Dalacin - instructions for use, analogs, reviews and release forms (capsules or tablets 150 mg and 300 mg, suppositories 100 mg, vaginal cream 2%, gel or ointment T 1%, pricks C) for the treatment of acne in adults , children and pregnancy

In this article, you can read the instructions for using the drug Dalacin. There are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors of specialists on the use of the antibiotic Dalacin in their practice. A big request is to actively add their feedback on the drug: the medicine helped or did not help get rid of the disease, which were observed complications and side effects, possibly not declared by the manufacturer in the annotation. Analogues of Dalacin in the presence of existing structural analogues. Use to treat acne (acne), scarlet fever, tonsillitis and other infections in adults, children, as well as during pregnancy and lactation. Composition of the preparation.

Dalacin is a semisynthetic antibiotic of the lincosamides group formed from Lincomycin upon substitution of 7- (R) -hydroxyl group for 7- (S) -chlor, which is active against aerobic gram-positive microorganisms and a wide spectrum of anaerobic bacteria. Most gram-negative aerobic bacteria, including Enterobacteriaceae, are resistant to clindamycin.

Lincosamides like macrolides (for example, erythromycin) bind to the 50S subunit of the bacterial ribosome and inhibit protein synthesis in the early stages. Depending on the sensitivity of the microorganism and the concentration of the drug, Clindamycin can act bacteriostatically (predominantly) or bactericidal (in high concentrations).

The following microorganisms are sensitive to clindamycin in vitro:

1. Aerobic Gram-positive cocci, including: Staphylococcus aureus; Staphylococcus epidermidis (strains that produce and do not produce penicillinase). In vitro, rapid development of clindamycin resistance in some staphylococcal strains resistant to Erythromycin was noted. Streptococcus spp. (with the exception of Streptococcus faecalis), Pneumococcus spp.

2. Anaerobic gram-negative bacilli, including: Bacteroides spp. (including the B. fragilis group, B. disisens, B. bivius and B. melaninogenicus), Fusobacterium spp.

3.Anaerobic Gram-positive bacilli that do not form spores, including Propionibacterium spp., Eubacterium spp., Actinomyces spp.

4. Anaerobic and microaerophilic gram-positive cocci, including Peptococcus spp., Peptostreptococcus spp., Microaerophilic Streptococcus spp., Clostridia spp .: clostridia show greater resistance to clindamycin than most other anaerobes. Most Clostridium perfringens are sensitive to clindamycin, but other species, such as C. sporogenes and C.tertium, are often resistant to clindamycin, so it is necessary to sample for sensitivity.

5. Various organisms, including Chlamydia trachomatis, Toxoplasma gondii, Plasmodium falciparum and Pneumocystis carinii (in combination with primaquine), Gardnerella vaginalis, Mobiluncus mulieris, Mobiluncus curtisii, Mycoplasma hominis.

The following microorganisms are usually resistant to clindamycin: aerobic gram-negative bacilli Streptococcus faecalis, Nocardia spp., Neisseria meningitidis, strains of methicillin-resistant Staphylococcus aureus and strains of Haemophilus influenzae. There is a cross-resistance between lincomycin and clindamycin.

Composition

Clindamycin + excipients.

Pharmacokinetics

After oral administration, Dalacin is rapidly and almost completely absorbed (90%). When ingested, the absorption of clindamycin (quantitatively) does not depend to a large extent on the simultaneous intake of food, but taking with food can slow absorption.There is a linear relationship between the concentration of clindamycin in the serum and the dose taken. 40-90% of the injected drug binds in the body to proteins. Clindamycin does not penetrate the intact blood-brain barrier (BBB) ​​(even with inflammation of the meninges, permeability increases insignificantly). In an unchanged form, about 10% of the drug is excreted from the body by the kidneys, 3.6% - with feces. The rest of the amount is excreted in the form of inactive metabolites, mainly with bile and feces. Clindamycin is not excreted by hemodialysis and peritoneal dialysis.

Indications

Infectious-inflammatory diseases caused by clindamycin-sensitive anaerobic bacteria or strains of Gram-positive aerobic bacteria, such as Streptococcus spp., Staphylococcus spp. and Pneumococcus spp., as well as clindamycin-sensitive serovars Chlamydia trachomatis:

