Clindamycin phosphate parenteral
- Drugs List
- Therapeutic Indications
- Dosage
- Administration
- Contraindications
- Precautions and Warnings
- Pregnancy and Lactation
- Side Effects
- Monograph
Presentation
Solution for injection or infusion containing clindamycin (as clindamycin phosphate)
Drugs List
Therapeutic Indications
Uses
Severe antibiotic sensitive infections
Treatment of serious infections caused by:
Susceptible Gram positive organisms, staphylococci (both penicillinase- and non-penicillinase producing)
Streptococci (except Streptococcus faecalis)
Pneumococci
Susceptible anaerobic pathogens such as Bacteroides spp, Fusobacterium spp, Propionbacterium spp, Peptostreptococcus spp and microaerophilic streptococci
Clindamycin does not penetrate the blood/brain barrier in therapeutically effective quantities.
Dosage
Treatment for infections caused by beta-haemolytic streptococci should be continued for at least 10 days to guard against subsequent rheumatic fever or glomerulonephritis.
Adults
Solution for injection or infusion
Serious infections
600 to 1200mg/day in two, three or four equal doses.
More severe infections
1200 to 2700mg/day in two, three or four equal doses.
Infusion bags
Serious infections
1200 to 1800mg/day in two, three or four equal doses.
More severe infections
1800 to 2700mg/day in two, three equal doses.
For more serious infections, these doses may have to be increased. In life-threatening situations, doses as high as 4.8g daily have been given intravenously to adults.
Children
Not all products are licensed for use in children under 12 years.
Solution for injection or infusion
Children 1 month to 18 years
Serious infections
15 to 25mg/kg/day in three or four equal doses.
More severe infections
25 to 40mg/kg/day in three or four equal doses. In severe infections it is recommended that children be given at least 300mg/day regardless of body weight.
Administration
For intravenous infusion or intramuscular injection.
Intramuscular injection
Single intramuscular injections of greater than 600mg are not recommended.
Irritation, pain, and abscess formation at the intramuscular injection site can be minimised by administering the product by deep intramuscular injection.
Intravenous infusion
Solution for injection or infusion
Clindamycin phosphate must be diluted prior to intravenous administration should be infused over at least 10 to 60 minutes.
Administration of more than 1.2g in a single one hour infusion is not recommended.
The drug may be administered in the form of a single rapid infusion of the first dose followed by continuous intravenous infusion.
The concentration of clindamycin in diluent for intravenous infusion should not exceed 18mg/ml and infusion rates should not exceed 30mg/minute.
Infusion rates are as follows:
A dose of 300mg in 50ml of diluent should be infused over 10 minutes.
A dose of 600mg in 50ml of diluent should be infused over 20 minutes.
A dose of 900mg in 50 to 100ml of diluent should be infused over 30 minutes.
A dose of 1200mg in 100ml of diluent should be infused over 40 minutes.
Thrombophlebitis at the intravenous injection site can be minimised by avoiding the use of an indwelling catheter.
Infusion bags
Clindamycin phosphate does not require further dilution and should be infused over at least 10 to 60 minutes.
Contraindications
Neonates under 1 month
Porphyria
Precautions and Warnings
Atopy
Children under 12 years
Hypersensitivity to benzyl alcohol
Restricted sodium intake
Breastfeeding
Glucose-galactose malabsorption syndrome
Hepatic impairment
History of colitis
History of gastrointestinal disorder
Neuromuscular disorder
Pregnancy
Renal impairment
Some formulations contain more than 1mmol (23mg) sodium per dose
Advise ability to drive/operate machinery may be affected by side effects
Consult national/regional policy on the use of anti-infectives
Not all available products are licensed for all age groups
Some formulations contain glucose
Some presentations may contain benzyl alcohol
Monitor haematological status during prolonged and high dose therapy
Monitor hepatic function on long term therapy
Monitor renal and hepatic function in infants
Monitor renal function on long term therapy
Advise patient to inform physician if/when (delayed) diarrhoea occurs
Consider pseudomembranous colitis if patient presents with diarrhoea
Prolonged use may result in superinfection with non-susceptible organisms
Discontinue if severe skin reaction occurs
Discontinue immediately if diarrhoea occurs
Clindamycin phosphate 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 (including Clostridium difficile associated diarrhoea) which may develop. Cases of colitis have been reported during, or even 2 or 3 weeks following the administration of clindamycin.
Pregnancy and Lactation
Pregnancy
Use clindamycin with caution during pregnancy.
The manufacturer advises clindamycin should only be administered during pregnancy if the potential benefit outweighs the possible risk to the foetus. Schaefer suggests clindamycin is only indicated during pregnancy when penicillins, cephalosporins, erythromycin or the other macrolides are not effective. Inadvertent use is not an indication for termination of pregnancy or for additional prenatal diagnostic procedures (Schaefer 2007). Animal studies indicate that there is no evidence of reproductive toxicity.
Clindamycin crosses the placenta. After multiple dosing the foetal tissue levels of clindamycin increase, with the drug concentrating in the foetal liver.
Lactation
Use clindamycin with caution during breastfeeding.
The manufacturer does not recommend breastfeeding whilst taking clindamycin. Clindamycin is present in human breast milk. Effects on exposed infants is unknown, but there is potential for serious adverse reactions.
Side Effects
Abdominal pain
Abnormal liver function tests
Abscess formation (injection site)
Acute generalised exanthematous pustulosis
Agranulocytosis
Anaphylactic reaction
Anaphylactoid reaction
Antibiotic-associated colitis
Cardiac arrest
Diarrhoea
Dizziness
Drug rash with eosinophilia and systemic symptoms (DRESS)
Dysgeusia
Eosinophilia
Erythema multiforme
Exfoliative dermatitis
Headache
Hypersensitivity reactions
Hypotension
Induration (injection site)
Irritation (injection site)
Jaundice
Leucopenia
Local pain (injection site)
Maculopapular rash
Morbilliform-like skin rashes
Nausea
Neutropenia
Oesophageal ulceration
Oesophagitis
Polyarthritis
Pruritus
Stevens-Johnson syndrome
Thrombocytopenia
Thrombophlebitis (injection site)
Toxic epidermal necrolysis
Urticaria
Vaginitis
Vesiculo-bullous reactions
Vomiting
Overdosage
It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.
The following number will direct the caller to the relevant local centre (0844) 892 0111
Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( www.toxbase.org ) or if this is unavailable at the backup site ( www.toxbasebackup.org ).
Further Information
Last Full Review Date: February 2020
Reference Sources
Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.
Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.
Medications and Mothers' Milk, 14th Edition (2010) Hale, T. Hale Publishing, Amarillo, Texas.
Summary of Product Characteristics: Clindamycin 300mg/50ml solution for infusion. Bowmed Ibisqus Ltd. Revised April 2019.
Summary of Product Characteristics: Clindamycin 600mg/50ml solution for infusion. Bowmed Ibisqus Ltd. Revised April 2019.
Summary of Product Characteristics: Clindamycin 150 mg/ml solution for injection or infusion. Focus Pharmaceuticals. Revised May 2018.
Summary of Product Characteristics: Dalacin C Phosphate Sterile Solution. Pfizer Limited. Revised December 2018.
NICE Evidence Services Available at: www.nice.org.uk Last accessed: 25 February 2020
US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
Available at: https://www.ncbi.nlm.nih.gov/books/NBK501922/
Clindamycin Last revised: 31 October 2018
Last accessed: 24 February 2020
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