Source: Health Products Regulatory Authority (ZA) Revision Year: 2022 Publisher: Sandoz SA (Pty) Ltd<sup>1</sup>, Waterfall 5-lr, Magwa Crescent West, Waterfall City, Jukskei View, 2090 1 Company Reg. No.: 1990/001979/07
Pharmacological classification: A 20.1.1 Broad and medium spectrum antibiotics
Pharmacotherapeutic group: Anti-infectives for systemic use
ATC code: J01FF01
Clindamycin binds exclusively to the 50S subunit of the bacterial ribosomes and suppresses protein synthesis.
Depending on the sensitivity of the organism and the concentration of the antibiotic, it may be either bactericidal or bacteriostatic. Clindamycin has antibacterial activity against Gram-positive organisms and to a lesser degree against Gram-negative organisms.
Resistance to clindamycin is most often due to mutations on the site of antibiotic binding to rRNA or to the methylation of specific nucleotides of the 23S RNA of the 50S ribosomal subunit. These alterations may determine in vitro cross-resistance to macrolides and streptogramins B (MLSB phenotype).
Resistance mechanisms may be due to active efflux.
Resistance to clindamycin can be induced by macrolides in macrolide-resistant bacterial strains.
There is complete cross-resistance between clindamycin and lincomycin. The incidence of clindamycin resistance is higher among methicillin-resistant strains of staphylococci and pneumococcal strains with decreased sensitivity to penicillin.
The prevalence of acquired resistance may vary geographically and with time for selected species and local information on resistance is desirable, particularly when treating severe infections. As necessary, expert advice should be sought when local prevalence of resistance is such that the utility of the agent in at least some types of infections is questionable.
Gram-positive aerobes:
Bacillus cereus
Corynebacterium diphtheriae
Methicillin-susceptible staphylococcus
Streptococcus agalactiae
Gram-negative aerobic bacteria:
Campylobacter
Anaerobic bacteria:
Actinomyces
Capnocytophaga
Clostridium perfringens
Eubacterium
Fusobacterium
Gardnerella vaginalis
Porphyromonas
Prevotella
Propionibacterium acnes
Veillonella
Other:
Chlamydia trachomatis
Leptospires
Mycoplasma hominis
Mycoplasma pneumoniae
(Acquired resistance >10%)
Gram-positive aerobic bacteria:
Enterococcus faecium
Erysipelothrix
Methicillin-resistant staphylococcus
Streptococcus pneumoniae
Streptococcus pyogenes
Oral streptococci
Anaerobic bacteria
Bacteroides
Clostridium (other than C. difficile and C. perfringens)
Mobiluncus
Peptococcus
Peptostreptococcus
Gram-positive aerobic bacteria:
Corynebacterium jeikeium
Enterococcus spp. (other than Enterococcus faecium)
Listeria
Nocardia asteroides
Rhodococcus equi
Gram-negative aerobic bacteria:
Nonfermenting gram-negative bacilli:
(Acinetobacter, Pseudomonas)
Enterobacter
Haemophilus
Legionella
Branhamella catarrhalis
Neisseria
Pasteurella
Anaerobic bacteria
Clostridium difficile
Other:
Mycobacteria
Ureaplasma urealyticum
About 90% of a dose of clindamycin hydrochloride is absorbed from the gastro-intestinal tract; concentrations of 2 to 3 micrograms per ml occur within one hour after a 150 mg dose of clindamycin, with average concentrations of about 0,7 micrograms per ml after 6 hours. After doses of 300 and 600 mg peak plasma concentrations of 4 and 8 micrograms per ml, respectively, have been reported. Absorption is not significantly diminished by food in the stomach, but the rate of absorption may be reduced.
Clindamycin is widely distributed in body fluids and most tissues, including bone, but it does not reach the cerebrospinal fluid in significant concentrations, even in the presence of inflamed meninges. It diffuses across the placenta into the foetal circulation and has been reported to appear in breast milk. High concentrations occur in bile. It accumulates in leucocytes and macrophages. Over 90% of clindamycin in the circulation is bound to plasma proteins. The half-life is 2 to3 hours, although this may be prolonged in pre-term neonates and patients with severe renal impairment.
Clindamycin undergoes metabolism, presumably in the liver, to the active N-demethyl and sulphoxide metabolites, and also some inactive metabolites. About 10% of a dose is excreted in the urine as active substance or metabolites and about 4% in the faeces; the remainder is excreted as inactive metabolites. Excretion is slow and takes place over several days. It is not effectively removed from the blood by dialysis.
No special characteristics.
See section 4.4 for further information.
None stated.
© All content on this website, including data entry, data processing, decision support tools, "RxReasoner" logo and graphics, is the intellectual property of RxReasoner and is protected by copyright laws. Unauthorized reproduction or distribution of any part of this content without explicit written permission from RxReasoner is strictly prohibited. Any third-party content used on this site is acknowledged and utilized under fair use principles.
