Clindamycin

Clindamycin is used primarily to treat anaerobic infections caused by susceptible anaerobic bacteria, including dental infections,{{cite journal |vauthors=Brook I, Lewis MA, Sándor GK, Jeffcoat M, Samaranayake LP, Vera Rojas J |title=Clindamycin in dentistry: more than just effective prophylaxis for endocarditis? |journal=Oral Surg Oral Med Oral Pathol Oral Radiol Endod |volume=100 |issue=5 |pages=550–8 |date=November 2005 |pmid=16243239 |doi=10.1016/j.tripleo.2005.02.086 }} and infections of the respiratory tract, skin, and soft tissue, and peritonitis.{{cite web |url = http://www.rxlist.com/cgi/generic/clindamyciniv_ids.htm |title = Cleocin I.V. Indications & Dosage |year = 2007 |access-date = 1 December 2007 |publisher = RxList.com |url-status = dead |archive-url = https://web.archive.org/web/20071127021156/http://www.rxlist.com/cgi/generic/clindamyciniv_ids.htm |archive-date = 27 November 2007 }} In people with hypersensitivity to penicillins, clindamycin may be used to treat infections caused by susceptible aerobic bacteria, as well. It is also used to treat bone and joint infections, particularly those caused by Staphylococcus aureus.{{cite journal |vauthors=Darley ES, MacGowan AP |title=Antibiotic treatment of gram-positive bone and joint infections |journal=J Antimicrob Chemother |volume=53 |issue=6 |pages=928–35 |year=2004 |pmid=15117932 |doi=10.1093/jac/dkh191 |doi-access=free | title-link=doi }} Topical application of clindamycin phosphate can be used to treat mild to moderate acne.{{cite journal |vauthors=Feldman S, Careccia RE, Barham KL, Hancox J |title=Diagnosis and treatment of acne |journal=Am Fam Physician |volume=69 |issue=9 |pages=2123–30 |date=May 2004 |pmid=15152959 |url=https://www.aafp.org/afp/2004/0501/p2123.html |url-status=live |archive-url=https://web.archive.org/web/20110727113218/http://www.aafp.org/afp/2004/0501/p2123.pdf |archive-date=27 July 2011 }}{{cite journal |vauthors=Oge' LK, Broussard A, Marshall MD |title=Acne Vulgaris: Diagnosis and Treatment |journal=Am Fam Physician |volume=100 |issue=8 |pages=475–84 |date=October 2019 |pmid=31613567 |doi= |url=https://www.aafp.org/afp/2019/1015/p475.html }}

File:Clindamycin**.jpg

For the treatment of acne, in the long term, the combined use of topical clindamycin and benzoyl peroxide was similar to salicylic acid plus benzoyl peroxide. Topical clindamycin plus topical benzoyl peroxide is more effective than topical clindamycin alone.{{cite journal |vauthors=Seidler EM, Kimball AB |title=Meta-analysis comparing efficacy of benzoyl peroxide, clindamycin, benzoyl peroxide with salicylic acid, and combination benzoyl peroxide/clindamycin in acne |journal=J. Am. Acad. Dermatol. |volume=63 |issue=1 |pages=52–62 |date=July 2010 |pmid=20488582 |doi=10.1016/j.jaad.2009.07.052 }}

It is most effective against infections involving the following types of organisms:

• Aerobic Gram-positive cocci, including some members of the Staphylococcus and Streptococcus (e.g. pneumococcus) genera, but not enterococci.
• Anaerobic, Gram-negative rod-shaped bacteria, including some Bacteroides, Fusobacterium, and Prevotella, although resistance is increasing in Bacteroides fragilis.{{cite journal | vauthors = Di Bella S, Antonello RM, Sanson G, Maraolo AE, Giacobbe DR, Sepulcri C, Ambretti S, Aschbacher R, Bartolini L, Bernardo M, Bielli A, Busetti M, Carcione D, Camarlinghi G, Carretto E, Cassetti T, Chilleri C, De Rosa FG, Dodaro S, Gargiulo R, Greco F, Knezevich A, Intra J, Lupia T, Concialdi E, Bianco G, Luzzaro F, Mauri C, Morroni G, Mosca A, Pagani E, Parisio EM, Ucciferri C, Vismara C, Luzzati R, Principe L | title = Anaerobic bloodstream infections in Italy (ITANAEROBY): A 5-year retrospective nationwide survey | journal = Anaerobe | volume = 75 | pages = 102583 | date = June 2022 | pmid = 35568274 | doi = 10.1016/j.anaerobe.2022.102583 | hdl = 11368/3020691 | s2cid = 248736289 | hdl-access = free }}

