Clindamycin - instructions for use, release form, indications for adults and children, side effects. Clindamycin - instructions for use Clindamycin injection instructions
Clindamycin is a drug with an antibacterial effect.
Release form and composition
Clindamycin is available in the following forms:
- Vaginal cream 2% - from white with a creamy or yellowish tint to white, with a weak specific odor (20 g and 40 g in aluminum tubes, 1 tube complete with an applicator);
- Gelatin capsules - with a red cap and a purple body, size No. 1, capsule contents - yellowish-white to white powder (8 pcs. in blisters, 2 blisters in cardboard packs; 6 pcs. in blisters, 2 each, 5 and 10 blisters in cardboard packs);
- Solution for injection (intravenous and intramuscular administration) - transparent, slightly yellowish or colorless (2 ml in ampoules, 5 ampoules in strip packs, 2 packs in cardboard packs).
The composition of 100 g of vaginal cream includes:
- Active substance: clindamycin (in phosphate form) – 2 g;
- Auxiliary components: sodium benzoate, macrogol-1500 (polyethylene oxide-1500), castor oil, emulsifier No. 1, propylene glycol.
1 capsule contains:
- Active substance: clindamycin (in the form of hydrochloride) – 0.15 g;
- Auxiliary components: corn starch, talc, lactose monohydrate, magnesium stearate;
- Composition of the capsule cap: brilliant black dye (E151), titanium dioxide (E171), azorubine dye (E122), quinoline yellow dye (E104), crimson dye Ponceau 4R (E124), gelatin;
- Composition of the capsule body: diamond black dye (E151), azorubine dye (E122), gelatin.
The composition of 1 ml of solution for injection includes:
- Active substance: clindamycin (in phosphate form) – 0.15 g;
- Auxiliary components: disodium edetate, benzyl alcohol, water for injection.
Indications for use
Clindamycin in the form of a vaginal cream is prescribed to treat bacterial vaginosis.
The drug is used orally and by injection in the treatment of diseases:
- Infections of the ENT organs, upper respiratory tract (tonsillitis, pharyngitis, otitis, sinusitis), lower respiratory tract (pneumonia, including aspiration, pleural empyema, lung abscess, bronchitis), diphtheria, scarlet fever;
- Inflammatory and infectious diseases caused by microorganisms sensitive to the active substance;
- Infections of the oral cavity, soft tissues and skin (abscesses, infected wounds, panaritium, boils), abdominal cavity (abscess, peritonitis);
- Infections of the urogenital tract (endometritis, chlamydia, tubo-ovarian inflammation, vaginal infections);
- Septicemia;
- Osteomyelitis (acute and chronic);
- Bacterial endocarditis.
Clindamycin is also prescribed simultaneously with aminoglycosides for the prevention of intra-abdominal abscesses and peritonitis after intestinal perforation or due to traumatic infection.
Contraindications
Hypersensitivity to the components of Clindamycin.
Contraindications to the use of the drug in the form of capsules and solution for injection are also:
- Bronchial asthma;
- Myasthenia;
- Ulcerative colitis (history);
- Rare hereditary diseases: galactose intolerance, lactase deficiency or glucose-galactose malabsorption (for capsules);
- Pregnancy and lactation period.
Clindamycin is prescribed for children:
- Solution for intravenous and intramuscular administration - from 3 years;
- Capsules – from 8 years of age with a weight of at least 25 kg.
The drug should be used with caution in patients with severe hepatic and/or renal failure and in elderly patients.
Directions for use and dosage
For diseases of moderate severity, adults and children over 15 years of age (weighing over 50 kg) orally Clindamycin is prescribed 1 capsule (150 mg) 4 times a day at equal intervals. For severe infections, the single dose can be increased 2-3 times.
Younger children are usually prescribed:
- 8-12 years (weight – 25-40 kg): severe disease – 4 times a day, 1 capsule; maximum per day – 600 mg;
- 12-15 years (weight – 40-50 kg): average severity of the disease – 3 times a day, 1 capsule; severe disease – 3 times a day, 2 capsules; maximum per day – 900 mg.
The adult recommended dose for intramuscular and intravenous administration is 300 mg 2 times a day. When treating severe infections, 1.2-2.7 g per day is prescribed, divided into 3-4 administrations. Intramuscular administration of a single dose of more than 600 mg is not recommended. The maximum single dose for intravenous administration is 1.2 g over 1 hour.
For children over 3 years old, Clindamycin is prescribed at a dose of 15-25 mg/kg per day, divided into 3-4 equal doses. When treating severe infections, the daily dose can be increased to 25-40 mg/kg with the same frequency of use.
For patients with severe renal and/or liver failure, in cases where the drug is used at intervals of at least 8 hours, no dosage adjustment is required.
For intravenous administration, Clindamycin should be diluted to a concentration not exceeding 6 mg/ml. The solution is administered intravenously over 10-60 minutes.
The following solutions can be used as a solvent: 0.9% sodium chloride and 5% dextrose. The dilution and duration of infusion is recommended to be performed according to the following scheme (dose / volume of solvent / duration of infusion):
- 300 mg / 50 ml / 10 minutes;
- 600 mg / 100 ml / 20 minutes;
- 900 mg / 150 ml / 30 minutes;
- 1200 mg / 200 ml / 45 minutes.
Vaginal cream is used intravaginally. A single dose is one full applicator of cream (5 g), preferably before bedtime. Duration of use – 3-7 days daily.
