Dalacin T
clindamycin hydrochloride
clindamycin palmitate hydrochloride
clindamycin phosphate
Pharmacologic class: Lincosamide
Therapeutic class: Anti-infective
Pregnancy risk category B
FDA Box Warning
• Clostridium difficile-associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including Cleocin, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon, leading to overgrowth of C. difficile.
• Because Cleocin therapy has been associated with severe colitis that may be fatal, it should be reserved for serious infections for which less toxic antimicrobials are inappropriate. It shouldn't be used in patients with non-bacterial infections such as most upper respiratory tract infections.
• C. difficile produces toxins A and B, which contribute to the development of CDAD. Hypertoxin-producing strains of C. difficile cause increased morbidity and mortality because these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary because CDAD has occurred more than 2 months after administration of antibacterial agents.
• If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation should be instituted as clinically indicated.
Action
Inhibits protein synthesis in susceptible bacteria at level of 50S ribosome, thereby inhibiting peptide bond formation and causing cell death
Availability
Aerosol foam: 1%
Capsules: 75 mg, 150 mg, 300 mg
Granules for oral suspension: 75 mg/5 ml
Injection: 150 mg base/ml
Topical: 1% gel, lotion, single-use applicators, solution, and suspension
Vaginal cream: 2%
Vaginal suppositories (ovules): 100 mg
Indications and dosages
➣ Severe infections caused by sensitive organisms (such as Bacteroides fragilis, Clostridium perfringens, Fusobacterium, pneumococci, staphylococci, and streptococci)
Adults: 300 to 450 mg P.O. q 6 hours, or (for other than C. perfringens) 1.2 to 2.7 g/day I.M. or I.V. in two to four equally divided doses
Children: 16 to 20 mg/kg/day P.O. (hydrochloride) in three to four equally divided doses, or 13 to 25 mg/kg/day P.O. (palmitate hydrochloride) in three to four equally divided doses
Neonates younger than 1 month: 15 to 20 mg/kg/day I.M. or I.V. in three to four equally divided doses
➣ Acute pelvic inflammatory disease
Adults: 900 mg I.V. q 8 hours (given with gentamicin)
➣ Acne vulgaris
Adults and children older than age 12:
Apply a thin film of topical gel, lotion, or solution locally to affected area b.i.d.
Off-label uses
• Bacterial vaginosis (phosphate)
• Chlamydia trachomatis infection in females
• CNS toxoplasmosis in AIDS patients (given with pyrimethamine)
• Pneumocystis jiroveci pneumonia (given with primaquine)
• Rosacea (lotion)
Contraindications
• Hypersensitivity to drug or lincomycin
Precautions
Use cautiously in:
• renal or hepatic impairment
• known alcohol intolerance
• pregnant patients
• neonates.
Administration
• Give oral doses with full glass of water, with or without food.
See Don't give as I.V. bolus injection.
• Dilute I.V. solution to a concentration of 18 mg/ml using normal saline solution, dextrose 5% in water, or lactated Ringer's solution. Infuse no faster than 30 mg/minute.
• Don't administer I.M. dosages above 600 mg.
• Inject I.M. doses deep into large muscle mass to prevent induration and sterile abscess.
Adverse reactions
GI: nausea, vomiting, diarrhea, abdominal pain, esophagitis, pseudomembranous colitis
Hematologic: neutropenia, leukopenia, agranulocytosis, thrombocytopenia purpura
Hepatic: jaundice, hepatic dysfunction
Skin: maculopapular rash, generalized morbilliform-like rash
Other: bitter taste (with I.V. use), phlebitis at I.V. site, induration and sterile abscess (with I.M. use), anaphylaxis
Interactions
Drug-drug. Erythromycin: antagonistic effect
Kaolin/pectin: decreased GI absorption of clindamycin
Hormonal contraceptives: decreased contraceptive efficacy
Neuromuscular blockers: enhanced neuromuscular blockade
Drug-diagnostic tests. Alanine aminotransferase, alkaline phosphatase, aspartate aminotransferase, bilirubin, creatine kinase: increased levels
Platelets, white blood cells: transient decrease in counts
Patient monitoring
• Monitor creatinine level closely in patients with renal insufficiency.