• infections of the upper respiratory tract, incl. tonsillitis, pharyngitis, sinusitis;
• inflammation of the middle ear, scarlet fever;
• infections of the lower respiratory tract, incl. bronchitis, pneumonia, pleural empyema and lung abscess;
• infectious diseases of the skin and soft tissues, incl.acne, furunculosis, subcutaneous adipose tissue infection, impetigo, abscesses, infected wounds, specific infectious processes in the skin and soft tissues caused by pathogens sensitive to this drug, such as erysipelas and paronychia (panaritium);
• infectious diseases of bones and joints, incl. osteomyelitis and septic arthritis;
• gynecological infectious diseases, including endometritis, infections of subcutaneous fat, infections of tissues surrounding the vagina, abscesses of the fallopian tubes and ovaries, salpingitis and inflammatory diseases of the pelvic organs, in combination with an antibacterial drug active against gram-negative aerobic pathogens (eg, gentamycin);
• monotherapy of infectious diseases of the cervix, caused by Chlamydia trachomatis;
• infectious diseases of the abdominal cavity, including: peritonitis and abscesses of the abdominal cavity (in combination with other antibacterial drugs that act on gram-negative aerobic bacteria);
• septicemia and endocarditis;
• infections of the oral cavity, such as: periodontal abscess and periodontitis;
• toxoplasmic encephalitis in AIDS patients (in combination with pyrimethamine in patients with intolerance to standard therapy);
• pneumocystis pneumonia in AIDS patients (in combination with primaquine in patients with intolerance or resistant to standard therapy);
• malaria, incl. caused by multiresistant Plasmodium falciparum, either in monotherapy or in combination with quinine or chloroquine;
• prophylaxis of endocarditis in patients with hypersensitivity to penicillins;
• bacterial vaginosis.

Forms of release

Capsules 150 mg and 300 mg (sometimes mistakenly called pills).

Candles vaginal 100 mg №3.

Gel for external use 1% (Dalacin T).

Vaginal cream 3% (sometimes mistakenly called ointment).

Solution for intravenous and intramuscular administration (Dalacin TS phosphate) (injections in ampoules for injection).

Instructions for use and dosing regimen

Capsules

To avoid complications, use strictly according to the doctor's prescription.

Adults: 600-1800 mg / day orally in 2, 3 or 4 doses (equal doses).

Children: 8-25 mg / kg body weight / day inside in 3-4 divided doses (equal doses).

To avoid irritation of the esophageal mucosa, the capsules should be taken with a full glass of water.

If the calculated dose is one dose lower than the amount of clindamycin in the capsule or there are swallowing disorders, parenteral forms of the drug should be recommended.

Infections caused by beta-hemolytic streptococcus: doses are indicated above, treatment should be continued for at least 10 days.

Infectious-inflammatory diseases of the pelvic organs: 900 mg clindamycin iv every 8 h + iv an appropriate antibacterial agent active against gram-negative aerobic pathogens (eg, Gentamicin at a dose of 2.0 mg / kg followed by administration of 1.5 mg / kg every 8 hours for patients with normal renal function), for at least 4 days, and after the onset of improvement of the patient's condition - for at least 48 hours. Then they switch to clindamycin ingestion for 450-600 mg every 6 hours daily. The full course of therapy is 10-14 days.

Cervical infections caused by Chlamydia trachomatis: 450-600 mg orally 4 times daily for 10-14 days.

Toxoplasmosis encephalitis in AIDS patients: in patients with intolerance to standard therapy, clindamycin is used in combination with pyrimethamine according to the following scheme: 600-1200 mg orally every 6 hours for 2 weeks, then 300-600 mg orally every 6 hours. Pyromethamine is administered at a dose of 25 -75 mg orally every day.Usually the course of therapy is 8-10 weeks. When using higher doses of pyrimethamine, folinic acid should be given at a dose of 10-20 mg / day.

Pneumocystis pneumonia in AIDS patients: 300-450 mg orally every 6 hours for 21 days and primaquine 15-30 mg orally once a day for 21 days.

Acute streptococcal tonsillitis / pharyngitis: 300 mg orally 2 times a day for 10 days.

Malaria: 10-20 mg / kg / day for adults and 10 mg / kg / day for children every 12 hours in equal doses for 7 days as monotherapy, or in combination with quinine (12 mg / kg every 12 hours) or chloroquine (15-25 mg every 24 hours) for 3-5 days.

Prophylaxis of endocarditis in patients with hypersensitivity to penicillins: 600 mg orally for adults and 20 mg / kg for children 1 hour before a minor surgical or dental intervention or any other procedure associated with a risk of endocarditis.

Elderly patients: there is no need to modify the dose at normal (for a given age) liver and kidney function.

Gel

Outwardly. A thin layer of gel is applied to the affected area of ​​clean dry skin 2 times a day. To obtain satisfactory results, treatment should be continued for 6-8 weeks, and if necessary, continue for up to 6 months.

Cream

A single dose (1 complete applicator (5 g of cream, approximately 100 mg of clindamycin)) is inserted into the vagina preferably at bedtime for 3 or 7 consecutive days.

In the package with 20 g of cream there are 3 plastic applicators, and in the package with 40 g - 7 applicators intended for the correct introduction of cream into the vagina.

