Lincosamides (Clindamycin, Cleocin)
Christopher M. Bland, Pharm.D., FCCP, FIDSA, BCPS

Lincosamides - Objectives

Summarize

Identify

Review

Summarize the mechanism of action and spectrum of activity

Identify the primary agents used as well as disease states typically treated

Review the adverse events, drug interactions and monitoring parameters

 

Lincosamides: Overview

  • •Very commonly used in pediatrics and adults 

  • •Primarily used for skin and skin structure infections 

  • •Can be used for bacterial vaginosis or acne (topically) 

  • •Excellent Gram-positive coverage 

    • •S. aureus including MRSA 

    • •Streptococcal species (Beta-hemolytic strep such as S. pyogenes) 

  • •Excellent Gram-positive anaerobic coverage 

    • •Peptostreptococcus species 

  • •No appreciable Gram-negative coverage 

  • •Clindamycin primary agent 

  • •Chloramphenicol more historical in United States 

    • •Significant bone marrow toxicity 

 

Clindamycin (Cleocin)

  • •Most common agent used in clinical practice 

  • •Inhibit protein synthesis 

    • •Ribosomal inhibition at 50S subunit 

    • •Similar mechanism of action to macrolides 

  • •Resistance rates to MRSA high in certain geographical locations 

  • •Used adjunctly for toxin inhibition for necrotizing fasciitis 

    • •Group A streptococcus 

    • •MRSA 

  • •Dosing (Adults) 

    • •600mg-900mg IV q6-8h 

    • •300-450mg PO q6h 

    • •2% vaginal cream/gel 

  • •Dosing (Pediatrics) 

    • •30-40mg/kg/day PO (divided q6-8h) 

    • •20-40mg/kg/day IV (divided q6-8h) 

  • •No renal dose adjustment! 

 

Bland CM and Bookstaver PB. Clin Infect Dis. 2015;61:1155-56.

Clindamycin: Adverse Reactions

  • •Hypersensitivity reactions 

  • •Gastrointestinal 

    • •Hepatotoxicity (rare) 

    • •C. difficile colitis!!! 

    • •N/V/D 

    • •Pill esophagitis 

 

Dilley M et al. Clin Rev Allergy Immunol. 2022;62:463-75.

Clindamycin: Drug Interactions

  • •Very few clinically relevant drug interactions 

  • •Can potentiate neuromuscular blockers 

    • •May have to decrease dose of IV agents used in ICU 

    • •Train of four (peripheral nerve stimulator) monitoring 

 

Lee JH et al. Korean J Anesthesiol. 2013;64:143-51.

Clindamycin: Monitoring Parameters

  • •Signs and symptoms of infection 

  • •Complete blood count 

  • •New hypersensitivity reactions 

  • •GI tolerability 

  • •Any new watery diarrhea (especially 3 or more per 24 hour) 

    • •Potential C. difficile colitis 

 

Clindamycin: Final Take

  • •Excellent Gram-positive activity 

  • •Most commonly used for skin/skin structure infections 

  • •Sometimes used for vaginal infections 

  • •C. difficile risk is highest among antibiotics 

 

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