• Monitor hepatic enzyme levels in patients with hepatic disease.
• Assess for signs and symptoms of hypersensitivity reactions, including anaphylaxis.
• Assess for diarrhea and signs and symptoms of colitis.
Patient teaching
• Tell patient to take drug with food if it causes stomach upset.
See Urge patient to contact prescriber immediately if he develops rash, unusual fatigue, or yellowing of skin or eyes or if diarrhea occurs during or after treatment.
• Tell patient that I.V. use may cause bitter taste. Reassure him that this effect will resolve on its own.
• Caution patient not to rely on condoms or diaphragm for contraception for 72 hours after using vaginal preparation; drug may weaken latex products and cause breakage.
• Instruct patient taking hormonal contraceptives to use supplemental birth control method, such as condoms (unless she's using a vaginal preparation); drug may reduce hormonal contraceptive efficacy.
• As appropriate, review all other significant and life-threatening adverse reactions and interactions, especially those related to the drugs and tests mentioned above.
clindamycin
(klin-da-mye-sin) clindamycin,Cleocin
(trade name),Cleocin T
(trade name),Clinda-Derm
(trade name),Clinda-T
(trade name),Clindagel
(trade name),Clindesse
(trade name),Clindets
(trade name),Dalacin C
(trade name),Dalacin T
(trade name),Evoclin
(trade name)Classification
Therapeutic: anti infectivesIndications
- Skin and skin structure infections,
- Respiratory tract infections,
- Septicemia,
- Intra-abdominal infections,
- Gynecologic infections,
- Osteomyelitis,
- Endocarditis prophylaxis.
Action
Therapeutic effects
- Staphylococci,
- Streptococcus pneumoniae,
- other streptococci, but not enterococci.
Pharmacokinetics
Time/action profile (blood levels)
| ROUTE | ONSET | PEAK | DURATION |
|---|---|---|---|
| PO | rapid | 60 min | 6–8 hr |
| IM | rapid | 1–3 hr | 6–8 hr |
| IV | rapid | end of infusion | 6–8 hr |
Contraindications/Precautions
Adverse Reactions/Side Effects
Central nervous system
- dizziness
- headache
- vertigo
Cardiovascular
- arrhythmias
- hypotension
Gastrointestinal
- pseudomembranous colitis (life-threatening)
- diarrhea (most frequent)
- bitter taste (IV only)
- nausea
- vomiting
Dermatologic
- rash
Local
- local irritation (topical products)
- phlebitis at IV site
Interactions
Drug-Drug interaction
Kaolin/pectin may ↓ GI absorption.May enhance the neuromuscular blocking action of other neuromuscular blocking agents. Topical: Concurrent use with irritants, abrasives, or desquamating agents may result in additive irritation.Route/Dosage
Availability (generic available)
Nursing implications
Nursing assessment
- Assess for infection (vital signs; appearance of wound, sputum, urine, and stool; WBC) at beginning of and during therapy.
- Obtain specimens for culture and sensitivity prior to initiating therapy. First dose may be given before receiving results.
- Monitor bowel elimination. Diarrhea, abdominal cramping, fever, and bloody stools should be reported to health care professional promptly as a sign of pseudomembranous colitis. This may begin up to several weeks following the cessation of therapy.
- Assess patient for hypersensitivity (skin rash, urticaria).
- Lab Test Considerations: Monitor CBC; may cause transient ↓ in leukocytes, eosinophils, and platelets.
- May cause ↑ alkaline phosphatase, bilirubin, CPK, AST, and ALT concentrations.