Side effects
When used orally or by injection, side effects may develop:
- Cardiovascular system: with rapid intravenous administration - a decrease in blood pressure, up to collapse; weakness, dizziness;
- Digestive system: dyspepsia (nausea, abdominal pain, diarrhea, vomiting), esophagitis, liver dysfunction, jaundice, dysbacteriosis, hyperbilirubinemia, pseudomembranous enterocolitis;
- Hematopoietic organs: neutropenia, leukopenia, thrombocytopenia, agranulocytosis;
- Musculoskeletal system: rarely – disturbance of neuromuscular conduction;
- Local reactions: at the site of intramuscular injection - pain, irritation, at the site of intravenous injection - thrombophlebitis;
- Allergic reactions: rarely - urticaria, itching, maculopapular rash; in some cases - vesiculobullous and exfoliative dermatitis, anaphylactoid reactions, eosinophilia;
- Other: development of superinfection.
When using Clindamycin in the form of vaginal cream, the following side effects may occur (with an incidence of less than 10%):
- Urinary system: abnormal labor, trichomonas vaginitis, vulvovaginitis, vaginal candidiasis, irritation of the vulvar and vaginal mucosa, menstrual irregularities, vaginal infections, vaginal pain, uterine bleeding, urinary tract infections, dysuria, vaginal discharge, glycosuria, endometriosis, proteinuria ;
- Central nervous system: dizziness;
- Skin: urticaria, maculopapular rash, pruritus, rash, itching at the injection site, erythema, candidiasis (skin);
- Respiratory system: nosebleeds;
- Endocrine system: hyperthyroidism;
- Digestive system: flatulence, dyspepsia, diarrhea, vomiting, constipation, nausea, gastrointestinal disorders;
- General: bloating, fungal and bacterial infections, headache, generalized and localized abdominal pain, back pain, bad breath, inflammatory swelling, allergic reactions, abnormal microbiological test results;
- Other: perversion of taste.
special instructions
Before prescribing a vaginal cream, Chlamydia trachomatis, Trichomonas vaginalis, Neisseria gonorrhoeae, Herpes simplex and Candida albicans, which often cause vulvovaginitis, should be excluded using appropriate laboratory methods.
Intravaginal use of the drug may cause increased growth of insensitive microorganisms, especially yeast-like fungi.
Women using Clindamycin should be warned that they should not have sexual intercourse during treatment, and it is also not recommended to use other means for intravaginal administration (douching, tampons).
The vaginal cream contains components that can reduce the strength of rubber or latex products, therefore the use of condoms, vaginal contraceptive diaphragms and other latex products for intravaginal use during treatment is not recommended.
The safety of Clindamycin in children under 3 years of age has not been established. During long-term treatment, children need to undergo periodic monitoring of the functional state of the liver and blood count.
While taking Clindamycin and 2-3 weeks after stopping therapy, pseudomembranous colitis may develop, manifested by diarrhea, fever, leukocytosis, abdominal pain (sometimes accompanied by the release of mucus and blood with feces). In mild cases, it is sufficient to cancel treatment and use ion exchange resins (colestipol, cholestyramine); in severe cases, compensation for the loss of electrolytes, protein and fluid and the appointment of metronidazole or vancomycin orally is indicated.
When using the drug in high doses, it is necessary to monitor the concentration of Clindamycin in plasma.
Patients with severe liver failure should monitor liver function (liver enzymes).
Drug interactions
No interactions were observed in pharmacodynamic, clinical or pharmacokinetic studies of clindamycin vaginal cream.
There are no data on the simultaneous use of the drug with other drugs. The combined use of vaginal cream with other drugs for intravaginal administration is not recommended.
Clindamycin mutually enhances the effect of aminoglycosides: streptomycin, rifampicin, gentamicin (especially in the prevention of peritonitis after intestinal perforation and the treatment of osteomyelitis).
The drug in the form of capsules and solution for injection:
- Incompatible with barbiturates, ampicillin, aminophylline, magnesium sulfate and calcium gluconate;
- Increases the risk of developing pseudomembranous colitis when administered simultaneously with antidiarrheal drugs;
- Shows antagonism with chloramphenicol and erythromycin.
When used simultaneously with narcotic (opioid) analgesics, the respiratory depression they cause may increase (up to apnea).
Terms and conditions of storage
Store in a dry, dark place, out of reach of children.
Best before date:
- Vaginal cream – 2 years at temperatures up to 20 °C;
- Solution for injection – 2 years, capsules – 3 years at a temperature of 15-25 °C.
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Group: lincosamides
Indications:
- upper respiratory tract infections (sinusitis, tonsillitis, pharyngitis, otitis media);
- infections of the lower respiratory tract (bronchitis, aspiration pneumonia, pneumonia, pleural empyema, lung abscess);
- urinary tract infections (chlamydia, endometritis, vaginal infections, tubo-ovarian inflammation);
- infectious diseases of the skin and soft tissues (infected wounds, abscesses, boils, panaritium);
- infectious diseases of joints and bones (acute and chronic osteomyelitis);
- bacterial endocarditis;
- abdominal organs (peritonitis, abscess);
Contraindications:
Hypersensitivity, myasthenia gravis, bronchial asthma, ulcerative colitis (history), diarrhea, pregnancy, lactation, rare hereditary diseases such as galactose intolerance, lactase deficiency or glucose-galactose malabsorption (for capsules), children under 3 years - for a solution for intravenous and intramuscular administration (due to the lack of data on the safety of the use of benzyl alcohol), children under 8 years of age for capsules (the average weight of a child is less than 25 kg).
Side effects:
From the digestive system: nausea, vomiting, diarrhea, esophagitis, jaundice, liver dysfunction, hyperbilirubinemia, dysbacteriosis, and the development of pseudomembranous colitis;
Blood disorders: leukopenia, neutropenia, thrombocytopenia, agranulocytosis;
From the cardiovascular system: with rapid intravenous administration - a decrease in blood pressure, up to collapse. Dizziness, weakness;
Allergic reactions: maculopapular rash, urticaria, itching, in some cases exfoliative and vesiculobullous dermatitis, eosinophilia, anaphylactoid reactions;
When administered by injection, the development of undesirable local reactions is possible. When administered intramuscularly, pain is noted at the injection site. With intravenous administration, thrombophlebitis may develop;
Pharmacological properties:
Clindamycin is a semisynthetic antibiotic obtained by replacing the 7 - (S)-chlorine group with the 7 - (R)-hydroxyl group of lincomycin. Due to its effect on the synthesis of microbial proteins, it has a significant antimicrobial effect. Clindamycin can have both bactericidal and bacteriostatic effects, depending on the sensitivity of microorganisms and the concentration of the antibiotic.
