Clindamycin - instructions for use, analogs, reviews and release forms (cream and candles vaginal 2%, gel or ointment, capsules or tablets 150 mg, injections in ampoules for injections) drugs for the treatment of infections in adults, children and pregnancy

In this article, you can read the instructions for using the drug Clindamycin. Presented are reviews of visitors to the site - consumers of this medication, as well as opinions of doctors of specialists on the use of Clindamycin 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 Clindamycin in the presence of existing structural analogues.Use for the treatment of infectious diseases in adults, children, as well as during pregnancy and lactation.

Clindamycin - a drug from the group of antibiotics - lincosamides, has a wide spectrum of action, a bacteriostatic, binds to the 50S subunit of the ribosome and inhibits protein synthesis in microorganisms. It is active against Staphylococcus spp. (including Staphylococcus epidermidis, producing penicillinase), Streptococcus spp. (excluding Enterococcus spp.), Streptococcus pneumoniae, anaerobic and microaerophilic Gram-positive cocci (including Peptococcus spp. and Peptostreptococcus spp.), Corynebacterium diphtheriae, Clostridium perfringens, Clostridium tetani, Mycoplasma spp., Bacteroidesspp. (including Bacteroides fragilis and Bacteroides melaningenicus), anaerobic gram-positive, non-spore-forming bacilli (including Propionibacterium spp., Eubacterium spp., Actinomyces spp.).

Most strains of Clostridium perfringens are sensitive to clindamycin, but other clostridium species (Clostridium sporogenes, Clostridium tertium) are resistant to the drug, therefore, for antibodies diagnosed with Clostridium spp., An antibioticogram is recommended.

The mechanism of action and antimicrobial spectrum is close to that of Lincomycin (for some microorganisms, especially for bacteroids and non-spore forming anaerobes, it is 2-10 times more active).

Composition

Clindamycin (in the form of hydrochloride) + excipients (capsules and solution for injection).

Clindamycin (in the form of phosphate) + auxiliary substances (cream).

Pharmacokinetics

Quickly and completely absorbed in the digestive tract, simultaneous intake of food slows down absorption, without changing the concentration of the drug in the plasma. Easily penetrates into biological fluids and tissues (tonsils, muscle and bone tissue, bronchi, lungs, pleura, bile ducts, appendix, fallopian tubes, prostate, synovial fluid, saliva, sputum, wound surfaces); through the blood-brain barrier (BBB) ​​is poor (with inflammation of the meninges, the permeability of the BBB increases). Metabolized mainly in the liver (70-80%) with the formation of active (N-dimethyl-clindamycin and clindamycin sulfoxide) and inactive metabolites; is excreted for 4 days by kidneys (10%) and through the intestine (3.6%) as an active preparation, the rest - in the form of inactive metabolites.

Indications

• Infectious-inflammatory diseases caused by microorganisms sensitive to clindamycin;
• infection of the upper respiratory tract and infection of the ENT organs (pharyngitis, tonsillitis, sinusitis, otitis), lower respiratory tract (pneumonia, including aspiration, lung abscess, pleural empyema, bronchitis), scarlet fever, diphtheria;
• infection of the urogenital tract (chlamydia, endometritis, vaginal infections, tubo-ovarian inflammation);
• bacterial vaginosis;
• infections of the skin and soft tissues (infected wounds, abscesses, furuncles, panaritium), abdominal cavity (peritonitis, abscess), oral cavity;
• acute and chronic osteomyelitis;
• septicemia (primarily anaerobic);
• bacterial endocarditis;
• prevention of peritonitis and intra-abdominal abscess after intestinal perforation or as a result of traumatic infection (in combination with aminoglycosides).

Forms of release

Vaginal cream 2% (sometimes mistakenly call ointment).

Capsules 150 mg (sometimes mistakenly called pills).

Solution for intravenous and intramuscular injection (injections in ampoules for injection).

Vaginal candles and gel for external use are available in the forms of the preparation Dalacin on the basis of the active substance Clindamycin.

Instructions for use and how to use them

Capsules and ampoules

Inside, adults and children over 15 years of age (the average weight of a child is 50 kg and above) with moderate severity is prescribed 1 capsule (150 mg) 4 times a day (every 6 hours).

In severe infections for adults and children older than 15 years, a single dose can be increased to 2-3 capsules (300-450 mg).

With intramuscular and intravenous administration, the recommended dose for adults is 300 mg 2 times a day.In severe infections - up to 1.2-2.7 g per day, divided into 3-4 injections. It is not recommended to appoint a single dose in excess of 600 mg. The maximum single dose for intravenous administration is 1.2 g for 1 hour.

