Lincomycin and Clindamycin are collectively known as as Lincosamides

 Interacting drugs-summary

 + Lincomycin

 Erythromycin + Lincosamides

 antagonism has occured in vitro between clindamycin and erythromycin

Kaolin -Pectin + Lincosamides

 G I absorption is decreased for lincomycin and delayed for clindamycin when they are administered with kaolin- pectin antidiarrheals

Lincosamides  + Neuromuscularblockers

 actions of the neuromuscular blockers enhanced, possibly contributing  to profound and severe respiratory depression

Serious respiratory tract infections.

 Lincomycin and Clindamycin are collectively known as as Lincosamides

GI- nausea, vomiting, diarrhea, pseudomembraneous colitis,

Hematologic- neutropenia, leukopenia, agranulocytosis, thrombocytopenic purpura

Hypersensitivity- skin rashes, urticaria, erythema multiforme, some cases resembling Stevens-Johnson syndrome(rare) anaphylaxis

Hepatic- jaundice, liver function test abnormalities(serum transminase elevation)

Renal- dysfunction has been characterized by azotemia, oliguria, and proteinuria (rare)

Local- pain following injection, induration and sterile abscess have occurred after IM injection and thrombophlebitis after IV infusion with clindamycin, give deep IM injections and avoid prolonged use of IV catheters.

Clindamycin

GI -abdominal pain, esophagitis, anorexia, unpleasant or metallic taste,(following higher doses of IV clindamycin)

Hypersensitivity- maculopapular rash, generalized morbilliform-lke rash Body as a whole- transcient eosinophilia,polyarthritis (rare)

Lincomycin

GI- glossitis, stomatitis, pruritus ani. Hematologic- aplastic anemia, pancytopenia (rare)

Hypersensitivity- angioneurotic edema, serum sickness

Special senses- tinnitus, vertigo

Body as a whole- vaginitis, exfoliative vesiculobullous dermatitis (rare)

Hypersens,development of pseudomembranous colitis.

Special precautions:

Renal and hepatic disease, pregnancy and lactation.

Monitoring- prolonged therapy-perform liver/kidney functiontests,blood counts IV infusion- Do NOT inject IV undiluted as a bolus, infuse over at least 10 to 60 minutes.

GI diseases- use cautiously in patients with GI disease, particularly colitis

Benzyl alcohol- some products contain benzyl alcohol which has been associated with fatal and - gasping syndrome- in premature infants

Superinfection- use of antibiotics for prolonged periods may result in bacterial or fungal overgrowth of nonsuseptible organisms, particularly yeasts. Such overgrowth may lead to secondary infection. Take appropiate measures if superinfection occurs

. Drug/Food interactions- Food impairs the absorption of linconycin, do not take anything by mouth (except water) for 1 or 2 hours before and after lincomycin.

Clindamycin absorption is not affected by food.

Warnings

Meningitis- clindamycin does not diffuse adequately into CSF, not for meningitis

Hypersensitivity- use with caution in patients with history of asthma or significant allergies. If hypersensitivity occurs, discontunue the drug and institute emergency treatment.

Renal function impairment- cautiously give clindamycin to patients with severe or heptic disease accompanied by severe metabolic aberations. Monitor serum clindamycin during high dose therapy. Use of lincomycin in preexisting liver disease is not recommended.

Elderly- older patients with associated severe illness may not tolerate diarrhea well. Carefully monitor patients for changes in bowel frequency.

Pregnancy- Safety for use in pregnancy has not been established.

Lactation- Both Clindamycin and Lincomycin appear in breat milk. Breast feeding is probably best discontinued when taking these agents to avoid potential problems to the infant. However,the American Academy of Pediatrics considers clindamycin to be compatible with breast feeding.

Children- Lincomycin is not indicated fr use in the newborn. When clindamycin is administered to newborns and infants monitor organ system functions.

Serious respiratory tract infections.

Serious respiratory tract infections.

Dosage:

Oral - Take with a full glass of water or with food to avoid esophageal irritation.

Clindamycin not affected with food.

Adults- Serious infections-150 to 300mg every 6 hrs..

More serious infections- 300 to 450mg every 6 hrs..

Children- Serious infections- 8 to 16mg/kg/day divided into 3 or 4 equal doses.

1. May cause diarrhea, notify physician if this occurs

2. Take each dose with a full glass of water.

3. Complete full course of therapy

4. Do not take anything by mouth ( except water ) for 1 or 2 hours before and after lincomycin.

5. Lincomycin may be taken without regards to meals.

6. Allergies- Tell your doctor if you have ever had any unusual or allergic raections to clindamycin or other related medicines. Also tell your doctor if youn are allergic to to any other substances such as foods, preservatives or dyes.

7. Pregnancy- clindamycin hasnot been reported to cause birth defects or other problems in humans.

8. Breast feeding- clindamycin passes into breast milk, however has not been reported to cause problems to nursing babies

9. Children- this medicine has not been shown to cause different side effects or problems in children than the in adults.

10. Elderly- no specific information comparing clindamycin in the elderly with use in other age groups

11. Other medicines- tell your doctor if you are taking any of the following- Chloramphenicol or Diarrheoa medicines containg kaolin or attapulgite or Erythromycin -taking thease medicines together with clindamycin may decreae the effect of clindamycin

12. Other medical problems- tell your doctor if you have anyother medical problems- Kidney disease or Liver disease (severe ) severe kidney disease or liver disease may increase blood levels of this medicine, increasing the side effects. Stomach or intestinal diosease- patients with a history of stomach or intestinal disease may have an increased chance of side effects.

13. Missed dose- If you miss a dose of this medicine take it as soon as possible. However if it is almost time for your next dose go back to your regular dosing schedule. Do not double doses.

Pharmacology-

Lincomycin and Clindamycin (7-deioxy,7-chloro derrivative of lincomycin) known collectively as lincosamides , bind exclusively to the 50S subunit of bacterial ribosomes and supress protein synthesis.Clindamycin is preferred because it is better absorbed and more potent.

Pharmacokinetics-

Administration with food markedly impairs lincomycin (but not clindamycin) oral absorption. Both agents acheive significant tissue penetratin, lincomycin may reach cerebrosppinal fluid (CSF) concentration 40% of serum levels with inflated meniges, but neither crosses well if meninges are normal.

Food impairs the absorption of linconycin, do not take anything by mouth (except water) for 1 or 2 hours before and after lincomycin.

Clindamycin absorption is not affected by food

Pregnancy-

Safety for use in pregnancy has not been established.

Lactation-

Both Clindamycin and Lincomycin appear in breat milk. Breast feeding is probably best discontinued when taking these agents to avoid potential problems to the infant. However,the American Academy of Pediatrics considers clindamycin to be compatible with breast feeding.

Children-

Lincomycin is not indicated fr use in the newborn. When clindamycin is administered to newborns and infants monitor organ system functions.