DRUG STUDY

clindamycin
GENERIC NAME: clindamycin hydrochloride
BRAND NAME: Cleocin Hydrochloride, Dalacin C, Cleocin T, Clindagel, Clindesse
CLASSIFICATION: Lincosamide / antibiotics
PREGNANCY CATEGORY: Category B

INDICATION:
• Clindamycin treats serious infections caused by susceptible organisms (such as
Bacteroides fragilis, Clostridium perfringens, Fusobacterium, pneumococci,
staphylococci, and streptococci) or other susceptible aerobic and anaerobic pathogens.
• Also, for treatment for skin, skin structure, respiratory tract infections; septicemia;
intra-abdominal infections; endocarditis prophylaxis
• Treatment for pneumonia caused by Pneumocystis jirovecii, acne, and bacterial
vaginosis
• Endocarditis prevention in valvular heart disease

ACTION:
• Inhibits protein synthesis at the level of the 50S ribosome in susceptible bacteria,
preventing the creation of peptide bonds and causing cell death.
• Topically, it decreases fatty acid concentration on skin.
• Therapeutic Effect: Bacteriostatic or bactericidal

PHARMACOKINETICS:
Absorption:
• Rapidly absorbed from the GI tract.

Distribution:
• Widespread in body fluids and tissues, except for cerebrospinal fluids.
• Protein binding: 92%–94%

Metabolism:
• Primarily metabolized in the liver.
• Not affected by first-pass metabolism.

Half-life:
• 1.6–5.3 hrs. (increased renal/hepatic impairment in premature infants)

Excretion:
• Excreted in urine, bile, and feces as inactive metabolites.
• It can cross the placenta and be excreted in breast milk.
• Not removed by hemodialysis.

PHARMACOLOGY: ACTIVITY 1 DRUG STUDY TUNGUL, MA. RITA CONCEPCION B.

 Route Onset Peak Duration

P.O. Rapid 45–60 min 6–8 hrs.

I.V. Rapid End of infusion 6–8 hrs.

I.M. Rapid 1–3 hrs. 6–8 hrs.

Topical, vaginal Unknown Unknown Unknown

CONTRAINDICATION/PRECAUTION:
• Hypersensitivity to drug or lincomycin, tartrazine dye, ulcerative colitis/enteritis.
• Use cautiously in neonates and patients with renal or hepatic disease, asthma,
pregnant patients, known alcohol tolerance, history of GI disease, or significant
allergies.
• Severe hypersensitivity reactions necessitated immediate medical attention—reported
harsh skin responses and dress syndrome cases. If these side effects develop,
discontinue the medication.
• Clindamycin use may result in the overgrowth of non-susceptible organisms,
particularly yeasts—Monitor the patient for a sign of superinfection.
• Reactions that are severe or fatal, such as toxic epidermal necrolysis. If a severe skin
reaction occurs, the medication must be discontinued.

ADVERSE REACTION/SIDE EFFECTS:

• GI: nausea, vomiting, diarrhea, abdominal pain, esophagitis, pseudomembranous
colitis, and anorexia.
• CV: thrombophlebitis, dysrhythmias, and hypotension.
• Hematologic: neutropenia, transient leukopenia, agranulocytosis, thrombocytopenia
purpura, and eosinophilia
• Renal: renal dysfunction as evidenced by azotemia, oliguria, and proteinuria.
• Hepatic: jaundice and hepatic dysfunction
• Skin and mucous membranes: maculopapular rash, generalized morbilliform-like
rash, abscess at the injection site, urticaria, pruritus, exfoliative dermatitis, and
Stevens-Johnson syndrome
• Other: bitter taste (with I.V. use), phlebitis at I.V. site, induration, and sterile abscess
(with I.M. use), anaphylaxis

INTERACTION:
• Drug-drug.
○ Erythromycin: antagonistic effect
○ Kaolin/pectin: decreased GI absorption of clindamycin
○ Hormonal contraceptives: decreased contraceptive efficacy
○ Neuromuscular blockers: enhanced neuromuscular blockade
• Drug-diagnostic tests.
○ Alanine aminotransferase, alkaline phosphatase, aspartate
aminotransferase, bilirubin, creatine kinase: increased levels
○ Platelets, white blood cells: transient decrease in counts

PHARMACOLOGY: ACTIVITY 1 DRUG STUDY TUNGUL, MA. RITA CONCEPCION B.

