJ (2007). "Adapalene pretreatment increases follicular penetration of clindamycin: in vitro and in vivo studies". Indian J Dermatol Venereol Leprol 73 (5): 326–9. PMID 17921613. Free full text
  12. ^ a b Lell B, Kremsner PG (2002). "Clindamycin as an antimalarial drug: review of clinical trials". Antimicrob Agents Chemother 46 (8): 2315–20. PMID 12121898. Free full text
  13. ^ a b Griffith KS, Lewis LS, Mali S, Parise ME (2007). "Treatment of malaria in the United States: a systematic review". JAMA 297 (20): 2264–77. doi:10.1001/jama.297.20.2264. PMID 17519416. Free full text
  14. ^ Annane D, Clair B, Salomon J (2004). "Managing toxic shock syndrome with antibiotics". Expert Opin Pharmacother 5 (8): 1701–10. doi:10.1517/14656566.5.8.1701. PMID 15264985.
  15. ^ Coyle EA, Society of Infectious Diseases Pharmacists (2003). "Targeting bacterial virulence: the role of protein synthesis inhibitors in severe infections. Insights from the Society of Infectious Diseases Pharmacists". Pharmacotherapy 23 (5): 638–42. PMID 12741438. Free full text with registration at Medscape
  16. ^ Gemmell CG, O'Dowd A (1983). "Regulation of protein A biosynthesis in Staphylococcus aureus by certain antibiotics: its effect on phagocytosis by leukocytes". J Antimicrob Chemother 12 (6): 587–97. PMID 6662837.
  17. ^ Gemmell CG, Peterson PK, Schmeling D, et al (1981). "Potentiation of opsonization and phagocytosis of Streptococcus pyogenes following growth in the presence of clindamycin". J Clin Invest 67 (5): 1249–56. PMID 7014632. Full text at PMC: 370690.
  18. ^ Lamont RF (2005). "Can antibiotics prevent preterm birth--the pro and con debate". BJOG 112 Suppl 1: 67–73. doi:10.1111/j.1471-0528.2005.00589.x. PMID 15715599.
  19. ^ Homer MJ, Aguilar-Delfin I, Telford SR, Krause PJ, Persing DH (2000). "Babesiosis". Clin Microbiol Rev 13 (3): 451–69. PMID 10885987. Free full text
  20. ^ a b c Lincosamides, Oxazolidinones, and Streptogramins. Merck Manual of Diagnosis and Therapy. Merck & Co., Inc. (November 2005). Retrieved on 2007-12-01.
  21. ^ Pleyer U, Torun N, Liesenfeld O (2007). "[Ocular toxoplasmosis]" (in German). Ophthalmologe 104 (7): 603–15, quiz 616. doi:10.1007/s00347-007-1535-8. PMID 17530262.
  22. ^ Jeddi A, Azaiez A, Bouguila H, et al (1997). "[Value of clindamycin in the treatment of ocular toxoplasmosis]" (in French). J Fr Ophtalmol 20 (6): 418–22. PMID 9296037.
  23. ^ Fishman JA (1998). "Treatment of infection due to Pneumocystis carinii". Antimicrob Agents Chemother 42 (6): 1309–14. PMID 9624465. Free full text
  24. ^ a b Bell EA (January 2005). Clindamycin: new look at an old drug. Infectious Diseases in Children. Retrieved on 2007-12-01.
  25. ^ Waknine, Yael (December 1 2006). FDA Approvals: Ziana, Kadian, Polyphenon E (free registration required). Medscape. Retrieved on 2007-12-01.
  26. ^ a b c Rossi S, editor. Australian Medicines Handbook 2006. Adelaide: Australian Medicines Handbook; 2006.
  27. ^ Starr J (2005). "Clostridium difficile associated diarrhoea: diagnosis and treatment". BMJ 331 (7515): 498–501. doi:10.1136/bmj.331.7515.498. PMID 16141157. Free full text
  28. ^ Meyers BR, Kaplan K, Weinstein L (1969). "Microbiological and pharmacological behavior of 7-chlorolincomycin". Appl Microbiol 17 (5): 653–7. PMID 4389137. Full text at PMC: 377774
  29. ^ Klempner MS, Styrt B (1981). "Clindamycin uptake by human neutrophils". J. Infect. Dis. 144 (5): 472–9. PMID 6171600.
  30. ^ Wynalda MA, Hutzler JM, Koets MD, Podoll T, Wienkers LC (2003). "In vitro metabolism of clindamycin in human liver and intestinal microsomes". Drug Metab Dispos 31 (7): 878–87. doi:10.1124/dmd.31.7.878. PMID 12814964. Free full text
  31. ^ Neu P, Seyfert S, Brockmöller J, Dettling M, Marx P (2002). "Neuroleptic malignant syndrome in a patient with succinic semialdehyde dehydrogenase deficiency". Pharmacopsychiatry 35 (1): 26–8. PMID 11819156 Thieme-connect - Full text article
  32. ^ Plaisance KI et al. (1989). "Pharmacokinetic evaluation of two dosage regimens of clindamycin phosphate". Antimicrob Agents Chemother 33 (5): 618–20. PMID 2751277. Full text at PMC: 172501
  33. ^ Klasco RK, editor. Drugdex system, volume 128. Greenwood Village (CO): Thomson Micromedex; 2006.
  34. ^ Schlünzen F, Zarivach R, Harms J, et al. (2001). "Structural basis for the interaction of antibiotics with the peptidyl transferase centre in eubacteria". Nature 413 (6858): 814–21. doi:10.1038/35101544. PMID 11677599.
  35. ^ Cleocin I.V. Side Effects & Drug Interactions. RxList.com (2007). Retrieved on 2007-12-01.
  36. ^ Fogdall RP, Miller RD (1974). "Prolongation of a pancuronium-induced neuromuscular blockade by clindamycin". Anesthesiology 41 (4): 407–8. PMID 4415332.
  37. ^ al Ahdal O, Bevan DR (1995). "Clindamycin-induced neuromuscular blockade". Can J Anaesth 42 (7): 614–7. PMID 7553999.
  38. ^ Sloan PA, Rasul M (2002). "Prolongation of rapacuronium neuromuscular blockade by clindamycin and magnesium". Anesth Analg 94 (1): 123–4, table of contents. PMID 11772813. Free full text
  39. ^ (February 8 2005) "Osteomyelitis", in Kahn, Cynthia M., Line, Scott, Aiello, Susan E. (ed.): The Merck Veterinary Manual, 9th ed., John Wiley & Sons. ISBN 0-911910-50-6. Retrieved on 2007-12-14.
  40. ^ (February 8 2005) "Toxoplasmosis: Introduction", in Kahn, Cynthia M., Line, Scott, Aiello, Susan E. (ed.): The Merck Veterinary Manual, 9th ed., John Wiley & Sons. ISBN 0-911910-50-6. Retrieved on 2007-12-14.


 
This article is licensed under the GNU Free Documentation License. It uses material from the Wikipedia article "Clindamycin". A list of authors is available in Wikipedia.
Your browser is not current. Microsoft Internet Explorer 6.0 does not support some functions on Chemie.DE