administered by intravenous infusion only, single
doses by intravenous infusion not to exceed 1. 2 g
Staphylococcal lung infection in cystic fibrosis
▶BY MOUTH
▶Child: 5 – 7 mg/kg 4 times a day (max. per dose 600 mg)
Treatment of falciparum malaria (to be given with or
following quinine)
▶BY MOUTH
▶Child: 7 – 13 mg/kg every 8 hours (max. per dose
450 mg) for 7 dayslUNLICENSED USENot licensed for treatment of falciparum
malaria.
lCONTRA-INDICATIONSAvoid injections containing benzyl
alcohol in neonates.diarrhoeal states
lCAUTIONSAvoid in Acute porphyrias p. 603
lINTERACTIONS→Appendix 1 : clindamycin
lSIDE-EFFECTS
GENERAL SIDE-EFFECTS
▶Common or very commonAbdominal pain.antibiotic
associated colitis.diarrhoea (discontinue).skin reactions
▶UncommonNausea.vomiting
▶Frequency not knownAgranulocytosis.angioedema.
eosinophilia.jaundice.leucopenia.neutropenia.severe
cutaneous adverse reactions (SCARs).taste altered.
thrombocytopenia.vulvovaginal infection
SPECIFIC SIDE-EFFECTS
▶Frequency not known
▶With oral useGastrointestinal disorders
▶With parenteral useCardiac arrest.hypotension
SIDE-EFFECTS, FURTHER INFORMATIONClindamycin has
been associated with antibiotic-associated colitis, which
may be fatal. Although antibiotic-associated colitis can
occur with most antibacterials, it occurs more frequently
with clindamycin. IfC. difficileinfection is suspected or
confirmed, discontinue the antibiotic if appropriate. Seek
specialist advice if the antibiotic cannot be stopped and
the diarrhoea is severe.
lPREGNANCYNot known to be harmful.
lBREAST FEEDINGAmount probably too small to be
harmful but bloody diarrhoea reported in 1 infant.
lMONITORING REQUIREMENTSMonitor liver and renal
function if treatment exceeds 10 days. Monitor liver and
renal function in neonates and infants.
lDIRECTIONS FOR ADMINISTRATIONAvoid rapid
intravenous administration. Forintravenous infusion,
dilute to a concentration of not more than 18 mg/mL with
Glucose 5 %orSodium Chloride 0. 9 %; give over
10 – 60 minutes at a max. rate of 20 mg/kg/hour.
lPATIENT AND CARER ADVICECapsules should be swallowed
with a glass of water. Patients and their carers should be
advised to discontinue immediately and contact doctor if
diarrhoea develops.
lPROFESSION SPECIFIC INFORMATION
Dental practitioners’formulary
Clindamycin capsules may be prescribed.lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution
Solution for injection
EXCIPIENTS:May contain Benzyl alcohol
▶Clindamycin (Non-proprietary)
Clindamycin (as Clindamycin phosphate) 150 mg per
1mlClindamycin 600 mg/ 4 ml solution for injection ampoules|
5 ampouleP£ 59. 00 – £ 61. 75
Clindamycin 300 mg/ 2 ml solution for injection ampoules|
5 ampouleP£ 29. 50 – £ 31. 01▶Dalacin C(Pfizer Ltd)
Clindamycin (as Clindamycin phosphate) 150 mg per 1 mlDalacin
C Phosphate 300 mg/ 2 ml solution for injection ampoules|
5 ampouleP£ 31. 01 (Hospital only)
Dalacin C Phosphate 600 mg/ 4 ml solution for injection ampoules|
5 ampouleP£ 61. 75 (Hospital only)
Capsule
CAUTIONARY AND ADVISORY LABELS9, 27
▶Clindamycin (Non-proprietary)
Clindamycin (as Clindamycin hydrochloride) 150 mgClindamycin
150 mg capsules| 24 capsuleP£ 18. 29 DT = £ 3. 79 |
100 capsuleP£ 15. 16 – £ 76. 20
Clindamycin (as Clindamycin hydrochloride) 300 mgClindamycin
300 mg capsules| 30 capsuleP£ 46. 00 DT = £ 38. 45
▶Dalacin C(Pfizer Ltd)
Clindamycin (as Clindamycin hydrochloride) 75 mgDalacin C
75 mg capsules| 24 capsuleP£ 7. 45 DT = £ 7. 45
Clindamycin (as Clindamycin hydrochloride) 150 mgDalacin C
150 mg capsules| 24 capsuleP£ 13. 72 DT = £ 3. 79 |
100 capsuleP£ 55. 08ANTIBACTERIALS›MACROLIDES
Macrolides
Overview
The macrolides have an antibacterial spectrum that is similar
but not identical to that of penicillin; they are thus an
alternative in penicillin-allergic patients. They are active
against many-penicillin-resistant staphylococci, but some
are now also resistant to the macrolides.
Indications for the macrolides include campylobacter
enteritis, respiratory infections (including pneumonia,
whooping cough, Legionella, chlamydia, and mycoplasma
infection), and skin infections.
Erythromycin p. 331 is also used in the treatment of early
syphilis, uncomplicated genital chlamydial infection, and
non-gonococcal urethritis. Erythromycin has poor activity
againstHaemophilus influenzae. Erythromycin causes nausea,
vomiting, and diarrhoea in some patients; in mild to
moderate infections this can be avoided by giving a lower
dose or the total dose in 4 divided doses, but if a more
serious infection, such as Legionella pneumonia, is
suspected higher doses are needed.
Azithromycin p. 329 is a macrolide with slightly less
activity than erythromycin against Gram-positive bacteria,
but enhanced activity against some Gram-negative
organisms includingH. influenzae. Plasma concentrations
are very low, but tissue concentrations are much higher. It
has a long tissue half-life and once daily dosage is
recommended. Azithromycin is also used in the treatment of
uncomplicated genital chlamydial infection, non-gonococcal
urethritis, typhoid [unlicensed indication], and trachoma
[unlicensed indication].
Clarithromycin p. 330 is an erythromycin derivative with
slightly greater activity than the parent compound. Tissue
concentrations are higher than with erythromycin. It is given
twice daily. Clarithromycin is also used in regimens for
Helicobacter pylorieradication.
Erythromycin, azithromycin, and clarithromycin have a
role in the treatment of Lyme disease p. 360.
Spiramycin is also a macrolide which is used for the
treatment of toxoplasmosis.Macrolides f
lCAUTIONSElectrolyte disturbances (predisposition to QT
interval prolongation).may aggravate myasthenia gravis.
predisposition to QT interval prolongation
lSIDE-EFFECTS
▶Common or very commonAppetite decreased.arthralgia.
diarrhoea.dizziness.eye discomfort.gastrointestinal328 Bacterial infection BNFC 2018 – 2019
Infection5