WARNING
Pseudomembranous colitis has been reported with nearly all antibacterial agents, including clindamycin, and may range in severity from mild to life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea subsequent to the administration of antibacterial agents.
Because clindamycin therapy has been associated with severe colitis which may end fatally, it should be reserved for serious infections where less toxic antimicrobial agents are inappropriate, as described in the INDICATIONS AND USAGE section. It should not be used in patients with nonbacterial infections such as most upper respiratory tract infections. Treatment with antibacterial agents alters the normal flora of the colon and may permit over-growth of clostridia. Studies indicate that a toxin produced by Clostridium difficile is one primary cause of "antibiotic-associated colitis".
After the diagnosis of pseudomembranous colitis has been established, therapeutic measures should be initiated. Mild cases of pseudomembranous colitis usually respond to drug discontinuation alone. In moderate to severe cases, consideration should be given to management with fluids and electrolytes, protein supplementation, and treatment with an antibacterial drug clinically effective against C. difficile colitis.
Diarrhea, colitis, and pseudomembranous colitis have been observed to begin up to several weeks following cessation of therapy with clindamycin.
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CLEOCIN SUMMARY
Clindamycin hydrochloride is the hydrated hydrochloride salt of clindamycin. Clindamycin is a semisynthetic antibiotic produced by a 7(S)-chloro-substitution of the 7(R)-hydroxyl group of the parent compound lincomycin.
Clindamycin is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria.
Clindamycin is also indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci, and staphylococci. Its use should be reserved for penicillin-allergic patients or other patients for whom, in the judgment of the physician, a penicillin is inappropriate. Because of the risk of colitis, as described in the WARNING box, before selecting clindamycin the physician should consider the nature of the infection and the suitability of less toxic alternatives (eg, erythromycin).
Anaerobes: Serious respiratory tract infections such as empyema, anaerobic pneumonitis and lung abscess; serious skin and soft tissue infections; septicemia; intra-abdominal infections such as peritonitis and intra-abdominal abscess (typically resulting from anaerobic organisms resident in the normal gastrointestinal tract); infections of the female pelvis and genital tract such as endometritis, nongonococcal tuboovarian abscess, pelvic cellulitis and postsurgical vaginal cuff infection.
Streptococci: Serious respiratory tract infections; serious skin and soft tissue infections.
Staphylococci: Serious respiratory tract infections; serious skin and soft tissue infections.
Pneumococci: Serious respiratory tract infections.
Bacteriologic studies should be performed to determine the causative organisms and their susceptibility to clindamycin.
In Vitro
Susceptibility Testing: A standardized disk testing procedure * is recommended for determining susceptibility of aerobic bacteria to clindamycin. A description is contained in the CLEOCIN® Susceptibility Disk insert. Using this method, the laboratory can designate isolates as resistant, intermediate, or susceptible. Tube or agar dilution methods may be used for both anaerobic and aerobic bacteria. When the directions in the CLEOCIN® Susceptibility Powder insert are followed, an MIC of 1.6 mcg/mL may be considered susceptible; MICs of 1.6 to 4.8 mcg/mL may be considered intermediate and MICs greater than 4.8 mcg/mL may be considered resistant.
*Bauer AW, Kirby WMM, Sherris JC, et al: Antibiotic susceptibility testing by a standardized single disc method.
Am J Clin Pathol 45:493-496, 1966. Standardized disc susceptibility test.
Federal Register 37:20527-29, 1972.
CLEOCIN Susceptibility Disks 2 mcg. See package insert for use.
CLEOCIN Susceptibility Powder 20 mg. See package insert for use.
For anaerobic bacteria the minimal inhibitory concentration (MIC) of clindamycin can be determined by agar dilution and broth dilution (including microdilution) techniques. If MICs are not determined routinely, the disk broth method is recommended for routine use. THE KIRBY-BAUER DISK DIFFUSION METHOD AND ITS INTERPRETIVE STANDARDS ARE NOT RECOMMENDED FOR ANAEROBES.
To reduce the development of drug-resistant bacteria and maintain the effectiveness of CLEOCIN HCl and other antibacterial drugs, CLEOCIN HCl should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. When culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. In the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.
