This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. There have been reports of resistance to vancomycin through a heteroresistance mechanism, but this is not easily identified with clinical microbiology testing and requires special detection techniques. Clindamycin is usually used for anaerobic infections; however, clindamycin resistance has emerged among these organisms in some regions. Clindamycin is a lincosamide antibiotic Lincosamides, Oxazolidinones, and Streptogramins Lincosamides ( clindamycin), oxazolidinones ( linezolid, tedizolid), and streptogramins ( dalfopristin [streptogramin A] and quinupristin [streptogramin B]) are structurally different but are read more that is primarily bacteriostatic. Nondepolarizing muscle relaxant (pancuronium, tubocurarine): lincosamides may enhances the action of nondepolarizing muscle relaxants. Local administration reactions such as pain, induration, and sterile abscess after IM injection may be minimized or avoided through administration via deep IM injection, and thrombophlebitis after IV infusion by avoiding prolonged use of indwelling catheters. The recommended treatment is vancomycin (15 mg per kg intravenously every six hours) in children with serious or invasive disease. Results: MeSH Regular bathing is advised, as well as hand washing with soap and water or an alcohol-based hand gel, especially after touching infected skin or an item that has been in contact with a draining wound. Improved outcome of, Safrin S, Finkelstein DM, Feinberg J, et al. The latter were less often community-acquired (45% vs. 69%), more often from infants <1 month of age (24% vs. 4%) and less likely to be in the community acquisition-associated PFGE Group 1 (62% vs. 87%) than those that were susceptible. Use with caution in pts receiving such agents. An official website of the United States government. The role of anticoagulation is controversial. Cmax 10 mcg/ml after 600 mg IV and 2.5 mcg/ml after 150 mg IV and po dose administration, respectively. The trusted provider of medical information since 1899, Lincosamides, Oxazolidinones, and Streptogramins, Polypeptide Antibiotics: Bacitracin, Colistin, Polymyxin B, Reviewed/Revised May 2022 | Modified Sep 2022. Clindamycin has been reported to appear in breast milk in range of 0.5 to 3.8 mcg/mL; clindamycin has potential to cause adverse effects on breastfed infant's gastrointestinal flora; if oral or intravenous clindamycin is required by nursing mother, it is not a reason to discontinue breastfeeding, but alternate drug may be preferred; monitor . Data are insufficient to support the routine use of combination therapy with rifampin or gentamicin in children with bacteremia or infective endocarditis. with or without a single dose of gentamicin if the MRSA isolate is known to be susceptible (weak recommendation). Early evaluation for valve replacement surgery is recommended. A clinical assessment to identify the source and extent of the infection with elimination and/or debridement of other sites of infection is recommended. Clindamycin diffuses well into body fluids except cerebrospinal fluid; it is concentrated in phagocytes. Also, if you stop taking this medicine too soon, your symptoms may return. Clindamycin, a protein synthesis inhibitor antibiotic, is thought to limit exotoxin production and improve outcomes in severe S. aureus infections. Take this medicine exactly as directed by your doctor. For those with nonpurulent cellulitis, five to 10 days of empiric therapy for -hemolytic streptococcal infection is recommended, based on the patient's clinical response. In patients with normal renal function, intravenous vancomycin (15 to 20 mg per kg every eight to 12 hours) is recommended, but should not exceed 2 g per dose. The prevalence of methicillin-resistant Staphylococcus aureus (MRSA) in the United States continues to increase, with more than 94,000 cases of invasive disease reported in 2005. Clindamycin was given as two 150-mg tablets three times daily. There is a risk for the appearance of resistance during clindamycin therapy of erythromycin-resistant MRSA infections because of the linked resistance mechanisms. In contrast a 12-year-old girl with abscesses caused by a similar MRSA developed another abscess after clindamycin therapy, but the organism was unchanged in susceptibility. Intramuscular doses should be administered as a deep IM