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Disclaimer to the On-line Edition
This Manual has been designed for use in the NICU at London Health Sciences Centre (LHSC), London, Ontario, Canada, and represents clinical practice at this institution. The information contained within the Manual may not be applicable to other centres. If users of this Manual are not familiar with a drug, it is recommended that the official monograph be consulted before it is prescribed and administered. Any user of this information is advised that the contributors, Editor and LHSC are not responsible for any errors or omissions, and / or any consequences arising from the use of the information in this Manual.

CLINDAMYCIN

Indication

  • the treatment of infections due to sensitive anaerobic bacteria (eg. Bacteroides species); also used in combination with a penicillin plus aminoglycoside 3rd generation cephalosporin for the treatment of mixed aerobic/anaerobic infections

Pharmacology

  • clindamycin has in vitro antibacterial activity against most aerobic Gram-positive cocci and several Gram-positive and Gram-negative anaerobic bacteria
  • NOT effective against aerobic Gram-negative organisms
  • clindamycin may be bactericidal (kills the organism) or bacteriostatic (slows down growth) in action; this depends on the drug concentration and the susceptibility of the organism
  • clindamycin acts by binding to the bacterial 50S Ribosomal subunit; this results in the inhibition of peptide bond formation
  • clindamycin is rapidly and almost completely (approx. 90%) absorbed from the GI tract: infants under 6 months of age attained similar peak serum levels (1 to 3 mcg/mL) compared to healthy adult volunteers
  • clindamycin is distributed into many body tissues and fluids (incl. pleural fluid, bone and bile); however, it poorly enters the CNS, even in the presence of inflamed meninges
  • the half-life in premature and full-term neonates has been reported as 8.7h and 3.6h, respectively
  • most of the drug is metabolized by the liver

Side Effects

  • adverse GI effects (vomiting, diarrhea, abdominal pain) have been frequently reported following administration by all routes (po, IV, IM)
  • non-specific colitis and diarrhea have occurred following clindamycin use
  • local reactions have occurred following IV (thrombophlebitis, erythema, swelling) and IM (induration, sterile abscess) administration
  • transient increases in liver enzymes have been reported
  • hypersensitivity reactions (generalized morbilliform rash is most common)
  • rare cases of cardiac arrest and hypotension have occurred following too rapid IV administration
  • each mL of the commercially available injection (150mg/mL) contains 9.45mg of benzyl alcohol, toxicity in neonates from benzyl alcohol results from large amounts (100-400 mg/kg/day)

Dose

  • may be given IV, or orally

    < 1,200 (for all ages)5 mg/kg q 12 h
    1,200-2,000g< 7 days
    > 7 days
    5 mg/kg q12h
    5 mg/kg q8h
    > 2,000g< 7 days
    > 7 days
    5 mg/kg q8h
    5 mg/kg q6h
  • administer IV by slow infusion
  • final concentration for IV administration should not exceed 12 mg/mL
  • COMPATIBLE WITH TPN AND LIPID

Supplied

  • oral solution (after reconstitution) has a concentration of 15mg/mL
  • clindamycin syringe, 12 mg/mL, prepared by Pharmacy
  • ampoule, 150 mg/mL
  • SAMPLE CALCULATION for IV administration; if order reads: 10 mg IV q12h
    1. Dilute to 12 mg/mL

      Add 1 mL of drug (150 mg/mL) to 11.5 mL of sterile water for injection to produce a final concentration of 150 mg/12.5 mL solution = 12 mg/mL solution

    2. Administer required volume

      Desired Dose
      Available Dose
      XAvailable Volume
      =10 MG
      12 mg
      X1mL
      =0.83 mL  

References

  1. McEvoy G K (ed): AHFS Drug Information, American Society of Hospital Pharmacists, 1991.
  2. Roberts, RJ: Drug Therapy in Infants, W.B. Saunders, Toronto, 1984.
  3. Trissel L.A.: Handbook on Injectable Drugs, American Society of Hospital Pharmacists 1988.
  4. Krogh CME et al (ed): Compendium of Pharmaceuticals and Specialties, Canadian Pharmaceutical Association, 1992.
  5. Taketomo CK, Hodding JH and Kraus DM: Pediatric Dosage Handbook, Lexi-Comp Inc., Cleveland, 1992.



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