Most aerobic Gram-negative bacteria (such as Pseudomonas, Legionella, Haemophilus influenzae and Moraxella) are resistant to clindamycin,{{cite web|url=http://www.pediatricsupersite.com/view.aspx?rid=35957 |title=Clindamycin: new look at an old drug |vauthors=Bell EA |date=January 2005 |access-date=1 December 2007 |work=Infectious Diseases in Children |url-status=dead |archive-url=https://web.archive.org/web/20111008040952/http://www.pediatricsupersite.com/view.aspx?rid=35957 |archive-date=8 October 2011 }} as are the facultative anaerobic Enterobacteriaceae.{{cite book | vauthors = Gold HS, Moellering RC |chapter=Macrolides and clindamycin |chapter-url=https://books.google.com/books?id=zvCOpighJggC&pg=PA294 | veditors = Root RE, Waldvogel F, Corey L, Stamm WE |title=Clinical infectious diseases: a practical approach |publisher=Oxford University Press |location=Oxford |year=1999 |pages=291–7 |isbn=978-0-19-508103-9 |archive-url=https://web.archive.org/web/20180513203552/https://books.google.com/books?id=zvCOpighJggC&pg=PA294 |archive-date=13 May 2018 }} {{Retrieved|access-date=19 January 2009}}through Google Book Search. A notable exception is Capnocytophaga canimorsus, for which clindamycin is a first-line drug of choice.{{cite journal |vauthors=Jolivet-Gougeon A, Sixou JL, Tamanai-Shacoori Z, Bonnaure-Mallet M |title=Antimicrobial treatment of Capnocytophaga infections |journal=Int J Antimicrob Agents |volume=29 |issue=4 |pages=367–73 |date=April 2007 |pmid=17250994 |doi=10.1016/j.ijantimicag.2006.10.005}}

The following represents MIC susceptibility data for a few medically significant pathogens.{{cite web |url=https://www.toku-e.com/content/product-documents/MIC_Clindamycin%20Phosphate.pdf |title=Clindamycin Phosphate Susceptibility and Minimum Inhibitory Concentration (MIC) Data |date=1 June 2020 |website=toku-e.com}}

• Staphylococcus aureus: 0.016 μg/mL – >256 μg/mL
• Streptococcus pneumoniae: 0.002 μg/mL – >256 μg/mL
• Streptococcus pyogenes: <0.015 μg/mL – >64 μg/mL

File:D test.jpg

When testing a gram-positive culture for sensitivity to clindamycin, it is common to perform a "D-test" to determine if there is a sub-population of bacteria present with the phenotype known as {{not a typo|iMLS_B}}. This phenotype of bacteria are resistant to the macrolide-lincosamide-streptogramin B group of antibiotics; however, the resistance mechanism is only induced by the presence of 14-membered ring macrolides, such as erythromycin. During a D-test, bacteria of the {{not a typo|iMLS_B}} phenotype demonstrate in vitro erythromycin-induced in vitro resistance to clindamycin. This is because of the activity of the macrolide-inducible plasmid-encoded erm gene.{{cite journal |vauthors=Leclerq R |title=Mechanisms of Resistance to Macrolides and Lincosamides: Nature of the Resistance Elements and Their Clinical Implications |journal=Clinical Infectious Diseases |date=February 2002 |volume=34 |issue=4 |pages=482–92 |doi=10.1086/324626 |pmid=11797175 | doi-access=free | title-link=doi }}

