Clindamycin (Intramuscular, Intravenous)

As an antibiotic, clindamycin is useful in fighting against numerous types of middle ear, bone, joint and throat infections and other conditions.

Overview

Clindamycin is a versatile and commonly-prescribed antibiotic which is beneficial in the treatments of middle ear infections, joint/bone infections, strep throat, pelvic inflammatory disease, endocarditis and pneumonia, among others. It can also be used in the fight against certain cases of methicillin-resistant Staphylococcus aureus, which is commonly known as MRSA.

This drug is regarded by the World Health Organization as an essential medicine, on account of its efficacy in fighting a huge number of bacterial infections while remaining relatively inexpensive to produce. It is used primarily to treat infections of the skin, soft tissue, respiratory tract, peritonitis and dental area.

In patients who are hypersensitive to penicillin, clindamycin can be used as an alternative. It is most effective against infections which involve the following organisms:

  • Aerobic, gram-positive cocci, including (but not exclusive to) Staphylococcus and Streptococcus genera
  • Anaerobic, gram-negative, rod-shaped bacteria, including (but not limited to) Fusobacterium, Prevotella and Bacteroides.

Doctors are advised against prescribing clindamycin for Bacteroides fragilis, as natural resistance to the antibiotic is on the increase. The majority of aerobic Gram-negative bacteria, like Haemophilus influenzae, Legionella, Pseudomonas and Moxarella are resistant to clindamycin.

Conditions treated

  • Middle ear infection
  • Joint/bone infection
  • Strep throat
  • Pelvic inflammatory disease
  • Endocarditis
  • Pneumonia

Type of medicine

  • Antibiotic

Side effects

Along with the desired effects, clindamycin can cause some unwanted side effects when administered intramuscularly. Although the likelihood of experiencing side effects while undergoing treatment with clindamycin is rare, some of the symptoms reported by individuals taking this medicine include: abdominal cramps, bleeding gums, bloating, blistering of the skin, blood in urine or stools, blurry vision, chills, chest pain, black or tarry stools, cloudy urine, coughing or hoarseness, decreased urination levels, diarrhea (which can be severe, watery or even bloody), difficulty swallowing, dizziness (especially when getting up suddenly from a prone position), dry mouth, fever, fast heartbeat, headache, hives and welts, increased level of thirst, headache, itching of the genital area, appetite loss, nausea, vomiting, lower back pain, pain during sexual intercourse, pinpoint spots on the skin, puffiness or swelling of the eyelids, rash, skin lesions (often with a purple center), redness of the skin, sores and ulcers in the mouth or on the lips, swollen glands, tightness in the chest, thick white vaginal discharge, unpleasant breath odor, unusual weakness or tiredness, vomiting blood, and/or yellowing of the eyes and skin.

As the patient continues treatment with clindamycin as prescribed, most (if not all) of these symptoms should lessen. If they continue to persist over a prolonged period or appear to get worse, the patient is urged to contact their doctor as soon as possible. In many instances, a doctor or healthcare professional should be able to offer advice or alternative treatments to tackle discomfort caused by side effects. For example, dry mouth and increased thirst can be alleviated by sucking on sugar-free rock candy, chewing sugar-free gum, or regularly drinking cold water with ice where possible.

Other side effects which are experienced less frequently, albeit often enough to mention, include: scaly skin, irritation at the side of administration, loss of heat from the body and/or cracks in the skin. Patients who experience any of these effects to the point of discomfort are advised to consult their healthcare provider.

Because clindamycin can cause dizziness and blurred vision, patients are advised against driving or operating heavy machinery when initially taking this drug. After it has been observed that the patient does not experience undue loss of control or concentration while undergoing treatment with this antibiotic, they should consider driving only if they do not pose a risk to themselves or other road users.

Dosage

As with all medicines, it is imperative that patients take clindamycin only as prescribed by a doctor. This means that patients must avoid taking more of this medication than advised, both in terms of dose size and frequency. In addition to this, patients should cease taking clindamycin if advised to do so by their doctor, even if they still have a supply of the medicine remaining.

Intramuscular doses of clindamycin will vary dependent on the infection the patient is fighting and should be determined by a physician, who will also consider a number of other factors, including the height, weight and age of the patient, before deciding on the most effective dose. The manufacturer of this medicine provides general dosage instructions in the literature distributed with it, although it should be reiterated that these instructions are mere recommendations which may be altered by the doctor as he or she sees fit.

Intramuscular adult dose for bacterial infection:

For serious or severe infections, the patient should be administered with 600mg to 1200mg of clindamycin via IM injection per day, divided into two to four equal doses. Incredibly severe infections may require treatment with up to 4800mg per day, adjusted as the patient responds to the medicine.

  • Single intramuscular injections greater than 600mg are not recommended
  • Intramuscular injections should be used in the treatment of anaerobic infections, with the patient switching to oral therapy as they respond to the medication.
  • Intramuscular clindamycin should be reserved for patients who are allergic to penicillin, or for whom penicillin is otherwise inappropriate.
  • Combination therapy with other antibiotics may be required, as per standard treatment protocols. Doctors should consult culture and susceptibility studies when combining antibiotics or determining dosage sizes.

