Clindamycin: 7 things you should know

Medicines that interact with clindamycin may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with clindamycin. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

What the forms of clindamycin are used for, and how to use them

Clindamycin is an antibiotic. It works to treat bacterial infections when penicillin is not an option.

Clindamycin is an antibiotic drug. Doctors prescribe clindamycin to treat bacterial infections in certain situations.

The drug comes in several different forms. These are:

• oral capsules
• topical creams, lotions, and gels
• intravaginal suppositories
• injections and intravenous drips

Depending on the type of infection and the dosage of clindamycin, the drug can either kill or stop the growth of bacteria.

Topical clindamycin is a common treatment option for acne and bacterial infections in the vagina. Doctors also use clindamycin to treat infections in people with penicillin allergies.

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Clindamycin is not suitable for everyone, however, and it can cause a range of serious side effects.

This article looks at some uses, dosages, and symptoms of clindamycin. It also explores types and alternatives.

Doctors use clindamycin to treat a variety of bacterial infections. They prescribe it when they cannot use penicillin and when they have determined the type of bacteria involved in the infection.

This is because the form of clindamycin the doctor prescribes depends on the kind of infection the person has.

A doctor may prescribe clindamycin in the form of oral capsules or dissolvable granules for:

• respiratory infections with streptococci, pneumococci, and staphylococci bacteria
• empyema, anaerobic pneumonitis, or an abscess in the lung
• blood poisoning
• infections from anaerobic bacteria in the gut, resulting in peritonitis or an abscess in the abdomen
• endometriosis, pelvic cellulitis, an abscess in the reproductive system, or a vaginal cuff infection

A doctor may prescribe intravenous or injectible clindamycin for serious infections, such as:

• respiratory infections
• lung infections
• blood poisoning
• infections in the reproductive system
• abdominal infections
• bone and joint infections, and they may sometimes prescribe it alongside other medications during surgery for chronic bone and joint infections
• serious skin infections

A doctor may prescribe clindamycin for children as an oral solution to treat:

• serious respiratory infections
• serious infections of the skin or soft tissue
• blood poisoning
• infections in the abdomen
• infections in the female reproductive tract

A dermatologist may prescribe clindamycin in the form of a gel, solution, or lotion to treat acne.

A doctor may prescribe clindamycin in the form of a transvaginal suppository to treat bacterial vaginal infections. Alternatively, they may prescribe a clindamycin lotion for vaginal infections. Pregnant people in their second and third trimesters can use the lotion.

Some people can also take clindamycin for uses that the Food and Drug Administration (FDA) has not formally approved. Sometimes, for example, doctors use clindamycin to treat anthrax and malaria.

Dentists also use clindamycin as a preventive treatment for endocarditis, which is an infection of the heart’s lining that can occur after a dental procedure in people who are at risk.

Before having surgery, some people receive clindamycin to prevent surgical site infections.

Clindamycin: 7 things you should know

Medically reviewed by Carmen Fookes, BPharm. Last updated on May 24, 2022.

1. How it works

• Clindamycin is an antibiotic that may be used to treat a wide range of infections including those involving gram-positive and anaerobic bacteria (anaerobic means living without air).
• Clindamycin works by inhibiting bacterial protein synthesis, which inhibits bacterial growth. It has a bacteriostatic effect which means it stops bacteria from reproducing but doesn’t necessarily kill them.
• Clindamycin belongs to the class of antibiotics known as lincosamide or lincomycin antibiotics.

2. Upsides

• Usually reserved for the treatment of serious infections caused by susceptible anaerobic bacteria, such as those occurring in the abdomen, gastrointestinal tract, lower respiratory tract, on the skin, and in the genitourinary area. Examples include acute otitis media in people who fail to respond to first-line or other preferred agents, serious bone and joint infections, gynecological infections, or serious intra-abdominal infections.
• Effective against several gram-positive and anaerobic bacteria, including susceptible strains of Staphylococcus aureus (methicillin-susceptible strains only), Streptococcus pneumoniae (penicillin-susceptible strains only), S. pyogenes, Clostridium perfringens, Fusobacterium necrophorum, F. nucleatum, Peptostreptococcus anaerobius, Prevotella melaninogenica.
• For infections caused by susceptible strains of streptococci, pneumococci, or staphylococci, clindamycin is usually reserved for penicillin-allergic patients or other patients in whom penicillin is unsuitable.
• Available as an oral capsule, oral solution, and parenterally (may be administered IM or by intermittent or continuous infusion). The oral capsule should not be given to children who are unable to swallow capsules; use the oral solution instead.
• For serious anaerobic infections, the parenteral route is usually used initially but should be switched to the oral route as soon as the patient’s condition allows.
• May be taken with or without food.
• Generic clindamycin is available.