To perform a D-test, an agar plate is inoculated with the bacteria in question and two drug-impregnated disks (one with erythromycin, one with clindamycin) are placed 15–20 mm apart on the plate. If the area of inhibition around the clindamycin disk is D-shaped, the test result is positive. Despite the apparent susceptibility to clindamycin in the absence of erythromycin, a positive D-test precludes therapeutic use of clindamycin. This is because the erythromycin-inducible erm gene is prone to mutations causing the inducible activity to switch to constitutive (permanently switched on).{{cite journal |vauthors=Woods CR |title=Macrolide-inducible resistance to clindamycin and the D-test |journal=The Pediatric Infectious Disease Journal |date=December 2009 |volume=28 |issue=12 |pages=1115–8 |doi=10.1097/INF.0b013e3181c35cc5 |pmid=19935273 | doi-access= | title-link=doi }} This, in turn, may lead to the therapeutic failure of clindamycin.

If the area of inhibition around the clindamycin disk is circular, the test result is negative and clindamycin can be used.

Given with chloroquine or quinine, clindamycin is effective and well tolerated in treating Plasmodium falciparum malaria; the latter combination is particularly useful for children, and is the treatment of choice for pregnant women who become infected in areas where resistance to chloroquine is common.{{cite journal |vauthors=Lell B, Kremsner PG |title=Clindamycin as an antimalarial drug: review of clinical trials |journal=Antimicrobial Agents and Chemotherapy |issn=0066-4804 |volume=46 |issue=8 |pages=2315–20 |year=2002 |pmid=12121898 |doi=10.1128/AAC.46.8.2315-2320.2002 |pmc=127356 | doi-access=free | title-link=doi }}{{cite journal |vauthors=Griffith KS, Lewis LS, Mali S, Parise ME |title=Treatment of malaria in the United States: a systematic review |journal=JAMA |volume=297 |issue=20 |pages=2264–77 |year=2007 |pmid=17519416 |doi=10.1001/jama.297.20.2264 |doi-access=free | title-link=doi }} Clindamycin should not be used as an antimalarial by itself, although it appears to be very effective as such, because of its slow action. Patient-derived isolates of Plasmodium falciparum from the Peruvian Amazon have been reported to be resistant to clindamycin as evidenced by in vitro drug susceptibility testing.{{cite journal |vauthors=Dharia NV, Plouffe D, Bopp SE, González-Páez GE, Lucas C, Salas C, Soberon V, Bursulaya B, Kochel TJ, Bacon DJ, Winzeler EA |title=Genome scanning of Amazonian Plasmodium falciparum shows subtelomeric instability and clindamycin-resistant parasites |journal=Genome Research |volume=20 |issue=11 |pages=1534–44 |year=2010 |pmid=20829224 |doi=10.1101/gr.105163.110 |pmc=2963817 }}

Clindamycin may be useful in skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus (MRSA). Many strains of MRSA are still susceptible to clindamycin; however, in the United States spreading from the West Coast eastwards, MRSA is becoming increasingly resistant.{{medical citation needed|date=December 2019}}

While it has been used in intraabdominal infections, such use is generally not recommended due to resistance.

Clindamycin is used in cases of suspected toxic shock syndrome,{{cite journal |vauthors=Annane D, Clair B, Salomon J |title=Managing toxic shock syndrome with antibiotics |journal=Expert Opin Pharmacother |volume=5 |issue=8 |pages=1701–10 |year=2004 |pmid=15264985 |doi=10.1517/14656566.5.8.1701|s2cid=24494787 }} often in combination with a bactericidal agent such as vancomycin. The rationale for this approach is a presumed synergy between vancomycin, which causes the death of the bacteria by breakdown of the cell wall, and clindamycin, which is a powerful inhibitor of toxin synthesis. Both in vitro and in vivo studies have shown clindamycin reduces the production of exotoxins by staphylococci;{{cite journal |vauthors=Coyle EA |title=Targeting bacterial virulence: the role of protein synthesis inhibitors in severe infections. Insights from the Society of Infectious Diseases Pharmacists |journal=Pharmacotherapy |volume=23 |issue=5 |pages=638–42 |date=May 2003 |pmid=12741438 |doi=10.1592/phco.23.5.638.32191 |s2cid=29061418 }} it may also induce changes in the surface structure of bacteria that make them more sensitive to immune system attack (opsonization and phagocytosis).{{cite journal |vauthors=Gemmell CG, O'Dowd A |title=Regulation of protein A biosynthesis in Staphylococcus aureus by certain antibiotics: its effect on phagocytosis by leukocytes |journal=J Antimicrob Chemother |volume=12 |issue=6 |pages=587–97 |year=1983 |pmid=6662837|doi=10.1093/jac/12.6.587}}{{cite journal |vauthors=Gemmell CG, Peterson PK, Schmeling D, Kim Y, Mathews J, Wannamaker L, Quie PG |title=Potentiation of opsonization and phagocytosis of Streptococcus pyogenes following growth in the presence of clindamycin |journal=J Clin Invest |volume=67 |issue=5 |pages=1249–56 |date=May 1981 |pmid=7014632 |doi=10.1172/JCI110152 |pmc=370690}}