Clindamycin is active against:
Aerobic gram-positive cocci: Staphylococcus aureus, Staphylococcus epidermidis (penicillinase-producing and non-penicillinase-producing colonies), streptococci, pneumococci.
Anaerobic Gram-negative bacilli: Bacteroides species including: B. fragilis group, P. melaninogenicus group (B melaninogenicus), Fusobacterium species.
Anaerobic gram-positive non-spore-forming bacilli: Propionibacterium, Eubacterium, Actinomyces, including A. Israelii.
Anaerobic and microaerophilic gram-positive cocci: Peptococcus species, Peptostreptococcus species, microaerophilic streptococci, Clostridia, including C. perfringens, other Clostridia species. C. sporogenes and C. tertium are often resistant, so susceptibility testing is necessary.
Other Chlamydia trachomatis, some strains of Toxoplasma gondii, Pneumocystis carinii, some strains of Plasmodium falciparum (including strains resistant to chloroquine), Gardnerella vaginalis, Mobiluncus species, including Mobiluncus mulieris and Mobiluncus curtisii, Mycoplasma hominis. Methicillin-sensitive strains of Staphylococcus aureus are predominantly sensitive to wedge damitsina.
Clindamycin has a pronounced effect against many strains of methicillin staphylococci (MRSA). However, due to the significant prevalence of clindamycin-resistant MRSA strains, the use of clindamycin for infections caused by these microorganisms without sensitivity testing is excluded. Some erythromycin-resistant strains of staphylococci rapidly develop resistance to clindamycin.
The following organisms are usually resistant: aerobic gram-negative bacilli, Enterococcus faecalis, Nocardia spp., Neisseria meningitides, Haemophilus influenzae strains (in areas where antibiotic resistance is common).
A cross-reaction has been detected between clindamycin and lincomycin. The existence of antagonism between clindamycin, erythromycin and macrolides similar in chemical structure has been proven. Clindamycin does not exhibit antagonism to penicillins. Although clindamycin hydrochloride is active both in vitro and in vivo, clindamycin phosphate and clindamycin palmitate are not active in vitro. Despite this, both compounds are rapidly hydrolyzed in vivo to form the active base.
After oral administration, clindamycin is rapidly and almost completely (90%) absorbed. From 40 to 90% of the dose is bound to proteins. No accumulation was detected after oral administration. Clindamycin easily penetrates into body fluids and tissues: bone tissue, breast milk, synovial fluid, sputum, peritoneal fluid, fetal blood, pus, pleural fluid. Clindamycin does not penetrate into the cerebrospinal fluid even with meningitis.
The half-life of clindamycin is approximately 1 1/2 - 3 1/2 hours. It is slightly longer lasting in patients with significantly reduced liver or kidney function. With moderately severe renal or liver dysfunction, there is no need to adjust the dosage regimen. Clindamycin is relatively extensively metabolized. 10-20% of the drug in the form of a microbiologically active substance is excreted in the urine, 4% in feces. The rest is excreted as biologically inactive metabolites. It is excreted mainly with bile and feces.
Directions for use and dosage:
For adults with infectious diseases of the abdominal cavity, as with other complicated or severe infections, the drug is usually prescribed as injections at a dose of 2.4-2.7 g per day, divided into 2-3-4 injections.
For milder forms of infection, the therapeutic effect is achieved by prescribing smaller doses of the drug - 1.2-1.8 g/day. (in 3-4 injections). Doses up to 4.8 g/day have been successfully used.
It is not recommended to prescribe more than 600 mg. the drug intramuscularly at once.
For adnexitis (inflammation of the uterine appendages) and pelvioperitonitis (inflammation of the peritoneum, localized in the pelvic area), it is administered intravenously in a dose of 0.9 g every 8 hours (with the simultaneous prescription of antibiotics active against gram-negative pathogens).
Intravenous medications are given for at least 4 days and then for 48 hours after the patient's condition improves. After achieving a clinical effect, treatment can be continued with oral forms (for oral administration) of the drug, 450 mg. every 6 hours until completion of the 10-14-day course of therapy.
The drug is also used internally for the treatment of infectious and inflammatory diseases of mild to moderate severity.
Adults are prescribed 150-450 mg. every 6 hours. The duration of treatment is determined individually, but for infections caused by beta-hemolytic streptococcus, it should be continued for at least 10 days.
For the treatment of cervical infections caused by Chlamydiatrachomatis (chlamydia), 450 mg. the drug 4 times a day for 10-14 days.
For children, it is preferable to prescribe the drug in syrup form. To prepare the syrup, add 60 ml to the bottle with flavored granules. water. After this, the bottle contains 80 ml. syrup with a concentration of 75 mg. clindamycin 5 ml.
For children over 1 month of age, the daily dose is 8-25 mg/kg. body weight in 3-4 doses. In children weighing 10 kg. and less than the minimum recommended dose should be 1/2 teaspoon of syrup (37.5 mg) 3 times a day.
For children over 1 month of age, the drug for parenteral (bypassing the digestive tract) administration is prescribed at a dose of 20-40 mg/kg. body weight per day only in cases of urgent need.
For bacterial vaginitis (inflammation of the vagina caused by bacteria), a vaginal cream is prescribed. A single dose (one full applicator) is inserted into the vagina before bed. The course of treatment is 7 days.