Potential Nursing Diagnoses
Risk for infection (Indications, Side Effects)Diarrhea (Side Effects)
Implementation
- Do not confuse Clindesse with Clindets.
- Oral: Administer with a full glass of water. May be given with or without meals. Shake liquid preparations well. Do not refrigerate. Stable for 14 days at room temperature.
- Intramuscular: Do not administer >600 mg in a single IM injection.
Intravenous Administration
- pH: 5.5–7.0.
- Intermittent Infusion: Diluent: Vials must be diluted before use. Dilute a dose of 300 mg or 600 mg in 50 mL and a dose of 900 mg or 1200 mg in 100 mL. Compatible diluents include D5W, 0.9% NaCl, D5/0.9% NaCl, D5/0.45% NaCl, or LR. Admixed solution stable for 16 days at room temperature. Premixed infusion is already diluted and ready to use.Concentration: Not to exceed 18 mg/mL.
- Rate: Not to exceed 30 mg/min. Hypotension and cardiopulmonary arrest have been reported following rapid IV administration.
- Y-Site Compatibility: amiodarone, ampicillin, atracurium, bumetanide, cefepime, ciprofloxacin, dobutamine, dopamine, gentamicin, hydrocortisone sodium phosphate, insulin, lidocaine, metoclopramide, metronidazole, penicillin G, potassium chloride, prochlorperazine, ranitidine, ticarcillin/clavulanate, vancomycin, vecuronium, verapamil.
- Y-Site Incompatibility: aminophylline, ceftazidime, cefuroxime, furosemide, heparin, phenytoin, quinupristin/dalfopristin, trastuzumab, trimethoprim/sulfamethoxazole
- Vaginal: Applicators are supplied for vaginal administration. When treating bacterial vaginosis, concurrent treatment of male partner is not usually necessary.
- Topical: Contact with eyes, mucous membranes, and open cuts should be avoided during topical application. If accidental contact occurs, rinse with copious amounts of cool water.
- Wash affected areas with warm water and soap, rinse, and pat dry prior to application. Apply to entire affected area.
Patient/Family Teaching
- Instruct patient to take medication around the clock at evenly spaced times and to finish the drug completely as directed, even if feeling better. Take missed doses as soon as possible unless almost time for next dose. Do not double doses. Advise patient that sharing of this medication may be dangerous.
- Instruct patient to notify health care professional immediately if diarrhea, abdominal cramping, fever, or bloody stools occur and not to treat with antidiarrheals without consulting health care professional.
- Advise patient to report signs of superinfection (furry overgrowth on the tongue, vaginal or anal itching or discharge).
- Notify health care professional if no improvement within a few days.
- Patients with a history of rheumatic heart disease or valve replacement need to be taught the importance of antimicrobial prophylaxis before invasive medical or dental procedures.
- Intravenous: Inform patient that bitter taste occurring with IV administration is not clinically significant.
- Vaginal: Instruct patient on proper use of vaginal applicator. Insert high into vagina at bedtime. Instruct patient to remain recumbent for at least 30 min following insertion. Advise patient to use sanitary napkin to prevent staining of clothing or bedding. Continue therapy during menstrual period.
- Advise patient to refrain from vaginal sexual intercourse during treatment.
- Caution patient that mineral oil in clindamycin cream may weaken latex or rubber contraceptive devices. Such products should not be used within 72 hr of vaginal cream.
- Topical: Caution patient applying topical clindamycin that solution is flammable (vehicle is isopropyl alcohol). Avoid application while smoking or near heat or flame.
- Advise patient to notify health care professional if excessive drying of skin occurs.
- Advise patient to wait 30 min after washing or shaving area before applying.
Evaluation/Desired Outcomes
- Resolution of the signs and symptoms of infection. Length of time for complete resolution depends on the organism and site of infection.
- Endocarditis prophylaxis.
- Improvement in acne vulgaris lesions. Improvement should be seen in 6 wk but may take 8–12 wk for maximum benefit.