Clindamycin has been proven to decrease the risk of premature births in women diagnosed with bacterial vaginosis during early pregnancy to about a third of the risk of untreated women.{{cite journal |vauthors=Lamont RF |title=Can antibiotics prevent preterm birth—the pro and con debate |journal=BJOG |volume=112 |issue= Suppl 1 |pages=67–73 |year=2005 |pmid=15715599 |doi=10.1111/j.1471-0528.2005.00589.x|s2cid=25572794 }}

The combination of clindamycin and quinine is the standard treatment for severe babesiosis.{{cite journal |vauthors=Homer MJ, Aguilar-Delfin I, Telford SR, Krause PJ, Persing DH |title=Babesiosis |journal=Clin Microbiol Rev |volume=13 |issue=3 |pages=451–69 |date=July 2000 |pmid=10885987 |doi=10.1128/CMR.13.3.451-469.2000 |pmc=88943 |doi-access=free | title-link=doi }}

Clindamycin may also be used to treat toxoplasmosis,{{cite journal |vauthors=Pleyer U, Torun N, Liesenfeld O | title = Okuläre Toxoplasmose |trans-title=Ocular toxoplasmosis |language=de |journal=Ophthalmologe |volume=104 |issue=7 |pages=603–16 |year=2007 |pmid=17530262 |doi=10.1007/s00347-007-1535-8| s2cid = 36696180 }}{{cite journal |vauthors=Jeddi A, Azaiez A, Bouguila H, Kaoueche M, Malouche S, Daghfous F, Ayed S | title = Intérêt de la clindamycine dans le traitement de la toxoplasmose oculaire |trans-title=Value of clindamycin in the treatment of ocular toxoplasmosis |language=fr |journal=Journal Français d'Ophtalmologie |volume=20 |issue=6 |pages=418–22 |year=1997 |pmid=9296037 | issn = 0181-5512 }} and, in combination with primaquine, is effective in treating mild to moderate Pneumocystis jirovecii pneumonia.{{cite journal |vauthors=Fishman JA |title=Treatment of infection due to Pneumocystis carinii |journal=Antimicrobial Agents and Chemotherapy |volume=42 |issue=6 |pages=1309–14 |date=June 1998 |pmid=9624465 |doi= 10.1128/AAC.42.6.1309|pmc=105593 | doi-access=free | title-link=doi }}

Clindamycin, either applied to skin or taken by mouth, may also be used in hidradenitis suppurativa.{{cite journal|vauthors=Saunte DM, Jemec GB |date=November 2017|title=Hidradenitis Suppurativa: Advances in Diagnosis and Treatment|journal=JAMA|volume=318|issue=20|pages=2019–32|doi=10.1001/jama.2017.16691|pmid=29183082|s2cid=5017318 }}