Intramuscular pediatric dose for bacterial infection:

New-born infants fighting severe infection should be administered with 15 to 20mg/kg per day via IM injection, divided into three or four equal doses.

Children between the ages of 1-16 years should receive dosage based on body weight, at a rate of 20 to 40mg/kg via IM injection per day, divided into three or four equal doses.

Clindamycin is suitable for fighting serious infection caused by:

  • Streptococci, Staphylococci and Pneumococci, including skin/soft tissue infections and serious respiratory tract infections.
  • Anaerobes, including septicaemia, skin/soft tissue infections, serious respiratory tract infections, infections of the genital tract and female pelvis.
  • Joint and bone infections, including acute hematogenous osteomyelitis as a result of Staphylococcus aureus infection.

Interactions

All drugs have the potential to interact with other chemicals or medications within the human body, and these interactions can change how one or more of the involved medicines work. In some instances, an interaction can cause a medicine to become ineffective. In other circumstances, interactions can cause potentially serious or even fatal side effects. Because of this risk, patients are advised to keep a full, detailed list of all drugs they are currently taking. This extends to vitamins, herbal supplements, over the counter remedies and complementary medicines as well as prescription medications.

Below is a partial list of medicines known to interact negatively with clindamycin. Patients who are currently undergoing therapy with any of these medications are advised to inform their doctor prior to being administered with a dose of clindamycin:

  • Live cholera vaccine
  • Esomeprazole
  • Zolpidem
  • Aspirin
  • Benadryl
  • Cipro
  • Duloxetine
  • Cyclobenzaprine
  • Furosemide
  • Atovastatin
  • Pregabalin
  • Acetaminophen
  • Montelukast
  • Levothyroxine
  • Vitamin B12
  • Vitamin C
  • Vitamin D3
  • Xanax
  • Zyrtec

Warnings

Clindamycin can cause diarrhea, which if left untreated can lead to serious or even life-threatening intestinal issues. Patients who experience bloody or watery diarrhea are advised to consult their doctor, who may advise against the discontinuation of treatment with this medicine.

Before using clindamycin, patients who suffer from liver disease, kidney disease or an intestinal disorder such as Crohn's disease or colitis, or those who have a history of asthma, eczema or allergic reactions, should inform their doctor.

Clindamycin must be taken for the duration of the prescription. Symptoms are likely to improve or even disappear entirely before the infection is completely cleared, and skipping doses or finishing the course prematurely can increase the risk of the infection returning at a stronger, antibiotic-resistant rate.

Patients who are due to undergo surgery should inform their surgeon ahead of the operation, as they may need to stop using clindamycin for a short period of time.

Clindamycin is injected intramuscularly. Although patients are likely to receive injections in a clinical setting as delivered by a healthcare professional, in some instances they may be required to use injections at home. Patients should not self-inject clindamycin unless they understand how to properly inject and dispose of used needles, tubing and other items associated with intramuscular injections. Disposable needles should be used only once.

Pregnant women should be administered clindamycin with great caution during the second trimester, and only if the benefits of treatment far outweigh the risk of fetal harm or miscarriage, both of which are associated with this medicine. Use in the first trimester is not recommended at all. Clindamycin solution contains benzyl alcohol for preservative purposes, and this can cross the placenta, causing potentially fatal 'œgasping syndrome'in infants.

Use of clindamycin during breastfeeding is not recommended. This is because this medication is excreted into human milk. Infants of breastfeeding mothers who are undergoing treatment with clindamycin should be monitored for gastrointestinal side effects such as diarrhea, blood in the stool or candidiasis which causes thrush and diaper rash.

Storage

Clindamycin solution for intramuscular injection should be stored at room temperature (25ºC). Ampoules should be stored in the outer carton to protect them from light. This product should not be refrigerated or frozen.

When unopened, clindamycin has a shelf-life of two years. Opened and diluted solutions should be used within 24 hours or discarded in accordance with local and/or state medication disposal law. Single-use syringes used to administer clindamycin should be disposed of in a dedicated 'œsharps' container only.

Summary

Clindamycin is an incredibly effective intramuscular antibiotic treatment for various types of infection, particularly in patients who are allergic to penicillin-based antibiotics. While it is a greatly beneficial medicine, it can also pose a risk to patients with pre-existing gastrointestinal conditions or allergies who fail to communicate effectively with their healthcare provider.

As a treatment designed to fight severe infection, clindamycin alleviates symptoms of infection which can include chills, sweats, fever, congestion, vomiting, pain and soreness. However, it can also cause a shortage of the 'œgood' flora within the body, leading to GI problems such as diarrhea.

When taken correctly, clindamycin helps to fight infections which could otherwise be fatal, helping the patient to return to full health in a matter of weeks. To achieve the best possible results from this medicine, patient and doctor must work together to ascertain the appropriate dosage and frequency of use.