injection. Until such data are complete, only anecdotal and retrospective data are available to guide treatment recommendations. Clindamycin is widely used in children for community-acquired MRSA skin and soft-tissue infections, and is anecdotally reported to be effective. For adults with complicated bacteremia (positive blood culture results without meeting criteria for uncomplicated bacteremia), four to six weeks of therapy is recommended, depending on the extent of infection. Accumulation of clindamycin has not been demonstrated when dosed every 8 hours. In children, intravenous vancomycin (15 mg per kg every six hours) is recommended for treating bacteremia and infective endocarditis. The dose is usually 37.5 milligrams (mg) or 1/2 teaspoonful 3 times a day. CHILDREN In children with minor skin infections (e.g., impetigo) or secondarily infected lesions (e.g., eczema, ulcers, lacerations), treatment with mupirocin 2% topical cream (Bactroban) is. The ideal dosage of TMP/SMX for treating community-acquired MRSA is unknown, although one small study reported higher success rates when two double-strength pills were given twice daily, compared with one pill twice daily. ", Avdic, E., & Pham, P. A. Transesophageal echocardiography is preferred over transthoracic echocardiography. Coyle EA, Cha R, Rybak MJ. Simple abscesses or boils may be managed with incision and drainage alone; more data are needed on the use of antibiotics in this setting. Lymphadenitis. Oral antimicrobial therapy for treatment of skin and soft tissue infections due to methicillin-resistant Staphylococcus aureus (MRSA) in adults The doses recommended above are intended for patients with normal renal function; the doses of some of these agents must be adjusted in patients with renal insufficiency. The National Institutes of Health has initiated several clinical trials examining the effectiveness of alternative antibiotics, but there are currently no randomized prospective trials of agents used to treat skin and soft-tissue infections from community-acquired MRSA. Data on vancomycin dosing in children are limited. Combination therapy with additional antibiotics may be required according to standard treatment protocols. An alternate regimen: per dose 450 mg). Drug information provided by: Merative, Micromedex. Clindamycin was given IV 10 mg/kg/dose up to 600 mg four times daily or oral 450 mg three times daily in adults (10 mg/kg/dose in children) for 7 days. information highlighted below and resubmit the form. rxns ranging in severity from mild diarrhea to fatal colitis reported during tx and even >2mo after D/C; reserve clindamycin for serious infections where less toxic abx inappropriate; do not use in nonbacterial infections incl. Some experts recommend higher dosages of daptomycin (8 to 10 mg per kg intravenously once per day). Unauthorized use of these marks is strictly prohibited. Strategies for decolonization include nasal decolonization with mupirocin twice per day for five to 10 days, or nasal decolonization with mupirocin twice per day for five to 10 days plus topical body decolonization with a skin antiseptic solution (e.g., chlorhexidine [Peridex]) for five to 14 days or dilute bleach baths. Combining rifampin with TMP/SMX, or fusidic acid where available, may be more effective than using either agent alone. A double-blind, randomized, trial of oral trimethoprim-sulfamethoxazole, dapsone-trimethoprim, and, Katlama C, De Wit S, O'Doherty E, et al. Available at: Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children.Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Copyright 2023 Merck & Co., Inc., Rahway, NJ, USA and its affiliates. Comment: IDSA guideline recommendations for the use of clindamycin for the treatment of rhinosinusitis. Can I take clindamycin if I am allergic to penicillin? information and will only use or disclose that information as set forth in our notice of Antibacterial activity of recently approved antibiotics against methicillin-resistant Staphylococcus aureus (MRSA) strains: A systematic review and meta-analysis. prednisone, amoxicillin, doxycycline, ciprofloxacin, azithromycin, metronidazole, cephalexin, clindamycin, dexamethasone, ceftriaxone. Clindamycin enters breast milk. Tetracyclines Need for drainage/source control of head and neck infections should be evaluated carefully in consultation with Pediatric Otolaryngology, Head