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NEWS HIGHLIGHTS
Published Studies Related to Cleocin (Clindamycin)
Comparing a novel solubilized benzoyl peroxide gel with benzoyl peroxide/clindamycin: final data from a multicenter, investigator-blind, randomized study. [2009.09]
INTRODUCTION: A solubilized 5% BPO gel has been developed to enhance the bioavailability, follicular penetration, and efficacy of BPO... CONCLUSION: Compared with BPO/clindamycin, the solubilized BPO gel offers significantly greater reductions in non-inflammatory lesion count and comparable reductions in inflammatory lesion count in the absence of an antibiotic.
Efficacy and tolerability of a fixed combination of clindamycin phosphate (1.2%) and low concentration benzoyl peroxide (2.5%) aqueous gel in moderate or severe acne subpopulations. [2009.08]
BACKGROUND: Oral antibiotics are commonly prescribed for moderate or severe acne, but there may be limitations due to concerns about side effects associated with systemic treatments. OBJECTIVE: To evaluate the efficacy and safety of a fixed combination clindamycin phosphate 1.2% and benzoyl peroxide 2.5% (clindamycin-BP 2.5%) aqueous gel in the treatment of moderate or severe acne subpopulations... CONCLUSION: Clindamycin-BP 2.5% aqueous gel is an effective and safe once-daily treatment for moderate or severe acne.
A 3-step acne system containing solubilized benzoyl peroxide versus clindamycin-benzoyl peroxide. [2009.07]
A 3-step acne system has been developed to enhance the bioavailability and follicular penetration of benzoyl peroxide (BPO). Participants with mild to moderate facial acne vulgaris were randomly assigned to 10 weeks' facial treatment with the 3-step acne system (proprietary salicylic acid cleanser 2% twice daily, proprietary salicylic acid toner 2% once daily, and solubilized BPO gel 5% twice daily) or with control cleanser twice daily plus clindamycin 1%-BPO 5% gel (jar formulation) twice daily...
Comparison of 2 clindamycin 1%-benzoyl peroxide 5% topical gels used once daily in the management of acne vulgaris. [2009.05]
Combination therapy for the topical treatment of acne vulgaris using benzoyl peroxide (BPO) and an antibiotic is more efficacious and better tolerated than treatment with either component alone... The addition of hydrating excipients in the C/BPO HE formulation appears to improve patient tolerance and acceptance, which will likely help patients to comply with therapy.
Tolerability of clindamycin/tretinoin gel vs. tretinoin microsphere gel and adapalene gel. [2009.04]
CONCLUSION: CLIN/RA was significantly better tolerated than was 0.1% tretinoin gel, as evidenced by significantly reduced erythema (P < 0.04), scaling (P < 0.03), itching (P < 0.02), burning (P < 0.03) and stinging (P < 0.04). A trend for greater erythema, scaling, and subjective discomfort for 0.1% adapalene gel compared to CLIN/RA was also evident.
Clinical Trials Related to Cleocin (Clindamycin)
Dalacin-T Gel Post Approval Study [Completed]
A Pilot Study of Oral Clindamycin and Pyrimethamine for the Treatment of Toxoplasmic Encephalitis in Patients With AIDS [Completed]
To collect information on the effectiveness and toxicity of clindamycin plus pyrimethamine
and leucovorin calcium for the treatment of acute toxoplasmic encephalitis in adult patients
with AIDS. Toxoplasmic encephalitis (encephalitis caused by Toxoplasma gondii) is the most
frequent cause of focal central nervous system infection in patients with AIDS. If untreated,
the encephalitis is fatal. At present, it is standard practice to give a combination of
pyrimethamine and sulfadiazine to treat toxoplasmic encephalitis. The high frequency of
sulfonamide-induced toxicity in AIDS patients often makes completion of a full course of
therapy difficult. There is some information that high doses of parenteral (such as by
injection) clindamycin used with pyrimethamine may be as effective as pyrimethamine plus
sulfadiazine in the management of the acute phase of toxoplasmic encephalitis in patients
with AIDS. Administration of parenteral clindamycin for prolonged periods of time, however,
is costly, requires hospitalization, and is inconvenient for the patient. There is some
indication that treatment of AIDS patients with acute toxoplasmic encephalitis with oral
clindamycin may be effective. Leucovorin calcium is useful in preventing
pyrimethamine-associated bone marrow toxicity.
