Medical News Today: What to know about clindamycin

Clindamycin is an antibiotic. It works by stopping bacteria from growing.

Doctors prescribe clindamycin to treat bacterial infections, and the drug comes in oral, topical, and injectable forms.

Topical clindamycin is a common treatment for acne and bacterial infections in the vagina.

Doctors use clindamycin to treat infections in people with a penicillin allergy. Clindamycin is not suitable for everyone, and it can cause a range of serious side effects.

In this article, we describe the uses, forms, dosage, warnings, and side effects of clindamycin.

Overview

Clindamycin is an antibiotic drug. People use antibiotics to treat bacterial infections. Antibiotics, including clindamycin, do not work for infections caused by viruses.

Clindamycin is in the lincosamide family. These antibiotics work by disrupting the way that bacteria produce proteins.

Depending on the type of infection and the dosage of clindamycin, the drug can either kill or stop the growth of bacteria.

Uses

Doctors use clindamycin to treat a variety of bacterial infections. The Food and Drug Administration (FDA) have approved clindamycin to treat:

• blood infections
• septicemia, which is blood poisoning
• abdominal infections
• lung infections
• infections of the female reproductive tract
• bone and joint infections
• skin infections

People can also take clindamycin for uses that are not FDA-approved. Sometimes doctors use clindamycin to treat anthrax and malaria, for example.

Dentists also use clindamycin as a preventive treatment for endocarditis, an infection of the heart’s lining that can occur after a dental procedure in people who are at risk.

Before undergoing surgery, some people need to take clindamycin to prevent surgical site infections.

Types

There are four forms of clindamycin: injectable, intravaginal, oral, and topical.

The following table lists forms of clindamycin, along with their dosages in milligrams (mg), milligrams per milliliter (mg/ml), or percentage.

Injectable	Intravaginal	Oral	Topical
Clindamycin phosphate injection 6 mg/ml	Cleocin cream 2%	Clindamycin capsule 75 mg	Evoclin foam 1%
Clindamycin phosphate injection 12 mg/ml	Cleocin suppository 100 mg	Clindamycin capsule 150 mg	Clindagel 1%
Clindamycin phosphate injection 18 mg/ml		Clindamycin capsule 300 mg	Cleocin T lotion 10 mg/ml
Clindamycin phosphate injection 150 mg/ml		Clindamycin palmitate hydrochloride granules 75 mg/5 ml	Clindamycin phosphate solution 1%

How to use and dosage

The form and dosage of clindamycin that a doctor prescribes will depend on the infection.

Oral capsules and granules

Doctors should only prescribe clindamycin to people who are allergic to penicillin or if they suspect that a different antibiotic would be inappropriate. This is because of the risk of colitis, which is inflammation of the colon’s inner lining.

If possible, the doctor should take samples from the infection site to check which bacteria are causing the infection.

Clindamycin capsules may irritate the esophagus, the tube that runs from the mouth to the stomach. To avoid this irritation, take clindamycin capsules with a full glass of water.

The dosages of clindamycin capsules for adults are:

• for serious infections, 150–300 mg every 6 hours
• for more severe infections, 300–450 mg every 6 hours

The dosages for children who can swallow capsules are:

• for serious infections, 8–16 milligrams per kilogram (mg/kg) per day, divided into three or four equal doses
• for more severe infections, 16–20 mg/kg per day, divided into three or four equal doses

For people who have difficulty swallowing, clindamycin comes in granules that a person can dissolve in water.

Vaginal cream and suppositories

Topical clindamycin can treat bacterial infections in the vagina.

The cream comes with an applicator. Insert the amount of one applicator, which is around 100 mg of clindamycin, into the vagina once daily at bedtime for 3 or 7 consecutive nights.

Cleocin vaginal cream is safe for pregnant women to use in the second and third trimesters. A pregnant woman requires 7 days of treatment.

Pregnant women should not use clindamycin vaginal suppositories. Researchers have yet to confirm the safety of suppositories during pregnancy.

To use a suppository, insert one suppository pill, which is equivalent to 100 mg of clindamycin, into the vagina once daily at bedtime for three consecutive nights.

People with a history of colitis should not use clindamycin creams or suppositories.

Lotion, gel, and solution

Doctors prescribe clindamycin lotion, gel, and solution to treat acne.

