Common side effects include nausea, diarrhea, rash, and pain at the site of injection. It increases the risk of hospital-acquired Clostridium difficile colitis about fourfold and thus is only recommended when other antibiotics are not appropriate. Alternative antibiotics may be recommended as a result. It appears to be generally safe in pregnancy. It is of the lincosamide class and works by blocking bacteria from making protein.
For treatment of acne, in the long term the combined use of topical clindamycin and benzoyl peroxide was similar to salicylic acid plus benzoyl peroxide. Topical clindamycin plus topical benzoyl peroxide is more effective than topical clindamycin alone.
It is most effective against infections involving the following types of organisms:
When testing a gram-positive culture for sensitivity to clindamycin, it is common to perform a "D-Test" to determine if there is a macrolide-resistant subpopulation of bacteria present. This test is necessary because some bacteria express a phenotype known as MLSB, in which susceptibility tests will indicate the bacteria are susceptible to clindamycin, but in vitro the pathogen displays inducible resistance.
To perform a D-test, an agar plate is inoculated with the bacteria in question and two drug-impregnated disks (one with erythromycin, one with clindamycin) are placed 15–20 mm apart on the plate. If the area of inhibition around the clindamycin disk is "D" shaped, the test result is positive and clindamycin should not be used due to the possibility of resistant pathogens and therapy failure. If the area of inhibition around the clindamycin disk is circular, the test result is negative and clindamycin can be used.
Given with chloroquine or quinine, clindamycin is effective and well tolerated in treating Plasmodium falciparum malaria; the latter combination is particularly useful for children, and is the treatment of choice for pregnant women who become infected in areas where resistance to chloroquine is common. Clindamycin should not be used as an antimalarial by itself, although it appears to be very effective as such, because of its slow action. Patient-derived isolates of Plasmodium falciparum from the Peruvian Amazon have been reported to be resistant to clindamycin as evidenced by in vitro drug susceptibility testing.
Clindamycin may be useful in skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus (MRSA); many strains of MRSA are still susceptible to clindamycin; however, in the United States spreading from the West Coast eastwards, MRSA is becoming increasingly resistant.
Common adverse drug reactions associated with systemic clindamycin therapy – found in over 1% of people – include: diarrhea, pseudomembranous colitis, nausea, vomiting, abdominal pain or cramps and/or rash. High doses (both intravenous and oral) may cause a metallic taste. Common adverse drug reactions associated with topical formulations – found in over 10% of people – include: dryness, burning, itching, scaliness, or peeling of skin (lotion, solution); erythema (foam, lotion, solution); oiliness (gel, lotion). Additional side effects include contact dermatitis. Common side effects – found in over 10% of people – in vaginal applications include fungal infection.
Use of clindamycin during pregnancy is generally consided safe.
Clindamycin is classified as compatible with breastfeeding by the American Academy of Pediatrics, however, the WHO categorizes it as "avoid if possible". It is classified as L2 probably compatible with breastfeeding according to Medications and Mothers' Milk. A 2009 review found it was likely safe in breastfeeding mothers, but did find one complication (hematochezia) in a breastfed infant which might be attributable to clindamycin. LactMed lists potentially negative gastrointestinal effects in babies who mothers take it well breastfeeding but did not see that as justification to stop breastfeeding.
It is available as a generic medication and is not very expensive. The wholesale cost in the developing world is about US$0.06 to US$0.12 per pill. In the United States it costs about $2.70 per dose.
Clindamycin preparations that are taken by mouth include capsules (containing clindamycin hydrochloride) and oral suspensions (containing clindamycin palmitate hydrochloride). Oral suspension is not favored for administration of clindamycin to children, due to its extremely foul taste and odor. Clindamycin is formulated in a vaginal cream and as vaginal ovules for treatment of bacterial vaginosis. It is also available for topical administration in gel form, as a lotion, and in a foam delivery system (each containing clindamycin phosphate) and a solution in ethanol (containing clindamycin hydrochloride) and is used primarily as a prescription acne treatment.
Several combination acne treatments containing clindamycin are also marketed, such as single-product formulations of clindamycin with benzoyl peroxide—sold as BenzaClin (Sanofi-Aventis), Duac (a gel form made by Stiefel), and Acanya, among other trade names—and, in the United States, a combination of clindamycin and tretinoin, sold as Ziana. In India, vaginal suppositories containing clindamycin in combination with clotrimazole are manufactured by Olive Health Care and sold as Clinsup-V. In Egypt, vaginal cream containing clindamycin produced by Biopharmgroup sold as Vagiclind indicated for vaginosis.