Common adverse drug reactions associated with systemic clindamycin therapy{{snd}}found in over 1% of people{{snd}}include: diarrhea, pseudomembranous colitis, nausea, vomiting, abdominal pain or cramps and/or rash. High doses (both intravenous and oral) may cause a metallic taste. Common adverse drug reactions associated with topical formulations{{snd}}found in over 10% of people{{snd}}include: dryness, burning, itching, scaliness, or peeling of skin (lotion, solution); erythema (foam, lotion, solution); oiliness (gel, lotion). Additional side effects include contact dermatitis.{{cite book | veditors = Rossi S | title = Australian Medicines Handbook | date = 2006 | location = Adelaide | publisher = AMH Pty Ltd }}{{cite journal |vauthors=de Groot MC, van Puijenbroek EP |doi = 10.1111/j.1365-2125.2007.02908.x | title = Clindamycin and taste disorders |journal = British Journal of Clinical Pharmacology |volume = 64 |issue = 4 |pages = 542–5 |date=October 2007 |pmid = 17635503 |pmc =2048568 }} Common side effects{{snd}}found in over 10% of people{{snd}}in vaginal applications include fungal infection.{{medical citation needed|date=December 2019}}

Rarely{{snd}} in less than 0.1% of people{{snd}} clindamycin therapy has been associated with anaphylaxis, blood dyscrasias, polyarthritis, jaundice, raised liver enzyme levels, renal dysfunction, cardiac arrest, and/or hepatotoxicity.

Pseudomembranous colitis is a potentially lethal condition commonly associated with clindamycin, but which also occurs with other antibiotics.{{cite journal |vauthors=Starr J |title=Clostridium difficile associated diarrhoea: diagnosis and treatment |journal=BMJ |volume=331 |issue=7515 |pages=498–501 |year=2005 |pmid=16141157 |doi=10.1136/bmj.331.7515.498 |pmc=1199032 }} Overgrowth of Clostridioides difficile, which is inherently resistant to clindamycin, results in the production of a toxin that causes a range of adverse effects, from diarrhea to colitis and toxic megacolon.{{cite journal |vauthors=Kelly CP, Pothoulakis C, LaMont JT |date=January 1994|title=Clostridium difficile colitis |journal=New England Journal of Medicine|volume=330|issue=4|pages=257–62|doi=10.1056/NEJM199401273300406|pmid=8043060 }}

Use of clindamycin during pregnancy is generally considered safe.{{cite journal |vauthors=Lell B, Kremsner PG |date=August 2002|title=Clindamycin as an antimalarial drug: review of clinical trials |journal=Antimicrobial Agents and Chemotherapy|volume=46|issue=8|pages=2315–20|doi=10.1128/AAC.46.8.2315-2320.2002|pmid=12121898|pmc=127356 }}

Clindamycin is classified as compatible with breastfeeding by the American Academy of Pediatrics,{{cite journal |vauthors=((American Academy of Pediatrics Committee on Drugs)) |title=Transfer of drugs and other chemicals into human milk |journal=Pediatrics |volume=108 |issue=3 |pages=776–89 |date=September 2001 |pmid=11533352 |doi=10.1542/peds.108.3.776 |doi-access=free | title-link=doi }} however, the WHO categorizes it as "avoid if possible".{{cite book |title=Breastfeeding and maternal medication : recommendations for drugs in the Eleventh WHO Model List of Essential Drugs |date=2002|hdl=10665/62435 | location = Geneva, Switzerland | work = Department of Child and Adolescent Health and Development |publisher=World Health Organization |last1=Organization |first1=World Health }} It is classified as L2 probably compatible with breastfeeding according to Medications and Mothers' Milk.{{cite book |title=Medications & mothers' milk | vauthors = Hale TW |publisher=Springer |others=Rowe, Hilary E. |year=2017 |isbn=9780826128584 |edition= Seventeenth |location=New York, NY |pages= |oclc=959873270 }} A 2009 review found it was likely safe in breastfeeding mothers, but did find one complication (hematochezia) in a breastfed infant which might be attributable to clindamycin.{{cite journal |vauthors=Mitrano JA, Spooner LM, Belliveau P |date=September 2009 |title=Excretion of antimicrobials used to treat methicillin-resistant Staphylococcus aureus infections during lactation: safety in breastfeeding infants |journal=Pharmacotherapy |volume=29 |issue=9 |pages=1103–9 |doi=10.1592/phco.29.9.1103 |pmid=19698015 |s2cid=2594769 }} LactMed lists potentially negative gastrointestinal effects in babies whose mothers take it while breastfeeding but did not see that as justification to stop breastfeeding.{{cite journal|title=Clindamycin|date=2006|url=https://www.ncbi.nlm.nih.gov/books/NBK501208/|journal=Drugs and Lactation Database (LactMed)|publisher=National Library of Medicine (US)|pmid=30000267|id=Bookshelf ID: NBK501208}}

