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aa bds m6 - therapeutics > 3. Antibiotics - Clindamycin > Flashcards

3. Antibiotics - Clindamycin Flashcards

1
Q

What class of drug is clindamycin?

A

lincosamide

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2
Q

What is the history of lincosamides?

A
  • first came Lincomycin, first isolated from Streptomyces lincolnesis
  • now replaced by clindamycin which is a semisynthetic derivative synthesised in 1968
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3
Q

What is the spectrum of activity of clindamycin (what does clindamycin work against)?

A
  • gram +ve/gram -ve bacteria
    • anaerobic/facultative/aerobic
  • penicillinase producing staph.
  • bacteroides
  • prevotella
  • porphyromonas, veillonella, peptostrep, actinomyces, eubacteria and clostridium
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4
Q

What tends to be resistant to clindamycin?

A

aerobic gram -ve bacilli

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5
Q

What is the mechanism of action of clindamycin?

A

inhibits protein synthesis
- binds to the 50S ribosomal subunit

bacteriostatic, bactericidal at higher concentrations

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6
Q

What does clindamycin have the same site/mechanism of action as?

A

macrolides:
- clarithromycin
- erythromycin

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7
Q

What is the oral absorption % of clindamycin?

A

90%

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8
Q

What is the half life of clindamycin?

A

3 hours

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9
Q

What is the peak serum level of clindamycin?

A

2.5ugmL

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10
Q

What is the peak serum time of clindamycin?

A

45-60 mins

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11
Q

Does food affect clindamycin?

A

no

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12
Q

What is the distribution of clindamycin?

A

wide, PMNs

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13
Q

What does clindamycin penetrate?

A
  • penetrates bone very well
  • does not penetrate the CSF
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14
Q

Where is clindamycin metabolised?

A

liver (90%)

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15
Q

Where is clindamycin concentrated?

A

polymorphonuclear leukocytes, alveolar macrophages and abscess tissue

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16
Q

How is clindamycin excreted?

A

urine

17
Q

What preparations can clindamycin come in?

A
  • IM
  • slow IV infusion
  • oral capsules
  • paediatric suspension
18
Q

What are the main unwanted effects of clindamycin?

A
  • Nausea/vomiting
  • Abdominal pain
  • Oesophagitis
  • Glossitis
  • Stomatitis
  • Allergy
  • Myelosupression (reversible)
  • Metallic taste
  • Maculopapular rash (3-10%)
19
Q

What is a serious and potentially fatal unwanted effect of clindamycin?

A

pseudomembranous colitis (possibly 10%)

20
Q

What kinds of patients are more at risk of pseudomembranous colitis?

A
  • had recent antibiotics
  • middle aged - elderly
  • women
  • following surgery
  • GI disturbance
21
Q

What other antiobiotic notably can also cause pseudomembranous colitis?

A

amoxicillin

22
Q

What antiobiotics would you give if the pt has pseudomembranous colitis?

A

vancomycin or metronidazole

23
Q

What are the symptoms of pseudomembranous colitis?

A

GI upset, diarrhoea, abdominal cramps (mild to severe)
- bloody stools
- fever
- urge to have a bowel movement
- watery diarrhoea (often 5-10 times per day)

24
Q

What interacts with clindamycin?

A
  • non-depolarising neuromuscular blocking agents (theoretical)
  • absorption slowed by some anti-diarrhoeal drugs
  • antagonism with erythromycin
25
Q

What are the contraindications of clindamycin?

A
  • allergy
  • avoid 2 months following pseudomembranous colitis
26
Q

What are the indications for clindamycin?

A

second-line antibiotic
- as for penicillin for oro-facial infections
- penicillin allergy
- refractory to penicillin(s)/metronidazole
- beta lactam resistance

27
Q

What does the BNF/SDCEP state regarding the use of clindamycin?

A
  • Clindamycin should not be used routinely
  • No more effective than Penicillin
  • Cross resistance with erythromycin-resistant bacteria
28
Q

What is the dose of clindamycin?

A

150-300mg

29
Q

What is the interval for taking clindamycin?

A

6 hourly

30
Q

What is the duration of taking clindamycin?

A

3-5 days

31
Q

What is the route of clindamycin delivery?

A

oral

32
Q

Does clindamycin require a loading dose?

A

no

33
Q

When would clindamycin use be immediately ceased?

A

diarrhoea

34
Q

Summary slide (clindamycin):

A

aa bds m6 - therapeutics (6 decks)

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