and Neck Surgery. Empiric coverage for community-associated MRSA is recommended in patients who do not respond to beta-lactam antibiotics, and also may be considered in those with systemic toxicity. government site. Use for phrases Child 3-6 mg/kg 4 times a day (max. Severe infection: 450 mg/m2 via IV infusion or IM injection per day UR - https://www.hopkinsguides.com/hopkins/view/Johns_Hopkins_ABX_Guide/540131/all/Clindamycin Dose adjustments are not required for renal failure. Disease is most severe in asplenic read more or falciparum malaria Falciparum malaria Malaria is infection with Plasmodium species. Neurosurgical evaluation for incision and drainage is recommended for patients with brain abscess, subdural empyema, or spinal epidural abscess. Clindamycin can be used for infections due to clindamycin - and erythromycin -susceptible strains. Comment: CDC guideline recommendations for the use of clindamycin in the treatment of malaria. Adult Mayo Clinic does not endorse companies or products. Methods: Serum trough concentrations should be obtained at steady state conditions, before the fourth or fifth dose. Determination of antimicrobial susceptibility patterns in Staphylococcus aureus strains recovered from patients at two main health facilities in Kabul, Afghanistan. Measuring erythrocyte sedimentation rate, C-reactive protein level, or both may help guide the response to therapy. 2017 Nov 29;17(1):737. doi: 10.1186/s12879-017-2844-4. Copyright 2009 by the American Academy of Family Physicians. Bethesda, MD 20894, Web Policies Some experts recommend adding rifampin. The concentration of clindamycin in diluent for IV infusion should not exceed 18 mg/mL. Only 10% is excreted in urine within 24hrs. ID consultation . Advertising revenue supports our not-for-profit mission. Pediatr Infect Dis J. ID - 540131 Federal government websites often end in .gov or .mil. The effectiveness and safety of targeting trough concentrations of 15 to 20 mcg per mL in children require additional study, but should be considered in those with serious infections, such as bacteremia, infective endocarditis, osteomyelitis, meningitis, pneumonia, or severe skin and soft-tissue infections. Clindamycin remains a treatment option if the clinician is notified of the risk by the microbiology laboratory and the clinical situation is suitable. Recommended treatment of neonatal MRSA sepsis is intravenous vancomycin, with dosing as outlined in Red Book. If initial non-operative management is chosen, a narrow spectrum regimen (i.e. This content does not have an English version. Infections can be asymptomatic or cause a malaria-like illness with fever and hemolytic anemia. This site needs JavaScript to work properly. Frank AL, Marcinak JF, Mangat PD, Schreckenberger PC. Diagnosis depends on species; culture, nucleic acid amplification read more , Chlamydophila species, and legionellae Legionella Infections Legionella pneumophila is a gram-negative bacillus that most often causes pneumonia with extrapulmonary features. There is a risk for the appearance of resistance during clindamycin therapy of erythromycin-resistant MRSA infections because of the linked resistance mechanisms. For isolates with a vancomycin minimal inhibitory concentration of 2 mcg per mL or less (e.g., susceptible according to Clinical and Laboratory Standards Institute breakpoints), the patient's clinical response should dictate the continued use of vancomycin, independent of the minimal inhibitory concentration. Enter your email below and we'll resend your username to you. Alternatives include linezolid or TMP/SMX (5 mg per kg intravenously every eight to 12 hours). Wu X, Yu H, He LY, Wang CQ, Xu HM, Zhao RQ, Jing CM, Chen YH, Chen J, Deng JK, Shi J, Lin AW, Li L, Deng HL, Cai HJ, Chen YP, Wen ZW, Yang JH, Zhang T, Xiao FF, Cao Q, Huang WC, Hao JH, Zhang CH, Huang YY, Ji XF. Oral: Linezolid is the only oral agent with demonstrated effectiveness against MRSA in controlled trials, but its use has been restricted because it is expensive. Vancomycin trough concentrations of 15 to 20 mcg per mL are recommended in patients with serious infections, such as bacteremia, infective endocarditis, osteomyelitis, meningitis, pneumonia, or severe skin and soft-tissue infections (e.g., necrotizing fasciitis) caused by MRSA. Liu F, Rajabi S, Shi C, Afifirad G, Omidi N, Kouhsari E, Khoshnood S, Azizian K. Ann Clin Microbiol Antimicrob. See permissionsforcopyrightquestions and/or permission requests. 