Release form:
Gelatin capsules 300 mg, 150 mg. and 75 mg. clindamycin hydrochloride.
15% solution of clindamycin phosphate 150 mg. in 1 ml. In ampoules of 2, 4 and 6 ml;
Flavored granules (for children) for the preparation of syrup containing 75 mg. clindamycin palmitate hydrochloride in 5 ml., in 80 ml bottles;
Vaginal cream 2% in tubes of 40 g with 7 disposable applicators.
Interaction with other drugs:
It is not recommended to use clindamycin concomitantly with drugs that slow down neuromuscular transmission. The combination of clindamycin with aminoglycosides is synergistic. Clindamycin in solution is not compatible with B vitamins, ampicillin, aminophylline, barbiturates, calcium gluconate, magnesium sulfate. The drug is compatible with solutions of amikacin, gentamicin, tobramycin, piperacillin, cefazolin, cefotaxime and some other cephalosporins.
Attention! Before using the medication CLINDAMYCIN, you should consult your doctor.
The instructions are provided for informational purposes only.
1 ml of injection solution contains clindamycin in the form of clindamycin phosphate - 150 mg
Excipients: benzyl alcohol, sodium edetate, sodium hydroxide, hydrochloric acid, water for injection.
Release form
injection.
Pharmacological group
antibacterial agents for systemic use. Macrolides and lincosamides. ATC code J01FF01.
Pharmacological properties
Pharmacological. Antibiotic of the lincosamide group. The active substance of the drug is clindamycin, a semisynthetic antibiotic that is synthesized from lincomycin by replacing the 7-(R) hydroxyl group with 7-(S)-chloro. Disturbs intracellular protein synthesis.
Clindamycin has a wide spectrum of action and can act bactericidal or bacteriostatic, which depends on the sensitivity of the microorganism and the concentration of the antibiotic.
Clindamycin acts on the following forms of microorganisms:
aerobic gram-positive cocci: Staphylococcus aureus, Staphylococcus epidermidis(strains producing and not producing penicillinase). When conducting research in vitro rapid development of resistance to clindamycin was observed in some strains of staphylococci resistant to erythromycin; Streptococcus spp.(with the exception of Enterococcus faecalis) Streptococcus pneumoniae;
anaerobic gram-negative bacteria: Bacteroides species(including group B. fragilis and group B. melaninogenicus), Fusobacterium specie;
anaerobic gram-positive bacteria that do not form spores: Propionibacterium spp.; Eubacterium spp.; Actinornyces spp.;
anaerobic and microaerophilic gram-positive cocci: Peptococcus spp.; Peptostreptococcus spp.; Microaerophilic streptococci; Clostridium spp.(Clostridia are more resistant to clindamycin than most other anaerobes) most Clostridia species, e.g. С1оstridium perfringens, are sensitive to clindamycin, but some species, e.g. C.sporogenes And C.terium, are often resistant to clindamycin. In this regard, it is necessary to conduct sensitivity tests.
Various organisms: Chlamydia trachomatis; Toxoplasma gondii; Plasmodium falciparum And Pneumocystis carinii(in combination with primaquine) Gardnerella vaginalis; Mobiluncus mulieris, Mobiluncus curtisii; Mycoplasma hominis.
Clindamycin-resistant:
aerobic gram-negative bacteria: Streptococcus faecalis ; Nocardia species; Neisseria meningitidis; penicillin-resistant strains Staphylococcus aureus; strains Haemophilus influenzae.
Pharmacokinetics. After intramuscular injection of 600 mg of clindamycin phosphate, the maximum concentration in the blood serum (9 μg / ml) is achieved 1 - 3:00 from the moment of administration. After intravenous infusion of 300 mg over 10 minutes or 600 mg over 20 minutes, the maximum concentration, which is 7 μg/ml and 10 μg/ml, respectively, is achieved at the end of drug administration. A constant level of the drug in the body is achieved after the third dose.
40 - 90% of the administered drug binds to proteins in the body. Clindamycin easily penetrates into body tissues and fluids. The concentration of Clindamycin in bone tissue reaches approximately 40% (20 - 75%) of the drug concentration in blood serum. In breast milk, the concentration of the drug is 50 - 100% of the concentration in blood serum, in synovial fluid - 50%, in sputum - 30 - 75%, in peritoneal fluid - 50%, in fetal blood - 40%, in manure - 30% and in pleural fluid - 50 - 90% of the concentration in blood serum. Clindamycin does not penetrate into the cerebrospinal fluid, even in cases of meningitis.
The half-life of Clindamycin is 1.5 - 3.5 hours. In patients with severely impaired renal or hepatic function, the half-life is slightly prolonged. If you have mild or moderate forms of kidney or liver disease, there is no need to change the treatment regimen. Clindamycin is almost completely metabolized.
10 - 20% is excreted from the body by the kidneys in a microbiologically active form, 4% - with feces. The rest is excreted from the body in the form of biologically inactive metabolic products, mainly with bile and feces.
Indications
Treatment of infections caused by sensitive anaerobic bacteria or strains of gram-positive aerobic microorganisms:
- upper respiratory tract infections, including: tonsillitis, pharyngitis, sinusitis, otitis media and scarlet fever;
- oral infections such as periodontal abscess and periodontitis;
- toxoplasmosis encephalitis in patients with AIDS. The effectiveness of clindamycin in combination with pyrimethamine has been proven in patients intolerant to standard therapy
- lower respiratory tract infections, including: bronchitis, pneumonia, pleural empyema and lung abscess;
- infectious diseases of the abdominal cavity, including: peritonitis and abdominal abscesses (in combination with antibiotics acting on gram-negative aerobic bacteria)
- Pneumocystis pneumonia in patients with AIDS. In patients intolerant or resistant to standard therapy, Clindamycin can be used in combination with primaquine;
- septicemia and endocarditis;
- infectious diseases of the skin and soft tissues, including: acne, boils, cellulite, impetigo, abscesses, infected wounds, specific infectious diseases of the skin and soft tissues caused by pathogens sensitive to the drug, such as erysipelas and paronychia (felon)
- infectious diseases of bones and joints, including: osteomyelitis and septic arthritis
- clindamycin is indicated for the treatment of gynecological infections, including endometritis, cervicitis, vaginal cuff infections, tubal and ovarian abscesses, salpingitis and pelvic inflammatory disease, when prescribed together with an appropriate antibiotic active against gram-negative pathogens; cervical infections caused by Chlamydia trachomatis ;
Directions for use and doses
the dose and method of administration of the drug depend on the severity of the disease, the condition of the patient and the sensitivity of the infectious agent to the prescribed drug.