Terms of use

1. Remove the cap of the tube with cream. Screw the plastic applicator onto the threaded neck of the tube.
2. Rolling the tube from the opposite end, gently squeeze the cream into the applicator. The applicator is full when its piston comes to a stop.
3. Unscrew the applicator from the tube and wrap the cap.
4. In the supine position on your back, pull your knees to your chest.
5. Hold the applicator horizontally, gently insert it into the vagina as deeply as possible, without causing unpleasant sensations.
6. Slowly pressing the piston against the stop, insert the cream into the vagina.
7. Carefully remove the applicator from the vagina and discard it.

Side effect

• abdominal pain;
• nausea, vomiting;
• diarrhea;
• esophagitis;
• ulcer of the esophagus;
• pseudomembranous colitis;
• dysbiosis;
• maculopapular rash;
• hives;
• itching;
• generalized measles-like rash of mild to moderate severity;
• erythema multiforme;
• exfoliative and vesicle-bullous dermatitis;
• toxic epidermal necrolysis;
• anaphylactoid reactions;
• cases of neutropenia (leukopenia) and eosinophilia of a passing character were noted;
• vaginitis;
• development of superinfection.

Contraindications

• increased sensitivity to clindamycin, lincomycin or any component of the drug.

Application in pregnancy and lactation

Clindamycin penetrates the placenta. After the administration of several doses of the drug, the concentration in the amniotic fluid was approximately 30% of the concentration in the mother's blood. Clindamycin should be used in pregnant women only if the perceived benefit to the mother is greater than the potential risk to the fetus. Clindamycin is found in breast milk in a concentration of 0.7-3.8 μg / ml.

If necessary, the appointment in the lactation period should stop breastfeeding.

special instructions

In the case of cervical infections caused by Chlamydia trachomatis, clindamycin monotherapy is effective for complete cure.

Cases of pseudomembranous colitis of various severity levels up to life threatening were observed with the use of almost all antibacterial agents,including Dalacin, so in all cases of diarrhea after taking antibacterial drugs should consider the possibility of this diagnosis. Antibacterial drugs suppress the normal flora of the intestine, which can contribute to increased reproduction of clostridia. It is proved that the toxins produced by Clostridium difficile are the main cause of colitis associated with antibiotic therapy. Pseudomembranous colitis can occur both with the use of clindamycin, and 2-3 weeks after discontinuation of treatment; is manifested by diarrhea, leukocytosis, fever, abdominal pain (sometimes accompanied by discharge with mucous masses of blood and mucus). After diagnosis of pseudomembranous colitis in mild cases, it is sufficient to discontinue treatment and use ion-exchange resins (colestyramine, colestipol), in cases of moderate severity and in severe cases, compensation for loss of fluid, electrolytes and protein, the appointment of an antibacterial agent effective against Clostridium difficile, Vancomycin in a dose of 125-500 mg, or bacitracin in a dose of 25 000 units orally 4 times a day for 7-10 days, or Metronidazole 250-500 mg 3 times a day.Drugs that reduce gastrointestinal motility should not be prescribed simultaneously with clindamycin.

With the use of all antibacterial agents, including clindamycin, excessive growth of microorganisms insensitive to the given drug, especially yeast-like fungi, is possible. With the development of superinfection, appropriate measures should be taken depending on the clinical situation.

Clindamycin should not be prescribed for the treatment of meningitis, since it does not penetrate well through the blood-brain barrier (BBB).

When prescribing the drug in high doses, it is necessary to monitor the concentration of clindamycin in the plasma. If the treatment is carried out for an extended period of time, the liver and kidney function should be performed regularly.

In patients with impaired liver and kidney function, there is no need to modify the dose of the drug, since clindamycin practically does not accumulate in the body if the drug is taken internally at an interval of 8 hours.

Drug Interactions

It has been established that antagonism between Dalacin and erythromycin is manifested in vitro. Since this antagonism can be clinically significant, these drugs should not be taken concomitantly.There is evidence of a similar interaction with chloramphenicol.

It has been established that Dalacine disrupts neuromuscular transmission and, consequently, can enhance the action of other peripheral muscle relaxants, so the drug should be used with caution in patients receiving drugs of this group.

The simultaneous use with opioid (narcotic) analgesics, which have a central depressant effect on the respiratory function, can lead to more pronounced respiratory depression up to apnea.

Simultaneous appointment with antidiarrheal drugs, which reduce the motility of the gastrointestinal tract, increases the risk of developing pseudomembranous colitis.

Aminoglycosides expand the spectrum of antimicrobial action of clindamycin.

Analogues of the drug Dalacin

Structural analogs for the active substance:

• Dalacine TS phosphate;
• Mirror;
• Klimitsin;
• Clindamycin;
• Klindatop;
• Clindefer;
• Clindacine;
• Klindes;
• Klindovit.

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