Clindamycin: new indications for the old drug

Clindamycin, an antibiotic belonging to the lincosamide class, entered clinical practice in 1966. The mechanism of action of clindamycin is associated with impaired protein synthesis on bacterial ribosomes. The drug has high activity against Streptococcus pneumoniae (including penicillin-resistant strains), Staphylococcus aureus (including certain methicillin-resistant strains, MRSA), as well than many anaerobic bacteria, such as Bacteroides fragilis, Peptostreptococcus, Clostridium perfringens. The antimicrobial spectrum of the drug does not include aerobic gram (-) microorganisms, Heamophilus influenzae, Moraxella catarrhalis and Clostridium difficile. The resistance level of Streptococcus pneumoniae to clindamycin according to the results of the study of the Alexander project, which included more than 8000 strains of pneumococci from various regions of the world, is 13.9%.

Clindamycin is well absorbed orally. High concentrations of the drug are created in bile, bones and joints, respiratory organs, but the drug does not penetrate well into the cerebrospinal fluid, even under conditions of inflammation of the meninges. The drug is metabolized in the liver with the formation of active and inactive metabolites.

There are several dosage forms of clindamycin, which reflects the versatility of its clinical use: capsules and oral solution, injectable forms, topical forms (gel, lotion, solution, vaginal cream, suppositories).

Pseudomembranous colitis is the best known and most feared side effect of clindamycin. Although many antibiotics can cause pseudomembranous colitis, most often it develops in connection with the intake of lincosamides. The risk of this reaction does not depend on the dose and the duration of treatment and may occur several weeks after treatment with clindamycin.

Clindamycin is used for anaerobic infections, including pelvic inflammatory processes, intra-abdominal infections and oral infections, for bone and joint infections caused by anaerobic microflora or S.aureus , as well as infections of the skin and soft lung tissue and moderate severity caused by S. aureus, including some strains of MRSA. Clindamycin can also be used in patients allergic to β-lactam antibiotics.

Clindamycin has recently been recommended as an alternative to treat common childhood infections such as acute otitis media and sinusitis in patients with pneumococcal etiology of these diseases. In the guidelines of the American Academy of Pediatrics for the diagnosis and treatment of acute otitis media, clindamycin at a dose of 30 to 40 mg / kg / day in three doses is recommended as an alternative drug for allergic patients to penicillin who have not responded to empiric antibiotic therapy. In this case, it is precisely the pneumococcal etiology of the disease that must be suspected, since clindamycin is not active against H. influenzae and M.catarrhalis. This situation can be observed with the ineffectiveness of the drug having good activity against H. influenzae and M.catarrhalis. As a rule, the drug is prescribed when S. pneumoniae is isolated from the middle ear fluid in a child who has not responded to treatment, and when the microorganism is resistant to antibiotics β-lactam antibiotics. In the American Academy of Pediatrics guidelines for the treatment of sinusitis, clindamycin is also recommended for the treatment of children allergic to penicillin with a known pneumococcal etiology of the process.