A person with acne can apply a thin layer of Cleocin T 1% lotion or clindamycin 1% solution to the affected area of skin twice a day.

A person can apply Clindagel 1% once daily to the affected area when acne appears.

Topical clindamycin can cause diarrhea. Anyone who has had colitis should avoid using this treatment.

Injections

If a person has a very serious infection and they cannot take other antibiotics, they may receive injectable clindamycin in the hospital.

The following table includes the dosages of injectable clindamycin in mg/kg per day and in mg per day.

Babies (less than 1 month old)	Children and adolescents (ages 1 month to 16 years)	People older than 16 years
15–20 mg/kg per day in 3 or 4 equal doses	20–40 mg/kg per day in 3 or 4 equal doses	600–1,200 mg/day in 2, 3, or 4 equal doses
		more severe infections: 1,200–2,700 mg/day in 2, 3, or 4 equal doses
		life-threatening infections: up to 4,800 mg/day

Side effects

One of the most common side effects of a majority of antibiotics is diarrhea. Sometimes people experience severe diarrhea when taking clindamycin.

Clindamycin can alter the bacterial composition of the colon and cause an overgrowth of the Clostridium difficile (C. difficile) bacterium. This bacterium produces toxins that can cause C. difficile associated diarrhea (CDAD).

CDAD is a severe and life-threatening infection. If a person develops CDAD while taking clindamycin, the doctor will immediately stop the antibiotic.

Other possible side effects of oral or injectable clindamycin include:

• abdominal pain
• irritation of the esophagus
• nausea
• vomiting
• allergic skin reactions
• severe allergic reactions
• inflammation of the vagina
• fluid buildup under the skin
• impeded liver function
• impeded kidney function
• blood disorders
• disrupted function of the immune system
• arthritis

People using clindamycin solution or lotion for acne may report skin-related side effects, including:

• dryness
• redness
• a burning or stinging sensation
• peeling
• itchiness
• oiliness

For example, when an individual uses Clindagel for acne, the most common side effects are itchiness and skin peeling.

People rarely experience diarrhea or colitis after using clindamycin topically. However, some people have reported abdominal disturbances.

Clindamycin suppositories and vaginal cream may cause the same side effects as the oral or injectable forms.

Rarely, a person may develop colitis from using a vaginal clindamycin product.

Other side effects of using clindamycin suppositories or vaginal cream include:

• vaginal fungal infections
• inflammation of the vagina and vulva
• disorders of the vagina or vulva
• vaginal pain

Warnings

People with a history of pseudomembranous or ulcerative colitis should not take clindamycin. These two conditions cause severe inflammation of the lining of the intestine.

The side effects of taking clindamycin can worsen these two conditions.

Doctors should only prescribe clindamycin to people who have bacterial infections. This helps reduce the resistance that bacteria can develop to clindamycin. Learn more about antibiotic resistance here.

Drug interactions

Drug interactions may occur when using any form of clindamycin.

Doctors should prescribe clindamycin with caution to people taking neuromuscular blocking agents. These drugs play a role in certain medical procedures and operations.

When people take oral forms of clindamycin, the liver enzyme CYP3A4 breaks it down in the body. Stimulating the function of this enzyme can cause a decrease in levels of clindamycin. If something inhibits CYP3A4, clindamycin levels may increase in the blood.

Certain drugs can affect the functioning of CYP3A4. When people are taking CYP3A4 stimulants along with clindamycin, doctors must follow up and make sure that the antibiotic is working.

If a person is taking an inhibitor of CYP3A4 with clindamycin, the increased levels of the antibiotic may cause side effects. Doctors should monitor any increase in adverse effects.

Alternatives to clindamycin

Clindamycin and lincomycin are the only members of the lincosamide family.

Lincomycin is only available in an injectable solution and is prescribed by doctors for serious infections.

Depending on the infection and on a person’s history of allergies and side effects from antibiotics, a doctor may choose another class of antibiotic instead.

Summary

Clindamycin is an effective antibiotic for a variety of serious infections. People also use clindamycin for treating acne.

There are many possible side effects of clindamycin, and doctors should weigh the benefits and risks before prescribing this antibiotic.

People with a history of colitis should avoid taking clindamycin because it could damage their health.

When serious side effects occur, they tend to affect people taking oral or injectable forms of clindamycin, but they can arise in people using topical forms.