 • Drug food: Unknown

DOSAGE AND ROUTE:

Most infections
• Adult:
○ PO: 150-450 mg q6hr, max 2700 mg/day
○ IM/IV: 1.2-2.7 g/day in 2-4 divided doses, max 4800 mg/day severe infections
• Child >1 mo:
○ PO: 8-25 mg/kg/day in divided doses q6-8hr;
○ IM/IV: 20-40 mg/ kg/day in 3-4 equal divided doses q6-8hr
• Neonate:
○ IM/IV: 15-20 mg/kg/day divided doses q6-8hr

PID
• Adult:
○ IV: 900 mg q8hr plus gentamicin

Bacterial endocarditis prophylaxis

• Adult:
○ PO/IV: 600 mg 1 hr (PO), 30 min (IV) before procedure

Bacterial vaginosis
● Adult/adolescent:
○ Vaginal: (Cleocin, Clindamax) 1 applicator (5 g) at bedtime × 3-7 day;
(Clindesse) 1 applicator (5 g) single dose or 1 suppository (100 mg) at bedtime
× 3 nights

P. jiroveci pneumonia (unlabeled)

• Adult:
○ PO: 1200-1800 mg/day in divided doses with 15-30 mg primaquine/ day × 21
days

ADMINISTRATION:
• Equally throughout the day and night to maintain blood levels.
• Obtain C&S before usage; the product may be initiated before results are obtained.

PO route
• Do not break, crush, or chew caps.
• Give the capsule at least 8 oz of water to prevent esophageal irritation.

Oral solution
• Do not refrigerate the reconstituted product; store at room temperature for ≤2 weeks.
• Give oral doses with a full glass of water, with or without food.
• Reconstitute granules with most of 75 mL of water, shake well, add remaining water,
and shake well (75 mg/5 mL).

PHARMACOLOGY: ACTIVITY 1 DRUG STUDY TUNGUL, MA. RITA CONCEPCION B.

Vaginal route
• Use the applicator supplied.
• The partner does not receive treatment.

Topical route
• Be careful not to get into eye and mouth cuts.

IM route
• IM deep injection
• Rotate sites
○ Do not give more than 600 mg in a single IM injection.

IV route
• Visually inspect parenteral products for particulate matter and discoloration before
use.
• Vials: dilute 300 and 600 mg doses with 50 mL of a compatible diluent; dilute 900-
mg doses with 50-100 mL of a compatible diluent; dilute 1200-mg doses with 100 mL
of a compatible diluent, final concentration max 18 mg/mL.
• ADD-vantage vials: dilute 600- and 900-mg ADD-vantage containers with 50 or 100
mL of NS or D5W.
• Storage: when diluted in D5W, NS, or LR, solutions with concentrations of 6, 9, or 12
mg/mL are stable for 16 days at room temperature or 32 days under refrigeration when
stored in glass bottles or minibags; when diluted in D5W, solutions with a
concentration of 18 mg/mL are stable for 16 days at room temperature.

Intermittent IV infusion route

• Infuse over at least 10-60 min. The healthcare provider should infuse infusion rates
max 30 mg/min and ≤1.2 g in a 1-hr period.
• Infuse 300-mg doses over 10 min; 600-mg doses over 20 min; 900-mg doses over 30
min, and 1200-mg doses over 40 min.

Continuous IV infusion route

• Give the first dose rapidly, then follow with continuous infusion.
• The rate is based on desired serum clindamycin levels.
• To maintain serum concentrations above 4 mcg/mL, use a rapid infusion rate of 10
mg/min for 30 min and a maintenance rate of 0.75 mg/min; to maintain serum
concentrations above 5 mcg/mL, use a rapid infusion rate of 15 mg/min for 30 min and
a maintenance rate of 1 mg/ min; to maintain serum concentrations above 5 mcg/mL,
use a rapid infusion rate of 20 mg/min for 30 min and a maintenance rate of 1.25
mg/min.