The Safety and Efficacy of Clindamycin and Primaquine in the Treatment of Mild - Moderate Pneumocystis Carinii Pneumonia in Patients With AIDS [Completed]
Safety and Efficacy Study of Clindamycin/Benzoyl Peroxide/Tazarotene Cream in Subjects With Acne [Recruiting]
Benzoyl peroxide, clindamycin and tazarotene are known to be effective treatment alternative
for acne vulgaris. The purpose of this study is to assess the safety and efficacy of a
combination product including these actives for the treatment of acne vulgaris.
You may be suitable to take part in this study because you have acne vulgaris on your face.
Acne vulgaris usually affects the face, but it can also affect the skin on the chest, arms,
legs, and back.
Treatment of Malaria in Gabon With Fosmidomycin-Clindamycin [Completed]
Some antibiotics are also effective against malaria parasites. Fosmidomycin is an antibiotic
that has been shown to be effective against malaria, although it cannot achieve a total cure
in all patients. A previous small study has shown that in combination with clindamycin, an
commonly used antibiotic, it is highly effective and safe, in asymptomatic carriers of
malaria parasites. The current study will evaluate the efficacy and safety of the combination
given for three days in children with uncomplicated malaria in Gabon.
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PATIENT REVIEWS / RATINGS / COMMENTSBased on a total of 3 ratings/reviews, Cleocin has an overall score of 5.33. The effectiveness score is 7.33 and the side effect score is 4.67. The scores are on ten point scale: 10 - best, 1 - worst.
| | Cleocin review by 32 year old female patient | | | Rating |
| Overall rating: | |   |
| Effectiveness: | | Considerably Effective |
| Side effects: | | Moderate Side Effects | | |
Treatment Info |
| Condition / reason: | | acne |
| Dosage & duration: | | topical (dosage frequency: daily) for the period of 2 years |
| Other conditions: | | none |
| Other drugs taken: | | none | | |
Reported Results |
| Benefits: | | My acne improved when accompanied by monthly exfoliation peels. |
| Side effects: | | My skin was very sensitive to sunlight and it was difficult to protect my skin given the sensitivity of creams to cause acne flair ups. |
| Comments: | | Application of creme to clean skin in the morning and evening. It was the most effective acne treatment I have used that didn't cause excessive drying or irration to my skin. |
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| | Cleocin review by 61 year old female patient | | | Rating |
| Overall rating: | | |
| Effectiveness: | | Considerably Effective |
| Side effects: | | Extremely Severe Side Effects | | |
Treatment Info |
| Condition / reason: | | infection in mandible |
| Dosage & duration: | | 150 mg taken 4 times a day for the period of 6 weeks |
| Other conditions: | | asthma |
| Other drugs taken: | | benadryl | | |
Reported Results |
| Benefits: | | Eradicated the infection. |
| Side effects: | | Severe pruritis, bruising, hives. |
| Comments: | | Received IV in hospital x5 days for a very severe abscessed tooth leading to bone infection; developed hives with first dose, so they gave me benadryl every 6 hours. After being discharged, I took the oral Cleocin for about 5-6 weeks, along with benadryl. I developed severe itching (mostly in the legs and back, some in the neck area) and severe bruising as a result of trying to relieve the itch. The itching, hives and bruising dissipated about 2-4 weeks after final dose. |
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| | Cleocin review by 61 year old female patient | | | Rating |
| Overall rating: | | |
| Effectiveness: | | Considerably Effective |
| Side effects: | | Extremely Severe Side Effects | | |
Treatment Info |
| Condition / reason: | | infection in mandible |
| Dosage & duration: | | 150 mg taken 4 times a day for the period of 6 weeks |
| Other conditions: | | asthma |
| Other drugs taken: | | benadryl | | |
Reported Results |
| Benefits: | | Eradicated the infection. |
| Side effects: | | Severe pruritis, bruising, hives. |
| Comments: | | Received IV in hospital x5 days for a very severe abscessed tooth leading to bone infection; developed hives with first dose, so they gave me benadryl every 6 hours. After being discharged, I took the oral Cleocin for about 5-6 weeks, along with benadryl. I developed severe itching (mostly in the legs and back, some in the neck area) and severe bruising as a result of trying to relieve the itch. The itching, hives and bruising dissipated about 2-4 weeks after final dose. |
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Page last updated: 2009-10-20
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