Clindamycin may prolong the effects of neuromuscular-blocking drugs, such as succinylcholine and vecuronium.{{cite journal |vauthors=Fogdall RP, Miller RD |title=Prolongation of a pancuronium-induced neuromuscular blockade by clindamycin |journal=Anesthesiology |volume=41 |issue=4 |pages=407–8 |year=1974 |pmid=4415332|doi=10.1097/00000542-197410000-00023}}{{cite journal |vauthors=al Ahdal O, Bevan DR |title=Clindamycin-induced neuromuscular blockade |journal=Can J Anaesth |volume=42 |issue=7 |pages=614–7 |year=1995 |pmid=7553999 |doi=10.1007/BF03011880|doi-access=free | title-link=doi }}{{cite journal |vauthors=Sloan PA, Rasul M |title=Prolongation of rapacuronium neuromuscular blockade by clindamycin and magnesium |journal=Anesth Analg |volume=94 |issue=1 |pages=123–4, table of contents |year=2002 |pmid=11772813 |doi=10.1097/00000539-200201000-00023 | doi-access=free | title-link=doi }} Its similarity to the mechanism of action of macrolides and chloramphenicol means they should not be given simultaneously, as this causes antagonism and possible cross-resistance.{{medical citation needed|date=December 2019}}

File:Clindamycin phosphate Structural Formula V2.svg

Clindamycin is a semisynthetic derivative of lincomycin, a natural antibiotic produced by the actinobacterium Streptomyces lincolnensis. It is obtained by 7(S)-chloro-substitution of the 7(R)-hydroxyl group of lincomycin.{{cite journal |vauthors=Birkenmeyer RD, Kagan F |doi = 10.1021/jm00298a007 |title = Lincomycin. XI. Synthesis and structure of clindamycin, a potent antibacterial agent |journal = Journal of Medicinal Chemistry |volume = 13 |issue = 4 |pages = 616–19 |date=July 1970 |pmid = 4916317 }}{{cite journal |vauthors=Meyers BR, Kaplan K, Weinstein L |title=Microbiological and Pharmacological Behavior of 7-Chlorolincomycin |journal=Appl Microbiol |volume=17 |issue=5 |pages=653–7 |year=1969 |pmid=4389137 |doi= 10.1128/AEM.17.5.653-657.1969|pmc=377774}} The synthesis of clindamycin was first announced by BJ Magerlein, RD Birkenmeyer, and F Kagan on the fifth Interscience Conference on Antimicrobial Agents and Chemotherapy (ICAAC) in 1966.{{cite journal |vauthors=Magerlein BJ, Birkenmeyer RD, Kagan F |title = Chemical modification of lincomycin | journal = Antimicrobial Agents and Chemotherapy |volume = 6 |pages = 727–36 |year = 1966 |pmid = 5985307 }} It has been on the market since 1968.

Clindamycin is white or yellow powder that is very soluble in water.{{cite journal |vauthors=Spízek J, Rezanka T |date=May 2004|title=Lincomycin, clindamycin and their applications|journal=Applied Microbiology and Biotechnology|volume=64|issue=4|pages=455–64|doi=10.1007/s00253-003-1545-7|pmid=14762701|s2cid=7870760 }} The topically used clindamycin phosphate is a phosphate-ester prodrug of clindamycin.