Intramuscular and intravenous administration.
Clindamycin dosages for adults.
In the presence of infectious diseases of the abdominal cavity, inflammatory diseases of the pelvic organs in women, as well as other complicated or severe infections, 2400 - 2700 mg of clindamycin per day is usually prescribed, divided into 2, 3 or 4 equal doses. In mild forms of infection and in the presence of a pathogen more sensitive to therapy, the therapeutic effect is achieved by prescribing smaller doses of the drug - 1200 - 1800 mg per day, divided into 3 - 4 equal doses.
Doses of the drug that reached 4800 mg per day were successfully used. Single doses greater than 600 mg IM ¢ IM are not recommended.
Doses of Clindamycin for children from 1 month.
20 - 40 mg per kg body weight per day, divided into 3 - 4 equal doses.
newborns:
For newborns, Clindamycin is prescribed at a dose of 15 - 20 mg per kg of body weight per day, divided into 3 - 4 equal doses. For small premature babies, a lower dose may be sufficient: 10 - 15 mg per kg body weight per day.
Treatment of pelvic inflammatory diseases and cervical infections caused by Chlamydia trachomatis.
Pelvic inflammatory disease - inpatient treatment 900 mg clindamycin every 8:00 + intravenous antibiotic, active against gram-negative aerobic pathogens (for example, 2.0 mg/kg gentamicin followed by 1.5 mg/kg every 8:00 for a patient with normal kidney function). Continue the drug for at least 4 days and then for at least 48 hours after the patient's condition improves. In the future, continue to take oral Clindamycin in the amount of 450 mg every 6:00 until the completion of the 10-14-day therapy cycle.
Toxoplasmosis encephalitis in patients with AIDS.
Clindamycin intravenously at a dose of 600 - 1200 mg every 6:00 for 2 weeks, then 300 - 600 mg every 6:00.
Usually the course of treatment is 8 - 10 weeks. The dose of pyrimethamine is 25 to 75 mg orally every day for 8 to 10 weeks. Folic acid 10 - 20 mg/day should be prescribed when using high doses of pyrimethamine.
Pneumocystis pneumonia in patients with AIDS.
Clindamycin 600 to 900 mg intravenously every 8 hours for 21 days and primaquine 15 to 30 mg orally once daily for 21 days.
Dilution and rate of infusion.
The concentration of Clindamycin in the solution for infusion should not exceed 18 mg/ml, and the rate of administration should not exceed 30 mg per minute.
Doses higher than 1200 mg per 1:00 infusion are not recommended.
Side effect
- Digestive tract: abdominal pain, nausea, vomiting and diarrhea, pseudomembranous colitis.
- Hypersensitivity reactions: maculopapular rash, urticaria, generalized measles-like rash of mild to moderate severity. Rare cases of erythema multiforme resembling Stevens-Johnson syndrome have been associated with clindamycin. Several cases of anaphylactic reactions have been described.
- Liver: jaundice, liver dysfunction.
- Skin and mucous membranes: itching, vaginitis, rarely - exfoliative and vesiculobullous dermatitis.
- Hematopoiesis: neutropenia, leukopenia and eosinophilia of a transient nature, as well as agranulocytosis and thrombocytopenia.
- Cardiovascular system: when the drug was administered too quickly, cases of respiratory and cardiac arrest, as well as the development of hypotension, were observed.
- Local phenomena: when administering the drug, phenomena such as local irritation, pain and the formation of abscesses at the injection site may be observed, and sometimes thrombophlebitis has occurred. The incidence of such events decreases when this drug is injected deeply and when indwelling intravenous catheters are used as rarely as possible.
Contraindications
The use of Clindamycin is contraindicated in patients with hypersensitivity to clindamycin or lincomycin. Myasthenia.
!}
Overdose.
Symptoms: with parenteral administration of high doses of the drug (especially in the case of rapid administration), collapse and respiratory failure may develop. Treatment symptomatic.
Features of application
It has been shown that early administration of Clindamycin in combination with an appropriate antibiotic acts on gram-negative bacteria (for example, from the aminoglycoside group), successfully prevents the development of peritonitis or abdominal abscess after an intestinal breakthrough or as a result of traumatic infection. Limited data from uncontrolled studies using a wide range of doses suggest that Clindamycin, administered parenterally at a dose of 20 mg/kg/day for at least 5 days, is a good alternative therapy when used either as monotherapy or in combination. combination with quinine or amodiaquine for the treatment of multidrug-resistant Plasmodium falciparum.
Treatment with the drug may be accompanied by the development of pseudomembranous colitis.
When prescribing the drug to patients with a history of diseases of the digestive tract, especially colitis, Clindamycin should be prescribed with caution.
Clindamycin should not be used to treat meningitis because the drug does not cross the blood-brain barrier.
If treatment is carried out for a long time, then in this case it is necessary to monitor the function of the liver and kidneys.
As a result of treatment with the drug, activation of other flora that is not sensitive to this drug, especially the yeast flora, may occur.
