Clindamycin chemical structure
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Clindamycin

Clindamycin is a lincosamide antibiotic. Clindamycin is a semisynthetic antibiotic and derived from lincomycin by the addition of chloride. Clindamycin is sold under brand names such as Dalacin and Cleocin. It is most effective against infections involving the following types of organisms: more...

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

It is used primarily to treat infections caused by susceptible anaerobic bacteria. Such infections might include respiratory infections, septicemia and peritonitis. In penicillin allergic patients clindamycin may be used to treat susceptible aerobic infections as well. It is also used to treat bone-infections caused by Staphylococcus aureus. Topical application of clindamycin phosphate can be used to treat severe acne.

Available forms

Clindamycin is commonly administered in penal caps as hydrochloride or in oral suspension as palmitate hydrochloride. It is also available for intravenous injection as phosphate. In topical preparations clindamycin is as hydrochloride or phosphate (Evoclin®).

Mechanism of action

Clindamycin has a bacteriostatic effect. Clindamycin interferes with bacterial protein synthesis, in a similar way as erythromycin and chloramphenicol, by binding to the 50S subunit of the bacterial ribosome. This causes antagonism if administered simultaneously and possible cross-resistance.

Pharmacokinetics

Almost all of orally administered clindamycin is absorbed from the gastro-intestinal tract, and it is widely distributed throughout the body, excluding the central nervous system. Clindamycin phosphate, as injection, is inactive, but it is rapidly hydrolysed in the blood to active clindamycin. High concentrations of clindamycin can be found in the bile (up 100 times higher than in the plasma). Adequate concentrations can also be found in the bone, and there is also active uptake into leucocytes.

Metabolism

Most of clindamycin is metabolised in the liver, and some of its metabolites are active, such as N-demethyl and sulphoxide-metabolites, and some are inactive. Clindamycin's half-life is 21 hours. Both active clindamycin and its metabolites are excreted primarily in the urine and some in the bile.

Side effects

Common side effects are mainly gastrointestinal disturbances. Clindamycin can cause a potentially lethal condition, pseudomembranous colitis, which is caused by Clostridium difficile, a clindamycin resistant bacteria (all the other bacteria have been killed by clindamycin, allowing C. difficile to over-proliferate and cause inflammation of the colon). Rare instances of polyarthritis (inflamation of several joints) have also been reported. In some cases this polyarthritis side effect feels like extreme flu-like aching througout the body.

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Once-daily clindamycin foam easier for patients
From OB/GYN News, 4/15/05 by Damian McNamara

Compliance among adults and adolescents with acne vulgaris may improve with once-a-day clindamycin foam, which has been approved by the Food and Drug Administration.

The new product may be particularly useful for patients with mild to moderate acne on their shoulders, chest, or back, Lawrence Eichenfield, M.D., said.

Clindamycin phosphate foam 1% (Evoclin Foam, Connetics Corp.) is approved for topical treatment of acne vulgaris in patients aged 12 years and older.

Patients should be instructed to wash affected areas with soap and water, then allow the skin to dry. The recommended dosage is once daily for 12 weeks, Dr. Eichenfield said.

In a randomized, double-blind, multicenter clinical trial of more than 1,000 patients, mild to moderate adverse reactions included application-site reactions--burning, itching, and dryness--and headache.

Clindamycin is contraindicated in patients with a history of regional enteritis, ulcerative colitis, antibiotic-associated colitis, or hypersensitivity to preparations containing clindamycin or lincomycin.

In a study that compared 386 patients applying clindamycin phosphate foam 1% with 385 patients using clindamycin phosphate gel 1%, clindamycin foam reduced total acne lesions by 43%, whereas the gel was associated with a 36% reduction.

There were also 127 patients using vehicle-only foam who experienced a 31% reduction in total lesions.

Although clindamycin can be prescribed as monotherapy for mild to moderate cases, combination with benzoyl peroxide or a retinoid are alternatives.

"Having a once-a-day clindamycin is useful for patients with moderate disease where we can pair clindamycin with [a] once-a-day retinoid," said Dr. Eichenfield, clinical professor of pediatrics and dermatology, University of California, San Diego, and chief of pediatric and adolescent dermatology, Children's Hospital of San Diego.

The hospital was one of the investigational sites for clinical studies. Dr. Eichenfield serves on a Connetics advisory board, but stated that he has no financial interest in the company.

Evoclin is unique because of its proprietary VersaFoam vehicle, he said. The foam spreads easily on all body surfaces, and might be particularly helpful for improving compliance among patients who had adherence issues with traditional formulations, including adolescents with acne on their shoulders, chest, and back.

BY DAMIAN MCNAMARA

Miami Bureau

COPYRIGHT 2005 International Medical News Group
COPYRIGHT 2005 Gale Group

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