Cleocin

Description

Cleocin Capsule is prescribed to treat various serious bacterial infections in different parts of the body, including:

• Dental infections (odontogenic infections)
• Respiratory tract infections (e.g., severe pneumonia, lung abscesses, empyema)
• Skin and soft tissue infections (e.g., cellulitis, severe acne, surgical site infections, diabetic foot infections, necrotizing soft tissue infections)
• Intra-abdominal infections (e.g., peritonitis, intra-abdominal abscesses)
• Anaerobic infections generally
• Endocarditis prophylaxis (prevention of heart valve infection before certain dental procedures)
• Toxic shock syndrome (often used in combination with other antibiotics to inhibit toxin production)
• Bacterial vaginosis
• Pelvic inflammatory disease (often used in combination with other antibiotics)
• Bone and joint infections (often as adjunctive therapy in surgical treatment)

How to Take Cleocin Capsule

Important: Always follow your doctor’s specific instructions for dosage and duration of treatment.

Adult Dosing (Oral)

• Serious Anaerobic Infections: 150-300 mg every 6 hours. For more severe infections, the dose may be increased to 450 mg every 6 hours.
  • Maximum daily dose: 1.8 grams.
• Prophylaxis of Endocarditis (before dental procedures): 600 mg taken 1 hour before the procedure.
• Bacterial Vaginosis: 300 mg by mouth every 12 hours for 7 days.

Adult Dosing (Intravenous – for injectable forms, not Cleocin Capsule)

• Serious Anaerobic Infections: 0.6-2.7 g per day, given in divided doses. Up to 4.8 g per day may be used for very severe infections.
• Toxic Shock Syndrome: 900 mg every 8 hours, typically with penicillin G or ceftriaxone.
• Pelvic Inflammatory Disease: 900 mg every 8 hours, typically with gentamicin.
  • IV Preparation: Dilute 300 mg and 600 mg in 50 mL of D5W. Dilute 900 mg in 50-100 mL of D5W. Dilute 1200 mg in 100 mL of D5W.
  • IV Administration (Intermittent Infusion): Infuse over 10-60 minutes at a rate not exceeding 30 mg/min. (e.g., 300 mg over 10 min, 600 mg over 20 min, 900 mg over 30 min, 1200 mg over 60 min; no more than 1200 mg per hour).
  • Continuous IV Infusion: May be given after the first dose, which is administered by rapid IV infusion.

Child Dosing (Oral)

• Neonates (less than 1 month): 15-20 mg/kg/day in 3 to 4 equal doses. Lower effective dosages may be sufficient for small premature infants.
• Children: 10–25 mg/kg/day every 8 hours.
  • For CA-MRSA, intra-abdominal infections, or Acute Otitis Media (AOM): 30–40 mg/kg/day.

Child Dosing (Parenteral – IV/IM)

• 20–40 mg/kg/day every 8 hours. Higher doses are used for more severe infections.

Administration Instructions

• Capsules: Can be taken with or without food. Swallow the capsule whole with a full glass of water. It is recommended to remain in an upright position (sitting or standing) for at least 30 minutes after taking the capsule to prevent irritation of the esophagus.
• Granules (if applicable): Should be taken with food.

Renal Impairment

• No specific dosage adjustment is typically required for patients with renal impairment, including those with severe renal failure or undergoing hemodialysis, as clindamycin is primarily metabolized by the liver rather than excreted by the kidneys. However, careful monitoring is advised for patients with severe liver disease.

Important Warnings & Precautions

Contraindications (Do NOT take if):

• You have a known hypersensitivity or allergic reaction to clindamycin or lincomycin.
• You have a history of antibiotic-associated colitis (especially pseudomembranous colitis).

Precautions:

• Gastrointestinal Disease: Use with caution if you have a history of gastrointestinal diseases, particularly colitis. Clindamycin has a notable association with Clostridium difficile-associated diarrhea and pseudomembranous colitis, which can range from mild to life-threatening.
• Renal and Hepatic Impairment: While dosage adjustments are generally not needed for renal impairment, patients with severe liver disease should be monitored closely (e.g., periodic liver enzyme tests).
• Pregnancy and Lactation:
  • Pregnancy: Clindamycin is classified as Pregnancy Category B. Use during pregnancy only if clearly needed and the potential benefits outweigh the risks.
  • Lactation: Clindamycin is excreted in breast milk. The manufacturer suggests discontinuing the drug or refraining from nursing; however, the American Academy of Pediatrics (AAP) Committee on Drugs considers it compatible with nursing, with caution for possible adverse effects on the infant’s gut flora.
• Neonates and Atopic Patients: Use with caution.
• Elderly Patients: Monitor carefully, as some older patients may tolerate diarrhea less well.
• Prolonged Therapy: Regular monitoring of blood counts, liver function, and kidney function is recommended during prolonged treatment.
• Overgrowth of Non-susceptible Organisms: Prolonged use may lead to overgrowth of non-susceptible bacteria or fungi, potentially causing superinfections.
• Neuromuscular Blocking Properties: Clindamycin has neuromuscular blocking properties; use with caution in patients receiving other neuromuscular blocking agents.

Drug Interactions

Clindamycin can interact with other medications, potentially altering their effects:

• Neuromuscular Blocking Agents (e.g., atracurium, rocuronium): Clindamycin may enhance their action, leading to prolonged neuromuscular blockade.
• Parasympathomimetics: Clindamycin may antagonize their effects.
• Macrolides (e.g., erythromycin), Ketolides, Streptogramins, Linezolid, Chloramphenicol: May competitively inhibit the effects of these antibiotics if used concurrently, as they share similar binding sites on the bacterial ribosome.
• Vitamin K Antagonists (e.g., warfarin, acenocoumarol, fluindione): Increased coagulation tests (prothrombin time/INR) and/or bleeding risk have been reported. Close monitoring of coagulation parameters is essential.

Adverse Effects (Side Effects)

Common side effects of Clindamycin include:

• Gastrointestinal: Diarrhea, nausea, vomiting, abdominal pain.
• Skin: Erythema multiforme, contact dermatitis, exfoliative and vesiculous dermatitis, urticaria (hives).
• Other: Eosinophilia (increased white blood cells), local irritation (especially at injection site), thrombophlebitis (inflammation of a vein with clot formation, with IV administration).

Potentially Fatal Side Effects:

• Pseudomembranous Colitis: Severe and persistent diarrhea, abdominal pain, fever, and passage of blood/mucus. This can occur during or even several weeks after treatment. Seek immediate medical attention if this occurs.
• Gasping Syndrome: A rare but serious and potentially fatal respiratory syndrome reported in neonates, primarily linked to large doses of intravenous benzyl alcohol (a preservative sometimes found in injectable formulations).

How Does it Work? (Mechanism of Action)

Clindamycin works by inhibiting bacterial protein synthesis. It does this by reversibly binding to the 50S ribosomal subunit of susceptible bacteria. This binding prevents the transpeptidation or translocation reactions of the ribosomes, thereby blocking the synthesis of essential proteins required for bacterial growth and replication. This results in stunted cell growth, effectively stopping the infection.