Clindamycin Kalceks

/ A.L. Medi-Market LTD,

Parenteral (IM or IV administration). Clindamycin must be diluted prior to IV administration and should be infused over at least 10-60 minutes.
Adults:
Serious infections: 600 mg – 1.2 g/day in two, three or four equal doses.
More severe infections: 1.2-2.7 g/day in two, three or four equal doses.
Single IM injections of greater than 600 mg are not recommended nor is administration of more than 1.2 g in a single one-hour infusion.
For more serious infections, these doses may have to be increased. In life-threatening situations, doses as high as 4.8 g daily have been given intravenously to adults.
Alternatively, the drug may be administered in the form of a single rapid infusion of the first dose followed by continuous IV infusion.
Paediatric population
Children (over 1 month of age):
Serious infections: 15-25 mg/kg/day in three or four equal doses.
Clindamycin should be dosed based on total body weight regardless of obesity.
More severe infections: 25-40 mg/kg/day in three or four equal doses. In severe infections it is recommended that children be given no less than 300 mg/day regardless of body weight.
The concentration of clindamycin in diluent for infusion should not exceed 18 mg per ml and infusion rates should not exceed 30 mg per minute.
See prescribing information for full details.

Clindamycin is indicated for the treatment of infections caused by susceptible anaerobic bacteria.
Clindamycin does not penetrate the blood/brain barrier in therapeutically effective quantities.

Previously sensitive to clindamycin, lincomycin, any component of the formulation, or to any of the excipients

Warnings
Severe hypersensitivity reactions, including severe skin reactions such as drug reaction with eosinophilia and systemic symptoms (DRESS), Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), acute generalised exanthematous pustulosis (AGEP), and Kounis syndrome have been reported in patients receiving clindamycin therapy. If a hypersensitivity or severe skin reaction occurs, clindamycin should be discontinued, and appropriate therapy should be initiated.
Clindamycin should only be used in the treatment of serious infections. In considering the use of the product, the practitioner should bear in mind the type of infection and the potential hazard of the diarrhoea which may develop, since cases of colitis have been reported during, or even two or three weeks following, the administration of clindamycin.
Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of Clostridioides difficile. This has been reported with use of nearly all antibacterial agents, including clindamycin. Clostridioides difficile produces toxins A and B which contribute to the development of Clostridioides difficile associated diarrhoea (CDAD) and is a primary cause of ‘antibiotic-associated colitis’. The disease is likely to follow a more severe course in older patients or patients who are debilitated. Diagnosis is usually made by the recognition of the clinical symptoms, but can be substantiated by endoscopic demonstration of pseudomembranous colitis. Colitis is a disease, which has a clinical spectrum from mild, watery diarrhoea to severe, persistent diarrhoea, leucocytosis, fever, severe abdominal cramps, which may be associated with the passage of blood and mucus. If allowed to progress, it may produce peritonitis, shock and toxic megacolon. This may be fatal.
It is important to consider the diagnosis of CDAD in patients who present with diarrhoea subsequent to the administration of antibacterial agents. If antibiotic-associated diarrhoea or antibiotic-associated colitis is suspected, should be discontinued and adequate therapeutic measures should be initiated immediately. When 125 mg to 500 mg of vancomycin are administered orally four times a day for 7 – 10 days, there is a rapid observed disappearance of the toxin from faecal samples and a coincident clinical recovery from the diarrhoea. Drugs inhibiting peristalsis are contraindicated in this situation.
Precautions
Caution should be used when prescribing Clindamycin to individuals with a history of gastro-intestinal disease, especially colitis.
Since clindamycin does not diffuse adequately into cerebrospinal fluid, the drug should not be used in the treatment of meningitis.
If therapy is prolonged, liver and kidney function tests should be performed. Such monitoring is also recommended in neonates and infants. Safety and appropriate dosage in infants less than one month old have not been established.
Acute kidney injury, including acute renal failure, has been reported infrequently. In patients suffering from pre-existing renal dysfunction or taking concomitant nephrotoxic drugs, monitoring of renal function should be considered.
The use of clindamycin phosphate may result in overgrowth of non-susceptible organisms, particularly yeasts.
Prolonged administration of Clindamycin, as with any anti-infective, may result in super-infection due to organisms resistant to clindamycin.
Care should be observed in the use of Clindamycin in atopic individuals.
Clindamycin should not be injected intravenously undiluted as a bolus, but should be infused over at least 10-60 minutes.
See prescribing information for full details.

Common: Pseudomembranous colitis, thrombophlebitis, rash maculopapular, liver function test abnormal.
See prescribing information for full details.

Clindamycin administered by injection has been shown to have neuromuscular blocking properties that may enhance the action of other neuromuscular blocking agents. Therefore it should be used with caution, in patients receiving such agents.
Vitamin K antagonists
Increased coagulation tests (PT/INR) and/or bleeding have been reported in patients treated with clindamycin in combination with a vitamin K antagonist (e.g. warfarin, acenocoumarol and fluindione). Coagulation tests, therefore, should be frequently monitored in patients treated with vitamin K antagonists.
Co-administration of clindamycin with inhibitors of CYP3A4 and CYP3A5
Clindamycin is metabolised predominantly by CYP3A4, and to a lesser extent by CYP3A5, to the major metabolite clindamycin sulfoxide and minor metabolite N-desmethylclindamycin. Therefore inhibitors of CYP3A4 and CYP3A5 may reduce clindamycin clearance and inducers of these isoenzymes may increase clindamycin clearance. In the presence of strong CYP3A4 inducers such as rifampicin, monitor for loss of effectiveness.
In vitro studies indicate that clindamycin does not inhibit CYP1A2, CYP2C9, CYP2C19, CYP2E1 or CYP2D6 and only moderately inhibits CYP3A4. Therefore, clinically important interactions between clindamycin and co-administered drugs metabolised by these CYP enzymes are unlikely.

Pregnancy: Clindamycin crosses the placenta in humans. After multiple doses, amniotic fluid concentrations were approximately 30% of maternal blood concentrations.
In clinical trials with pregnant women, the systemic administration of clindamycin during the second and third trimesters has not been associated with an increased frequency of congenital abnormalities. There are no adequate and well-controlled studies in pregnant women during the first trimester of pregnancy.
Clindamycin should be used in pregnancy only if clearly needed.
Lactation: Orally and parenterally administered clindamycin has been reported to appear in human breast milk in ranges from <0.5 to 3.8 μg/ml. Clindamycin has the potential to cause adverse effects on the breastfed infant’s gastrointestinal flora such as diarrhoea or blood in the stool, or rash. If oral or intravenous clindamycin is required by a nursing mother, it is not a reason to discontinue breastfeeding, but an alternate drug may be preferred. The developmental and health benefits of breastfeeding should be considered along with the mother’s clinical need for clindamycin and any potential adverse effects on the breastfed child from clindamycin or from the underlying maternal condition.

In cases of overdosage no specific treatment is indicated.
The serum biological half-life of lincomycin is 2.4 hours. Haemodialysis and peritoneal dialysis are not effective in removing clindamycin from the serum.
If an allergic adverse reaction occurs, therapy should be with the usual emergency treatments, including corticosteroids, adrenaline and antihistamines.

Shelf life after opening the ampoule: the product should be used immediately.
Shelf life after dilution: Chemical and physical in use stability has been demonstrated for 48 hours at 25 °C and 2-8 °C. From a microbiological point of view, the product should be used immediately. If not used immediately, in use storage times and conditions prior to use are the responsibility of the user and would not normally be longer than 24 hours at 2-8 °C, unless dilution has taken place in controlled and validated aseptic conditions.