3. Downsides

If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:

• Abdominal pain, pain in the esophagus, nausea, vomiting, an unpleasant or metallic taste, skin rashes, and liver function test abnormalities.
• All antibiotics carry a risk of severe diarrhea caused by an overgrowth of Clostridium difficile bacteria. The risk may be higher with clindamycin compared with some other antibiotics. Further investigations are warranted if severe diarrhea occurs within several months of clindamycin administration. Symptoms include watery or bloody stools, stomach cramps, or fever. For this reason, clindamycin should only be used to treat serious infections when less toxic anti-infectives are inappropriate.
• Not suitable for the treatment of meningitis because it does not reach high enough concentrations in the cerebrospinal fluid (the fluid around the brain and spinal cord).
• May not be suitable for some people including those with a history of gastrointestinal disease (such as colitis) or a history of allergic reactions. Rarely, may cause severe hypersensitivity reactions and anaphylaxis.
• Be cautious when using in patients with kidney or liver disease. Although dosage reductions are not specifically recommended, liver and kidney function should be monitored.
• If administered long-term, monitor liver and renal function and blood counts regularly.
• Rapid IV infusion has caused cardiopulmonary arrest and low blood pressure.
• May interact withseveral drugs including neuromuscular blocking agents (such as succinylcholine, vecuronium), those that inhibit or induce CYP3A4 hepatic enzymes, and erythromycin.
• Clindamycin needs to be administered every six hours.
• Not effective in nonbacterial infections.
• Injectable clindamycin contains 9.45mg of benzyl alcohol, which may be toxic to children in large amounts and cause a potentially fatal “gasping syndrome”).
• Should only be used during pregnancy if the benefits outweigh the risks. Animal studies do not reveal any evidence of teratogenicity and there is not enough data in humans to make a recommendation. Clindamycin is secreted into breast milk and may potentially cause adverse effects on the GI flora of breast-fed infants. If used during breastfeeding, monitor the infant for possible adverse effects, such as diarrhea, thrush, or blood in the stool.

Note: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. View complete list of side effects

4. Bottom Line

Clindamycin is an antibiotic that is usually reserved for treating anaerobic infections or other serious infections caused by gram-positive bacteria in penicillin-allergic people. The risk of C. difficile-associated diarrhea may be higher with clindamycin compared with some other antibiotics.

5. Tips

• May be taken with or without food. Take with a full glass of water to stop the capsules from becoming inadvertently stuck in your throat.
• Take exactly as directed and for the duration intended. Finish the course of treatment prescribed.
• Only use when prescribed by a doctor to treat infections caused by susceptible bacteria as improper use increases the risk of resistant bacteria developing. Clindamycin does not treat infections caused by viruses, such as a cold or the flu.
• Report any instances of severe or persistent diarrhea, occurring either during clindamycin administration or within a few months following discontinuation to your doctor.
• Call your doctor immediately if you develop a severe rash.
• Some strengths (eg, 150mg capsules) contain FD & C Yellow No. 5 (tartrazine) which may cause allergic reactions; people with an aspirin sensitivity may be more at risk.
• Tell your doctor if you are pregnant or intending to become pregnant because it is not known how clindamycin affects a developing baby. Also, talk to your doctor if you intend to breastfeed while taking clindamycin.
• Tell your doctor about any other medications you take, including those brought over the counter from a pharmacy, supermarket, or health store.

6. Response and effectiveness

• Peak concentrations are reached within 45 minutes; however, it may take up to 48 hours before infection-related symptoms start to abate.

7. Interactions

Medicines that interact with clindamycin may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with clindamycin. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.

Common medications that may interact with clindamycin include:

• birth control treatments, such as estradiol, levonorgestrel
• botulinum toxin A
• bowel cleansing agents such as sodium picosulfate
• CYP3A4 inducers, such as erythromycin, diltiazem, itraconazole, ritonavir, or verapamil
• grapefruit juice
• kaolin
• lactobacillus
• neuromuscular blocking agents, such as atracurium or vecuronium
• mycophenolate mofetil
• rifampin
• vaccinations, such as BCG and Cholera.

Clindamycin is a substrate of CYP3A4 and to a lesser extent, CYP3A5. It is a moderate inhibitor of CYP3A4. Drugs that inhibit CYP3A5=or 3A4 may cause increase blood concentrations of clindomeyin. CYP3A4 or 3A5 may decrease plasma concetrations of clindamycin.

Note that this list is not all-inclusive and includes only common medications that may interact with clindamycin. You should refer to the prescribing information for clindamycin for a complete list of interactions.

More about clindamycin

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• Side effects
• Dosage information
• During pregnancy
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• Drug class: lincomycin derivatives
• Breastfeeding
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Patient resources

• Drug Information
• Clindamycin (Advanced Reading)
• Clindamycin Oral, Injection, Intravenous (Advanced Reading)
• Clindamycin and sodium chloride Intravenous (Advanced Reading)
• Clindamycin Capsules

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References

• Clindamycin. Revised 02/2022. Major Pharmaceuticals. https://www.drugs.com/pro/clindamycin-capsules.html

Further information

Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use clindamycin only for the indication prescribed.

Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances.

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