NURSING CONSIDERATION:
Baseline Assessment
• Obtain baseline WBC.
• Question the patient for a history of allergies.
• Avoid, if possible, concurrent use of neuromuscular blocking agents.

PHARMACOLOGY: ACTIVITY 1 DRUG STUDY TUNGUL, MA. RITA CONCEPCION B.

 • Infection:
○ C&S before product therapy
○ Product may be distributed as soon as culture is obtained
○ Monitor appearances of wounds, sputum, stools, urine baseline and
periodically
• Monitor blood studies: CBC
• Severe skin reactions:
○ Stevens-Johnson syndrome, exfoliative dermatitis (monitor for rash)
○ Immediately discontinue use at the first sign of an inflammation
○ Rashes may occur after therapy
• Pregnancy/breastfeeding:
○ There are no adequately controlled studies
○ Use only during pregnancy if the benefits outweigh the fetal risk
○ Can be excreted in breast milk, not recommended if breastfeeding

Intervention and Evaluation

• Observe the regular pattern and consistency of bowel movements.
• Due to the possibility of severe colitis, even with topical or vaginal treatment,
diarrhea should be reported immediately.
• Examine the skin for rash-like dryness and irritation after using a topical treatment.
• Be careful of superinfections, including fever, vomiting, diarrhea, anal/genital
pruritus, and oral mucosal abnormalities (ulceration, pain, erythema).
• Therapeutic response: negative C&S

Patient and Family Teaching

• To continue therapy throughout treatment.
• Healthcare providers should give space doses evenly.
• To take oral doses with at least 8 oz water.
• To avoid overall effects, take caution when applying topical clindamycin in
combination with peeling or abrasive acne products, soaps, and cosmetics containing
alcohol.
• Do not apply topical treatments near the eyes or to abraded areas.
• To report chronic severe diarrhea, cramping, and bloody stool.
• These symptoms may suggest a superinfection to report sore throat, fever, and
exhaustion.
• To take with food to reduce GI symptoms.
• Vaginal: If accidental contact with the eyes, flush with generous amounts of cool tap
water.
○ Do not engage in sexual intercourse during treatment.
○ Wear a sanitary pad to protect clothes against stains.
○ Women should not utilize tampons.

POTENTIAL NURSING DIAGNOSIS:

• Risk for Diarrhea, Nausea and Vomiting related to the possible side effect of
clindamycin.
• Risk for nephrotoxicity (fluid retention) related to drug intoxication.
• Risk for Anaphylactic Reactions related to patient’s allergy to clindamycin.

PHARMACOLOGY: ACTIVITY 1 DRUG STUDY TUNGUL, MA. RITA CONCEPCION B.

 • Risk for increase in serum alkaline phosphatase due to muscle irritation from IM
injections.

References

Antibiotics - Lincosamides: Nursing Pharmacology. (n.d.). Osmosis. Retrieved

October 19, 2022, from https://www.osmosis.org/learn/Antibiotics_-
_Lincosamides:_Nursing_Pharmacology

Barnaby, J. (2021). Nursing 2021 Drug Handbook (41st ed.). Wolters Kluwer.
CLINDAMYCIN HYDROCHLORIDE. (n.d.). RobHolland.com. Retrieved October 19, 2022,
from
http://www.robholland.com/Nursing/Drug_Guide/data/monographframes/C090.html

Kizior, R. J., & Hodgson, K. J. (2020). Saunders Nursing Drug Handbook 2021.
Elsevier Health Sciences.

Schull, P. D. (2013). McGraw-Hill Nurses Drug Handbook, Seventh Edition. McGraw

Hill LLC.

Skidmore-Roth, L. (2020). Mosby's 2021 Nursing Drug Reference. Elsevier - Health

Sciences Division.

PHARMACOLOGY: ACTIVITY 1 DRUG STUDY TUNGUL, MA. RITA CONCEPCION B.