File:Clindamycin mechanism.png

Clindamycin has a primarily bacteriostatic effect. At higher concentrations, it may be bactericidal. It is a bacterial protein synthesis inhibitor by inhibiting ribosomal translocation,[https://archive.today/20120718035925/http://sitemaker.umich.edu/mc3/clindamycin Clindamycin] University of Michigan. Retrieved 31 July 2009 in a similar way to macrolides. It does so by binding to the rRNA of the bacterial 50S ribosome subunit, overlapping with the binding sites of the oxazolidinone, pleuromutilin, and macrolide antibiotics, among others.{{cite web |url = https://www.merckmanuals.com/professional/infectious-diseases/bacteria-and-antibacterial-drugs/lincosamides,-oxazolidinones,-and-streptogramins |title = Lincosamides, Oxazolidinones, and Streptogramins |date = May 2020 |access-date = 19 December 2021 |publisher = Merck & Co. |work = Merck Manual of Diagnosis and Therapy |url-status = live |archive-url = https://web.archive.org/web/20071202164507/http://www.merck.com/mmpe/print/sec14/ch170/ch170g.html |archive-date = 2 December 2007 }}{{cite journal |vauthors=Wilson DN |title=Ribosome-targeting antibiotics and mechanisms of bacterial resistance |journal=Nature Reviews Microbiology |volume=12 |issue=1 |pages=35–48 |doi=10.1038/nrmicro3155 |pmid=24336183 |date=January 2014 |s2cid=9264620 }} The binding is reversible.Beauduy CE, Winston LG. Tetracyclines, Macrolides, Clindamycin, Chloramphenicol, Streptogramins, & Oxazolidinones. In: Katzung BG. eds. Basic & Clinical Pharmacology, 14e New York, NY: McGraw-Hill; . Clindamycin is more effective than lincomycin.

The X-ray crystal structures of clindamycin bound to ribosomes (or ribosomal subunits) derived from Escherichia coli,{{cite journal |vauthors=Dunkle JA, Xiong L, Mankin AS, Cate JH |date=October 2010 |title=Structures of the Escherichia coli ribosome with antibiotics bound near the peptidyl transferase center explain spectra of drug action |journal=Proceedings of the National Academy of Sciences |volume=107 |issue=40 |pages=17152–57 |doi=10.1073/pnas.1007988107 |pmid=20876128 |pmc=2951456|bibcode=2010PNAS..10717152D |doi-access=free | title-link=doi }} Deinococcus radiodurans,{{cite journal |vauthors=Schlünzen F, Zarivach R, Harms J, Bashan A, Tocilj A, Albrecht R, Yonath A, Franceschi F |title=Structural basis for the interaction of antibiotics with the peptidyl transferase centre in eubacteria |journal=Nature |volume=413 |issue=6858 |pages=814–21 |doi=10.1038/35101544 |pmid=11677599 |date=October 2001|bibcode=2001Natur.413..814S |s2cid=205022511 }} and Haloarcula marismortui{{cite journal |vauthors=Tu D, Blaha G, Moore PB, Steitz TA |title=Structures of MLSBK antibiotics bound to mutated large ribosomal subunits provide a structural explanation for resistance |journal=Cell |volume=121 |issue=2 |pages=257–70 |doi=10.1016/j.cell.2005.02.005 |pmid=15851032 |date=April 2005|s2cid=7086043 |doi-access=free | title-link=doi }} have been determined; the structure of the closely related antibiotic lincomycin bound to the 50S ribosomal subunit of Staphylococcus aureus has also been reported.{{cite journal |vauthors=Matzov D, Eyal Z, Benhamou RI, Shalev-Benami M, Halfon Y, Krupkin M, Zimmerman E, Rozenberg H, Bashan A, Fridman M, Yonath A |title=Structural insights of lincosamides targeting the ribosome of Staphylococcus aureus |journal=Nucleic Acids Research |doi=10.1093/nar/gkx658 |pmid=28973455 |pmc=5622323 |volume=45 |issue=17 |date=September 2017 |pages=10284–92 }}

Clindamycin is available as a generic medication and is relatively inexpensive.{{cite book | vauthors = Cunha BA |title=Infectious Diseases in Critical Care Medicine |date=2009 |publisher=CRC Press |isbn=978-1-4200-9241-7 |page=506 |url=https://books.google.com/books?id=syasCQAAQBAJ&dq=Cephalexin+inexpensive&pg=PA506 }}