Children older than 3 years - 15-25 mg / kg per day, divided into 3-4 equal doses. In severe infections, the daily dose can be increased to 25-40 mg / kg body weight, divided into 3-4 identical injections.

Patients with severe hepatic and / or renal insufficiency do not need correction of the dosing regimen in the case of prescribing the drug with an interval of at least 8 hours.

For intravenous administration, the drug is diluted to a concentration of no more than 6 mg / ml; the diluted solution is injected intravenously into the drip (dropper) for 10-60 minutes.

It is not recommended to administer the drug intravenously.

Dilution and duration of infusion is recommended to be performed according to the dose scheme - volume of solvent - duration of infusion (respectively): 300 mg - 50 ml - 10 min; 600 mg - 100 ml - 20 min; 900 mg - 150 ml - 30 min; 1200 mg - 200 ml - 45 min. The following solutions can be used as the solvent: 0.9% sodium chloride solution and 5% Dextrose solution.

Cream

Recommended dose: intravaginally one complete applicator (5 g of cream) preferably at bedtime for 3 or 7 consecutive days.

Side effect

• dyspepsia (abdominal pain, nausea, vomiting, diarrhea);
• esophagitis;
• jaundice;
• dysbiosis;
• pseudomembranous enterocolitis;
• neuromuscular conduction disorder;
• leukopenia, neutropenia, agranulocytosis, thrombocytopenia;
• maculopapular rash;
• hives;
• itching;
• exfoliative and vesicle-bulbous dermatitis;
• anaphylactoid reactions;
• a decrease in blood pressure, up to a collapse;
• dizziness;
• weakness;
• irritation, soreness (in the place of intramuscular injection);
• thrombophlebitis (at the site of intravenous injection);
• development of superinfection.

Contraindications

• myasthenia gravis;
• bronchial asthma;
• ulcerative colitis (in history);
• rare hereditary diseases, such as: galactose intolerance, lactase deficiency or glucose-galactose malabsorption (for capsules);
• pregnancy;
• lactation period;
• Children's age up to 3 years - for a solution for intravenous and / or injection (due to the lack of safety data for the use of benzyl alcohol);
• Children under 8 years old for capsules (the average weight of the child is less than 25 kg);
• hypersensitivity.

Application in pregnancy and lactation

Contraindicated in pregnancy and lactation (lactation).

Use in children

Contraindicated:

• Children under 3 years old - for intravenous and intramuscular injection (due to lack of safety data for benzyl alcohol);
• Children under 8 years of age for capsules (the average weight of the child is less than 25 kg).

special instructions

Pseudomembranous colitis can occur both with the use of clindamycin, and 2-3 weeks after discontinuation of treatment (3-15% of cases); is manifested by diarrhea, leukocytosis, fever, abdominal pain (sometimes accompanied by discharge with mucous masses of blood and mucus). If these phenomena occur in mild cases, it is sufficient to cancel treatment and use ion-exchange resins (colestyramine, colestipol), in severe cases, compensation for loss of fluid, electrolytes and protein, the appointment of Vancomycin inwards or Metronidazole is indicated.

Do not use drugs that inhibit the intestinal motility.

The safety of the drug in children under 3 years is not established. With prolonged therapy, children need periodic monitoring of the blood formula and the functional state of the liver.

When prescribing the drug in high doses, it is necessary to monitor the concentration of clindamycin in the plasma.

Patients with severe hepatic impairment should be monitored for liver function (hepatic enzymes).

Drug Interactions

Clindamycin increases (mutually) the effect of rifampicin, aminoglycosides streptomycin, Gentamicin (especially in the treatment of osteomyelitis and the prevention of peritonitis after intestinal perforation).

Strengthens the action of competitive muscle relaxants, and also enhances the muscle relaxancy caused by n-holinoblokatorami.

Incompatible with ampicillin, barbiturates, aminophylline, Calcium gluconate and magnesium sulfate.

It shows antagonism with Erythromycin and chloramphenicol.

It is not recommended simultaneous use with solutions containing a complex of B vitamins, aminoglycosides, phenytoin.

Simultaneous administration with antidiarrheal drugs increases the risk of developing pseudomembranous colitis.

With simultaneous use with opioid (narcotic) analgesics, it is possible to intensify the respiratory depression caused by them (up to apnea).

Analogues of the drug Clindamycin

Structural analogs for the active substance:

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

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