2020 Aug 2;58(8):628-634. doi: 10.3760/cma.j.cn112140-20200505-00469. Recommended treatment for adults with uncomplicated bacteremia includes vancomycin or daptomycin at a dosage of 6 mg per kg intravenously once per day for at least two weeks. MRSA-active therapy may be modified if there is no clinical response. This can be avoided by ordering tests, such as the double-disk D-test, to detect this type of inducible resistance. Learn more about the Merck Manuals and our commitment to. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. DB - Johns Hopkins Guides Mechanisms of Resistance to Macrolide Antibiotics among. In vitro evidence suggests TMP/SMX has greater bactericidal activity against community-acquired MRSA than linezolid (Zyvox), rifampin (Rifadin), clindamycin (Cleocin), or minocycline (Minocin). Clindamycin does not penetrate the blood brain barrier in therapeutically effective quantities and should not be used in the treatment of meningitis. Symptoms and signs include fever (which may be periodic), chills, rigors, sweating, diarrhea, abdominal pain, respiratory distress, confusion read more, With primaquine for Pneumocystis jirovecii pneumonia Pneumocystis jirovecii Pneumonia Pneumocystis jirovecii is a common cause of pneumonia in immunosuppressed patients, especially in those infected with human immunodeficiency virus (HIV) and in those receiving systemic read more. Magnetic resonance imaging with gadolinium is the imaging modality of choice for detecting early osteomyelitis and associated soft-tissue disease. We analyzed clindamycin-susceptible MRSA organisms from children (1987 to 2000) along with clinical data. Naimi HM, Rasekh H, Noori AZ, Bahaduri MA. The amount of medicine that you take depends on the strength of the medicine. Before 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). (Constitutive means that resistance is always present regardless of whether an inducer, such as erythromycin, is present.). Clindamycin systemic 300 mg (RX693 RX693). A search for and removal of other foci of infection, drainage, or surgical debridement is recommended. Save 2.20. Patients with infective endocarditis and a prosthetic valve should be treated with intravenous vancomycin and rifampin (300 mg orally or intravenously every eight hours for at least six weeks), plus gentamicin (1 mg per kg intravenously every eight hours for two weeks). Clindamycin is used in soft tissue infections due to its efficacy against MRSA. In clinical trials with pregnant women, clindamycin given during the 2nd and 3rd trimesters has not been associated with an increased frequency of birth defects. A clindamycin disk is placed at a standard distance from an erythromycin disk on an agar plate streaked with a standard inoculum of the CA-MRSA strain in question. Alternatives include linezolid and TMP/SMX. Although community-acquired MRSA occurs worldwide, the problem is of special concern in the United States where it accounts for up to 60 to 75 percent of all reported S. aureus infections. Active against most Gram-positive cocci except Enterococcus. Dosing Considerations Clindamycin is a lincosamide antibiotic that is primarily bacteriostatic. This medicine works best when there is a constant amount in the blood. Empiric therapy for MRSA is recommended, pending sputum and/or blood culture results, for hospitalized patients with severe community-acquired pneumonia defined by one of the following: a requirement for admission to the intensive care unit, necrotizing or cavitary infiltrates, or empyema. Unable to load your collection due to an error, Unable to load your delegates due to an error. Some experts recommend adding rifampin (600 mg per day, or 300 to 450 mg twice per day). Inducible clindamycin resistance and molecular epidemiologic trends of pediatric community-acquired methicillin-resistant Staphylococcus aureus in Dallas, Texas. If the patient has had a previous clinical and microbiologic response to vancomycin, it may be continued with close follow-up. Centers for Disease Control and Prevention. For localized disease in a premature or very low-birth-weight infant or more extensive disease involving multiple sites in full-term infants, intravenous vancomycin or clindamycin is recommended until bacteremia is excluded. Resistance to clindamycin has generally increased over the years. It binds to the 50S subunit of the ribosome, thus inhibiting bacterial protein synthesis. PB - The Johns Hopkins University Prompt debridement with device removal is recommended for unstable implants or late-onset infections, or in patients with more than three weeks of symptoms. . Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents. Trough vancomycin monitoring is recommended for patients with serious infections or who are morbidly obese, have renal dysfunction (including those receiving dialysis), or have fluctuating volumes of distribution. Because of the risk of red man syndrome and possible anaphylaxis associated with large doses of vancomycin, physicians should consider prolonging the infusion time to two hours and giving an antihistamine before administering the loading dose. Wald-Dickler N, Holtom PD, Phillips MC, Centor RM, Lee RA, Baden R, Spellberg B. Give daily dosage in 3 or 4 equally divided doses. We recommend weight- . Parenteral: Clindamycin FDA-approved to treat serious infections due to S. aureus D-zone test should be performed to identify inducible clindamycin resistance in erythromycin-resistant isolates Clostridium difficile-associated disease, while uncommon, may occur more frequently in association with clindamycin compared to other agents. Drainage or debridement of the joint space should be performed. Although linezolid may prove useful for community-acquired MRSA-associated pneumonia, there are no studies examining this to date. This content is owned by the AAFP. Excreted into breast milk. Clindamycin is part of combination therapy for the following: With penicillin for infections caused by toxigenic streptococci (because clindamycin decreases the bacterias toxin production), With pyrimethamine for cerebral toxoplasmosis CNS toxoplasmosis Toxoplasmosis is infection with Toxoplasma gondii. Patients who have moderate to severe infection with an inducible ribosomal-resistant CA-MRSA strain and a positive D test should not be treated with clindamycin. Pharmacokinetics Clindamycin is absorbed well orally and can be given parenterally. (2018). More complicated lesions (i.e., those with surrounding cellulitis or no drainable foci) are usually treated with antimicrobial agents. Approved as a pharmacy medicine, Sanofi will launch Cialis Together in the second half of the year. Patients with fever or other systemic symptoms are also usually treated with antimicrobial agents. What are the best antibiotics for a tooth infection? Select Try/Buy and follow instructions to begin your free 30-day trial. It binds to the 50S subunit of the ribosome, thus inhibiting bacterial protein synthesis. 2006 Dec;26(12):1758-70. doi: 10.1592/phco.26.12.1758. Clindamycin cannot be used for central nervous system infections (other than cerebral toxoplasmosis) because penetration into the brain and cerebrospinal fluid is poor. Intravenous doses should be diluted and administered as an infusion over 10 to 60 minutes, at a rate not exceeding 30 mg/min. This is to prevent irritation of the esophagus (tube between the throat and stomach). doi: 10.1016/j.amjmed.2021.10.007. Four times a day dosing may limit patient adherence with oral regimen. Use OR to account for alternate terms However, a reasonable alternative would be to use vancomycin with clindamycin for this purpose. Clindamycin. Chavez-Bueno S, Bozdogan B, Katz K, Bowlware KL, Cushion N, Cavuoti D, Ahmad N, McCracken GH Jr, Appelbaum PC. Clindamycin and linezolid should not be used if there is concern of infective endocarditis or an endovascular source of infection, although they may be considered in children with bacteremia that rapidly clears and is not related to an endovascular focus. information submitted for this request. 2022 Aug 17;21(1):37. doi: 10.1186/s12941-022-00529-z. The duration of therapy may range from two to six weeks depending on the source, the presence of endovascular infection, and metastatic foci of infection. In patients with MRSA pneumonia complicated by empyema, antimicrobial therapy should be used with drainage procedures. However, they can also cause more serious infections, including pneumonia, pelvic osteomyelitis, septic thrombophlebitis, and necrotizing fasciitis. The average household teaspoon may not hold the right amount of liquid. Curr Opin Infect Dis. 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