File:Clindamycin.jpg

Clindamycin preparations that are taken by mouth include capsules (containing clindamycin hydrochloride) and oral suspensions (containing clindamycin palmitate hydrochloride). Oral suspension is not favored for administration of clindamycin to children, due to its extremely foul taste and odor. Clindamycin is formulated in a vaginal cream and as vaginal ovules for treatment of bacterial vaginosis. It is also available for topical administration in gel form, as a lotion, and in a foam delivery system (each containing clindamycin phosphate) and a solution in ethanol (containing clindamycin hydrochloride) and is used primarily as a prescription acne treatment.{{cite journal |vauthors=Cunliffe WJ, Holland KT, Bojar R, Levy SF |title=A randomized, double-blind comparison of a clindamycin phosphate/benzoyl peroxide gel formulation and a matching clindamycin gel with respect to microbiologic activity and clinical efficacy in the topical treatment of acne vulgaris |journal=Clin Ther |volume=24 |issue=7 |pages=1117–33 |year=2002 |pmid=12182256|doi=10.1016/S0149-2918(02)80023-6}}

Several combination acne treatments containing clindamycin are also marketed, such as single-product formulations of clindamycin with benzoyl peroxide—sold as BenzaClin (Sanofi-Aventis), Duac (a gel form made by Stiefel), and Acanya, among other trade names—and, in the United States, a combination of clindamycin and tretinoin, sold as Ziana.{{cite web |url=https://www.medscape.com/viewarticle/548709 |title=FDA Approvals: Ziana, Kadian, Polyphenon E | vauthors = Waknine Y |date=1 December 2006 |access-date=1 December 2007 |website=Medscape Medical News |url-status=live |archive-url=https://web.archive.org/web/20110206012932/http://www.medscape.com/viewarticle/548709 |archive-date=6 February 2011 }} In India, vaginal suppositories containing clindamycin in combination with clotrimazole are manufactured by Olive Health Care and sold as Clinsup-V. In Egypt, vaginal cream containing clindamycin produced by Biopharmgroup sold as Vagiclind indicated for vaginosis.{{citation needed|date=December 2019}}

Clindamycin is available as a generic drug, for both systemic (oral and intravenous) and topical use. (The exception is the vaginal suppository, which is not available as a generic in the US{{cite web | title=Generic Cleocin Vaginal Availability | website=Drugs.com | url=https://www.drugs.com/availability/generic-cleocin-vaginal.html | access-date=13 October 2019}}).

The veterinary uses of clindamycin are quite similar to its human indications, and include treatment of osteomyelitis,(8 February 2005) [http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/91509.htm "Osteomyelitis"] {{webarchive|url=https://web.archive.org/web/20080107204544/http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm%2Fbc%2F91509.htm |date=7 January 2008 }}, in Kahn, Cynthia M., Line, Scott, Aiello, Susan E. (ed.): The Merck Veterinary Manual, 9th ed., John Wiley & Sons. {{ISBN|0-911910-50-6}}. Retrieved 14 December 2007. skin infections, and toxoplasmosis, for which it is the preferred drug in dogs and cats.(8 February 2005) [http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/52200.htm "Toxoplasmosis: Introduction"] {{webarchive |url=https://web.archive.org/web/20071220055127/http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm%2Fbc%2F52200.htm |date=20 December 2007}}, in Kahn, Cynthia M., Line, Scott, Aiello, Susan E. (ed.): The Merck Veterinary Manual, 9th ed., John Wiley & Sons. {{ISBN|0-911910-50-6}}. Retrieved 14 December 2007. It can be used both by mouth and topically. A disadvantage is that bacterial resistance can develop fairly quickly. Gastrointestinal upset may also occur. Toxoplasmosis rarely causes symptoms in cats, but can do so in very young or immunocompromised kittens and cats.{{citation needed|date=December 2019}}

{{Reflist}}

• {{ClinicalTrialsGov|NCT04370548|DARE-BV1 in the Treatment of Bacterial Vaginosis (DARE-BVFREE)}}

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