Clindamycin should not be administered undiluted, and rapid (bolus) administration of the drug should be avoided. The infusion must be carried out over at least 10 - 60 minutes.
Clindamycin should be prescribed with caution to patients prone to allergic reactions.
Clindamycin may suppress myoneural conduction.
The safety of use during pregnancy has not been established, so its prescription can only be for health reasons.
Clindamycin has been reported to appear in breast milk in concentrations ranging from 0.7 to 3.8 mcg/ml, therefore, when prescribing it during lactation, the need to use this drug should be assessed or breastfeeding should be discontinued.
Interaction with other drugs
There is antagonism between clindamycin and erythromycin. Clindamycin is a neuromuscular blocker to a certain extent and may enhance the effects of other neuromuscular blockers in the body, so the drug should be administered with caution to patients receiving muscle relaxants.
The following are incompatible with clindamycin: ampicillin, phenytoin sodium, barbiturates, aminophylline, calcium gluconate and magnesium sulfate.
Clindamycin is physically and chemically compatible when dissolved in 5% dextrose in water or sodium chloride injection with antibiotics used in standard concentrations: amikacin sulfate, cefamandole nafate, cefazolin sodium, cefotaxime sodium, cefoxitin sodium, ceftazidime sodium, ceftizoxime sodium, gentamicin sulfate, netromycin sulfate, piperacillin and tobramycin.
The compatibility and stability of mixtures of Clindamycin with other drugs will depend on the concentration and other conditions.
Storage conditions
Store at a temperature not exceeding 25 ° C, out of reach of children, protected from light. Shelf life - 2 years.
Vacation conditions
on prescription.
Package
1 bottle of solution for injection, 2 ml or 4 ml in a cardboard box.
Manufacturer
LLC "Pharmaceutical company" Health ".
Clindamycin in the fight... During inflammatory processes, acne and pimples form on the skin, and they can only be fought with antibacterial...The recommended dose for adults is 150 mg (1 capsule) 4 times a day, that is, every six hours. In case of severe disease, the dose can be doubled. For chlamydia, you need to take 450 g of clindamycin 3-4 times a day for 10 days. The treatment period can be increased to 14 days.
Children are recommended to take this drug at the rate of 8-25 mg per kilogram of weight three to four times a day. Clindamycin syrup is most suitable for children. The duration of therapy in each case is determined individually, but usually the course of the entire treatment can be about ten days.
Clindamycin is prescribed intravenously or intramuscularly only to adults for 4 days before the condition improves and for another two days after the improvement to consolidate the result. After intramuscular administration, the drug can be continued to be taken in capsules of 450 mg every 6 hours for 4-6 days. The maximum dose of the drug for intramuscular administration is 600 mg. In severe cases of the disease, the dosage can be increased to 1200-2700 mg per day, dividing this dosage into several doses.
When prescribing antibiotics to pregnant women, first of all, it is necessary to consider how it will affect the fetus. Antibiotics are divided into three groups based on their toxic effect on the fetus. According to this classification, penicillins, cephalosporins, erythromycin, macrolides and carbapenems can be used without danger to the fetus. Aminoglycosides, clindamycin, clarithromycin, vancomycin and rifampicins are prescribed with caution. These drugs are prescribed with caution due to insufficient knowledge of the effects of drugs on the fetus. Tetracyclines, fluoroquinolones, chloramphenicol, trimethoprim and streptomycin are contraindicated. Taking the last group of antibiotics can be fatal.
Clindamycin is rarely prescribed to pregnant women. It easily passes through the placenta to the fetus both early and late in pregnancy. The drug accumulates in the internal organs of the fetus, but to date its effect on the fetus has not been sufficiently studied, therefore it is prescribed during pregnancy in extreme cases and under the strict supervision of specialists.
The most harmless antibiotic for pregnant women is the antifungal drug Nystatin, which is often prescribed to pregnant women to treat various genital infections.
The most commonly used antibiotics for pregnant women are drugs from the penicillin group. Unlike clindamycin, penicillins have been widely studied and do not cause toxic effects on the developing fetus. Cephalosporins can also be prescribed to pregnant women, regardless of the stage of pregnancy.
Unlike clindamycin and penicillin, the use of tetracyclines for the treatment of pregnant women is absolutely contraindicated. When taking tetracyclines, the fetus develops various pathologies, for example, stopping bone growth. Therefore, drugs of this group cannot be prescribed to pregnant women.
Clindamycin is also prescribed to prevent peritonitis or intra-abdominal abscesses if there has been surgery or trauma to the intestine.
This drug is the main antibiotic for the treatment of diseases caused by bacteria that cannot be treated with penicillin (staphylococcus and other gram-positive bacteria).
As an external remedy, this drug is used for problem skin - acne, which is often caused by Staphylococcus aureus.
For vaginosis that is caused by bacteria within the range of action of clindamycin, this drug is an excellent remedy for topical use in the form of douching, as well as for use in tampons.
When prescribing this drug, it should be taken into account that it is contraindicated in patients with severe impairment of normal kidney function or liver function. This drug is not prescribed during pregnancy and breastfeeding, as well as to persons with hypersensitivity to the components of the drug.
Clindamycin should be prescribed with caution to patients who have ever had gastrointestinal disease. This drug is prescribed to children only under the strict supervision of a doctor, especially if the child is premature. As a local therapy for vaginosis during pregnancy, this drug is prescribed only in exceptional cases.
Lincosamides include lincomycin, a natural antimicrobial substance, and clindamycin, which is a semisynthetic analogue of lincomycin. This group of drugs is used to treat many diseases caused by various bacteria. Microorganisms that respond most well to treatment with this drug are staphylococci, pneumococci, streptococci, bacteroides and others. This drug is also effective against certain types of protozoan microorganisms.