Clindamycin is available as a generic drug, for both systemic (oral and intravenous) and topical use. (The exception is the vaginal suppository, which is not available as a generic in the USA).
Clindamycin is marketed as generic and under trade names including Cleocin HCl, Clindacin, Dalacin, Evoclin and Lincocin (Bangladesh). Other combination products include Clindoxyl.
The veterinary uses of clindamycin are quite similar to its human indications, and include treatment of osteomyelitis, skin infections, and toxoplasmosis, for which it is the preferred drug in dogs and cats. They can be used both by mouth and topically. A disadvantage is that bacterial resistance can develop fairly quickly. Gastrointestinal upset may also occur. Toxoplasmosis rarely causes symptoms in cats, but can do so in very young or immunocompromised kittens and cats.
^Brook I, Lewis MA, Sándor GK, Jeffcoat M, Samaranayake LP, Vera Rojas J (November 2005). "Clindamycin in dentistry: more than just effective prophylaxis for endocarditis?". Oral Surg Oral Med Oral Pathol Oral Radiol Endod. 100 (5): 550–8. doi:10.1016/j.tripleo.2005.02.086. PMID16243239.
^Gemmell CG, O'Dowd A (1983). "Regulation of protein A biosynthesis in Staphylococcus aureus by certain antibiotics: its effect on phagocytosis by leukocytes". J Antimicrob Chemother. 12 (6): 587–97. doi:10.1093/jac/12.6.587. PMID6662837.
^Jeddi A, Azaiez A, Bouguila H, et al. (1997). "Intérêt de la clindamycine dans le traitement de la toxoplasmose oculaire" [Value of clindamycin in the treatment of ocular toxoplasmosis]. Journal Français d'Ophtalmologie (in French). 20 (6): 418–22. ISSN0181-5512. PMID9296037.
^American Academy of Pediatrics Committee on Drugs (September 2001). "Transfer of drugs and other chemicals into human milk". Pediatrics. 108 (3): 776–89. doi:10.1542/peds.108.3.776. PMID11533352.
^"Breastfeeding and maternal medication : recommendations for drugs in the Eleventh WHO Model List of Essential Drugs". World Health Organization. 2002. hdl:10665/62435. Cite journal requires |journal= (help)
^Mitrano, Jennifer A; Spooner, Linda M; Belliveau, Paul (1 September 2009). "Excretion of Antimicrobials Used to Treat Methicillin-ResistantStaphylococcus aureusInfections During Lactation: Safety in Breastfeeding Infants". Pharmacotherapy. 29 (9): 1103–1109. doi:10.1592/phco.29.9.1103. ISSN1875-9114. PMID19698015.
^"Clindamycin", Drugs and Lactation Database (LactMed), National Library of Medicine (US), 2006, PMID30000267, retrieved 13 November 2019
^Birkenmeyer, R. D.; Kagan, F. (1970). "Lincomycin. XI. Synthesis and structure of clindamycin, a potent antibacterial agent". Journal of Medicinal Chemistry. 13 (4): 616–619. doi:10.1021/jm00298a007. PMID4916317.
^Schlünzen, Frank; Zarivach, Raz; Harms, Jörg; Bashan, Anat; Tocilj, Ante; Albrecht, Renate; Yonath, Ada; Franceschi, François (2001). "Structural basis for the interaction of antibiotics with the peptidyl transferase centre in eubacteria". Nature. 413 (6858): 814–821. doi:10.1038/35101544. PMID11677599.
^Tu, Daqi; Blaha, Gregor; Moore, Peter B.; Steitz, Thomas A. (2005). "Structures of MLSBK Antibiotics Bound to Mutated Large Ribosomal Subunits Provide a Structural Explanation for Resistance". Cell. 121 (2): 257–270. doi:10.1016/j.cell.2005.02.005. PMID15851032.
^"Clindamycin". International Drug Price Indicator Guide. Archived from the original on 7 January 2016. Retrieved 6 September 2015.
^Cunliffe WJ, Holland KT, Bojar R, Levy SF (2002). "A randomized, double-blind comparison of a clindamycin phosphate/benzoyl peroxide gel formulation and a matching clindamycin gel with respect to microbiologic activity and clinical efficacy in the topical treatment of acne vulgaris". Clin Ther. 24 (7): 1117–33. doi:10.1016/S0149-2918(02)80023-6. PMID12182256.