The lincosamide group does not dissolve in gastric juice. The absorption of clindamycin is much higher than the absorption of linocmycin and its administration does not necessarily need to be associated with food intake. The drug easily passes into breast milk, so it is not recommended to use this drug during lactation.
When taking the drug, side effects may occur in the form of diarrhea, nausea, abdominal pain, skin rashes and itching, as well as sore throat, fever and blood disorders.
In what cases is taking these drugs indicated?
Any infections of the lower respiratory tract, joints and bones, skin and soft tissues, pelvis (for example, adnexitis). For vaginal dysbiosis and acne, clindamycin is used topically.
Clindamycin differs from lincomycin in that it is better absorbed into the gastrointestinal tract and is more active when taken orally, but a side effect such as pseudomembranous colitis occurs more often. Another positive distinctive feature of the drug is that it can be taken both before and after meals with a glass of water.
This antibiotic drug is a representative of the lincosamide group. Influencing the patient’s body, this antibiotic has both bactericidal and bacteriostatic effects. It is used to fight many viruses and infections that cannot be treated with any other antibiotics. Despite such widespread use, clindamycin is not prescribed very often, as it causes a number of side effects.
Side effects that occur during the use of clindamycin can be caused both from the digestive and cardiovascular systems, and from the hematopoietic system. If we talk about the digestive system, its side effects are: pain in the abdomen, excessive gas formation, nausea, vomiting, changes in stool, changes in taste, the development of jaundice and some other liver diseases. As for side effects from the hematopoietic system, these include: neutropenia, agranulocytosis, thrombocytopenia, and leukopenia.
Allergic reactions such as urticaria, fever, anaphylactic shock, and swelling are also quite possible. Other side effects include: decreased blood pressure, dizziness, general malaise and some others. The development of many of the above side effects can be prevented through special dietary supplements (dietary additives). By maintaining a healthy lifestyle and taking dietary supplements, many people will be able to prevent the development of not only side effects, but also many diseases.
Clindamycin is an antibacterial agent with a broad antimicrobial spectrum of action, belonging to the lincosamide group. It is used for bacterial infections in adults and children. The drug is not effective for viral pathology.
The name of the antibiotic in Latin is Clindamycin.
Ath
The ATC (Anatomical Therapeutic Chemical Classification) code for the drug is D10AF51. Group - D10AF.
Release forms and composition
The medicine is produced in gelatin capsules of 150 mg, in the form of a cream, suppositories for insertion into the vagina (Clindacin) and a solution in ampoules of 300 mg.
Solution
The antibiotic is available in the form of a clear, colorless or slightly yellowish solution. In finished medicines it is presented in the form of phosphate. The amount of active ingredient in 1 ml of solution is 150 mg. Additional components of the solution are disodium edetate, alcohol and water. The drug is placed in ampoules of 2 ml, which are placed in packaging with cells or packs of cardboard.
Capsules
Antibiotic capsules are size No. 1, with a purple body and a red cap. Contents: white powder. The antibiotic in capsules is presented in the form of hydrochloride. The auxiliary components of the drug are: lactose, talc, magnesium stearate and corn starch. The cap contains titanium dioxide, quinoline yellow and Ponceau 4R crimson dye. The body contains gelatin, azurobine and black dye. The capsules contain 150 mg of antibiotic.
Candles
The antibiotic is used in the form of vaginal suppositories having a cylindrical-conical shape. Color - from white to slightly yellowish. There are no inclusions on the longitudinal section of the suppositories. The active substance in suppositories is presented in the form of phosphate. Auxiliary components are semi-synthetic glycerides. 1 suppository contains 100 mg of antibacterial agent.
Ointment
The antibiotic is not available in the form of an ointment, but is used in the form of a gel and a 2% white vaginal cream. The auxiliary components of the medicine are: sodium benzoate, castor oil, polyethylene oxide and propylene glycol. The cream is sold in aluminum tubes. One dose (5 g) contains 100 mg of antibiotic.
pharmachologic effect
This antibiotic acts on many microorganisms. It is effective against Gram-stained and non-Gram-stained bacteria. The medicine has a bacteriostatic effect, that is, it inhibits the growth and reproduction of microbes in tissues. The mechanism of antibacterial action is associated with disruption of protein formation.
Staphylococci (including epidermal), streptococci, enterococci, peptococci, peptostreptococci, the causative agent of botulism, bacteroides, mycoplasmas, ureaplasmas, bacilli and anaerobes that are not capable of forming spores are sensitive to the drug. This drug is similar in its therapeutic effect to Lincomycin.
Pharmacokinetics
Absorption of the drug in the stomach and intestines occurs quickly and completely. Eating slows down absorption. The medicine easily enters and distributes into the tissues. The antibiotic enters the brain in small quantities.
The largest amount of medicine is in the blood after 1 hour (when using capsules), after 1 hour (when administered into the gluteal muscle) in children and after 3 hours in adults. The antibiotic enters the bloodstream most quickly when administered into a vein. The medication in therapeutic concentration remains in the blood for 8-12 hours. The drug is metabolized in the liver tissues. The medicine is excreted by the kidneys in the urine and intestines along with feces.
Indications for use
Diseases for which the drug can be prescribed are:
- Infections of the ENT organs (inflammation of the pharynx, larynx, ear, paranasal sinuses, lungs, bronchi, abscesses), respiratory pathologies.
- Scarlet fever.
- Diphtheria.
- Diseases of the genitourinary organs (damage to the uterus, vulvovaginitis, colpitis, salpingoophoritis, chlamydia).
- Staphyloderma, pyoderma, abscesses, peritonitis.
- Septicemia (blood poisoning without purulent damage to internal organs).
- Purulent inflammation of bone tissue (osteomyelitis).
- Bacterial endocarditis (inflammation of the inner lining of the heart with damage to the valves).
The medicine can be prescribed for prophylactic purposes for injuries and perforation of the intestinal wall. In this case, preference is given to intramuscular or intravenous injections.
Contraindications
The instructions state the following contraindications to the use of the medicine:
- myasthenia gravis (muscle weakness);
- allergy to drugs based on clindamycin and Lincomycin;
- asthma;
- ulcerative form of colitis (inflammation of the colon);
- pregnancy (it is safe to use the cream in the 2nd and 3rd trimesters);
- lactation period;
- age up to 3 years (for solution);
- age up to 8 years or child weight less than 25 kg (for capsules).
The elderly and people with renal and hepatic pathologies should take the medicine with caution.
How to use
For children over 15 years of age and adults, it is recommended to take the antibiotic 1 capsule every 6 hours. In severe cases, the doctor may increase the dosage. Injections should be done twice a day (2 times 300 mg). When treating patients over 3 years of age, the dosage is 15-25 mg/kg/day.
In case of liver and kidney dysfunction, as well as in case of long intervals (8 hours or more), no dose adjustment is required.
Taking the drug for diabetes mellitus
For diabetes mellitus, the antibiotic is used both in the form of oral agents and in the form of suppositories for intravaginal administration and solution. During treatment, it is recommended to monitor blood sugar levels.
Side effects
Most often they are reversible and disappear when treatment is stopped.
Gastrointestinal tract
When using Clindamycin, the following are possible:
- dyspepsia (digestion in the form of diarrhea, nausea);
- signs of inflammation of the esophagus (difficulty swallowing, heartburn, pain);
- yellowness of the skin;
- excess of normal levels of liver enzymes;
- increased concentration of liver enzymes in the blood;
- increased concentration of bilirubin in the blood;
- intestinal dysbiosis.
Sometimes patients develop pseudomembranous colitis.
Blood-forming organs
The following changes are possible in the blood and hematopoietic organs:
- drop in white blood cell levels;
- decrease in neutrophils;
- agranulocytosis;
- drop in platelet levels.
From the cardiovascular system
If the drug enters the vein too quickly, dizziness, decreased blood pressure, collapse and weakness are possible.
From the musculoskeletal system
Occasionally, there is a disturbance in the transmission of impulses from nerves to muscles.
Allergies
The following types of allergic reactions are possible:
- urticaria (itchy rashes in the form of blisters on various parts of the body);
- maculopapular rash;
- dermatitis;
- eosinophilia (increased level of eosinophils in the blood);
- anaphylaxis (shock, Quincke's edema).
special instructions
If pseudomembranous colitis is detected, ion exchange resins are effective. Antibiotic treatment must be stopped. If necessary, a drug based on metronidazole is used and infusion therapy is performed.
The instructions for use indicate that while taking Clindamycin you should not:
- use medications that impair intestinal motility;
- drinking alcohol;
- use other vaginal products (for creams and suppositories).
With long-term use of Clindamycin, like Erythromycin, the risk of activation of yeast-like fungi and the development of candidiasis increases.
Alcohol compatibility
Impact on the ability to operate machinery
The antibiotic does not cause dizziness or movement disorders, so it does not affect control of machinery or driving a car.
Clindamycin for children
When prescribing medication to children, their age and body weight are taken into account. Capsules cannot be used up to 8 years, and the solution - up to 3 years.
Use during pregnancy and lactation
Medicine in the form of solution and capsules is contraindicated during pregnancy. Vaginal cream can only be used for strict indications, when the possible benefits of treatment outweigh the potential harm to the fetus. In the first 3 months of gestation, suppositories are not prescribed, since during this period the baby’s vital organs are formed.
The use of Clindamycin in cream form during lactation and breastfeeding is possible taking into account the possible risks.
Use in old age
The drug for injection and oral use in old age should be used with extreme caution.
Overdose
If you exceed the daily dose of the drug, undesirable effects may increase. An overdose occurs with abdominal pain, fever and other symptoms. Hemodialysis (blood purification) is ineffective in this case. Patients are prescribed symptomatic medications. There is no antidote. An overdose of medicine in the form of cream or suppositories is extremely rare.
Interaction with other drugs
This drug enhances the therapeutic effect of the following drugs:
- aminoglycosides (Streptomycin, Gentamicin);
- rifamycin derivatives (Rifampicin);
- muscle relaxants.
The simultaneous use of this antibiotic with Ampicillin, magnesium, barbituric acid derivatives and calcium gluconate is prohibited. The antagonists of Clindamycin are Erythromycin and Chloramphenicol.
The medicine does not combine well with antidiarrheals, B vitamins and Phenytoin. If you use narcotic analgesics at the same time, breathing may stop.
Analogues
Analogues of the drug in the form of a cream are Dalacin, Clindes and Clindacin. All of them are indicated for gynecological pathology. Gels for external use are produced: Klindatop, Klenzit-S and Klindovit. They are indispensable in the complex treatment of acne.
There is also Clindacin B Prolong cream. It differs in that it includes the antifungal substance butoconazole nitrate, which expands the spectrum of antimicrobial action. An analogue of Clindamycin in solution form is Zerkalin. It clears the skin of acne and pimples, just like the drug Adapalene.
Conditions for dispensing from a pharmacy
The medicine is dispensed according to a doctor's prescription.
Price for Clindamycin
Capsules cost from 170 rubles, and the price of a solution based on this antibiotic is more than 600 rubles. The cream costs from 350 rubles, the preparation in the form of suppositories costs more than 500 rubles.
Storage conditions for the drug Clindamycin
The solution is stored in a darkened place at a temperature of +15...+25ºC. The place where the antibiotic is stored must be inaccessible to children. The medicine belongs to list B. Suppositories are stored under the same conditions, the room must be dry. When storing the cream, the temperature should not exceed 20ºC. Clindamycin-based gel (Clindatop) should not be frozen or stored in the refrigerator.
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