To help clear up your infection completely, keep taking this medicine for the full time of treatment, even if you begin to feel better after a few days. Serious heart problems could develop later if your infection is not cleared up completely. Also, if you stop taking this medicine too soon, your symptoms may return. This medicine works best when there is a constant amount in the blood. To help keep the amount constant, do not miss any doses.
Also, it is best to take each dose at evenly spaced times day and night. For example, if you are to take 4 doses a day, doses should be spaced about 6 hours apart. If this interferes with your sleep or other daily activities, or if you need help in planning the best times to take your medicine, check with your health care professional. The number of capsules or teaspoonfuls of solution that you take depends on the strength of the medicine.
For recurrent tonsillitis, clindamycin may be indicated 1 , although reviewers remain concerned about its potential for inducing C difficile -associated diarrhea and for inducing erythromycin or clindamycin-resistant pneumococci. A small but clinically important and statistically significant study of 45 patients with recurrent group A streptococcal pharyngitis showed a major reduction of relapse rates and subsequent tonsillectomy with a day course of clindamycin versus erythromycin or penicillin Only two of 15 patients treated with penicillin, versus 14 of 15 with clindamycin, had eradication of their carrier status.
Twelve of those treated with penicillin had recurrent episodes, versus only one of 15 treated with clindamycin. A total of six patients underwent tonsillectomy: four of these had been treated with penicillin, and two had received erythromycin. No patient treated with clindamycin subsequently underwent tonsillectomy. Clindamycin may be considered for chronic sinusitis or chronic otitis media 17 , which may be caused by anaerobes, and is an alternative treatment for eradicating Corynebacterium diphtheriae carriage 3.
In conclusion, clindamycin is an alternative for treatment of several head and neck infections, including dental infections, recurrent pharyngitis and chronic sinusitis. The indications for its use in these conditions remains largely undefined, although level 1 evidence exists for its efficacy in preventing recurrence and tonsillectomy in patients with recurrent group A streptococcal pharyngitis.
For preoperative prophylaxis of head and neck cancers, which may be associated with mixed aerobic and anaerobic postoperative surgical site infections, clindamycin has been compared with cefazolin 18 and with ampicillin-sulbactam No antibiotic toxicity was identified. Clindamycin was compared with ampicillin-sulbactam in patients undergoing head and neck surgery, with 29 infections identified in those treated with clindamycin, versus 14 infections in those treated with ampicillin-sulbactam. There was a concomitant reduction of Gram-negative isolates in the latter group, and the authors argue for the inclusion of Gram-negative coverage in this type of surgery.
Clindamycin and cephalothin were compared in adult patients undergoing cardiac surgery Rates of wound infection were 3.
For pacemaker implantation, 48 h of flucloxacillin or clindamycin in those who were allergic was compared with placebo in a randomized trial of patients undergoing first-ever permanent pacemaker placement All nine serious infections occurred among those in the placebo group. Abdominal prophylaxis studies were often studies of early treatment of intra-abdominal sepsis and will be discussed below under abdominal infections.
In conclusion, clindamycin used for one to nine doses perioperatively is effective in reducing the rate of postoperative infection, with an efficacy similar to that of cefazolin and cephalothin. Clindamycin is indicated for pleuropulmonary infections including aspiration pneumonia, lung abscess and empyema, unless due to aerobic Gram-negative organisms.
Levine et al 7 considered clindamycin an alternative, in combination with ciprofloxacin, for the treatment of nursing home acquired pneumonia. The Ontario Anti-infective Review Panel 8 , 9 also considered clindamycin and ciprofloxacin as alternatives for severe nursing home pneumonia.
A small study of clindamycin versus metronidazole in patients with proven anaerobic pulmonary infection found clindamycin to be clearly superior Despite randomizing only 17 patients, two of seven patients on metronidazole versus nine of nine on clindamycin were cured. One patient on clindamycin died of massive aspiration. Despite the small numbers, these results were highly significant, and the baseline characteristics of the patients were more severe for those randomized to clindamycin.
A slightly larger study of 37 patients with lung abscess or necrotizing pneumonia randomized patients to clindamycin or penicillin for a minimum of eight days of intravenous and a total of four weeks of therapy Of those taking penicillin, eight of 18 failed therapy, versus only one of 19 on clindamycin. Many of the penicillin failures were attributed to penicillin-resistant Bacteroides species.
Thus, clindamycin is probably the therapy of choice for anaerobic necrotizing pneumonia and aspiration pneumonia. Whether other antibiotics, such as amoxicillin-clavulinate, are comparable or superior is unknown. Reviewers consider clindamycin the antibiotic of choice usually combined with an aminoglycoside for the treatment of intra-abdominal infection 3. Initially, the role of anaerobes in abdominal abscess was demonstrated by the reduced incidence of such complications in regimens, which included clindamycin.
Subsequently, the equal efficacy of clindamycin, metronidazole, cefoxitin and other antibiotics, in appropriate combination with Gram-negative agents, such as aminoglycosides, was demonstrated The wound infection rate was reduced by clindamycin but not cefazolin, although more advanced cases with higher rates of perforated or gangrenous appendices were allocated to the cefazolin group.
In a Canadian study of intra-abdominal sepsis, patients were treated with gentamicin and randomized to clindamycin or metronidazole Diarrhea occurred in six patients on metronidazole and three patients on clindamycin. All three patients with rash were in the clindamycin group.
A greater number of patients treated with clindamycin developed abnormal liver function tests; however, these abnormalities did not necessitate changes in therapy. For perforated appendicitis, clindamycin and gentamicin were similar in efficacy to cefoxitin Similarly, clindamycin with tobramycin was similar to monotherapy with moxalactam for patients with secondary peritonitis 28 , and meropenem was similar to tobramycin with clindamycin for advanced appendicitis Imipenem was slightly better than clindamycin and tobramycin in a study of patients evaluable for severe intra-abdominal infection The difference between the regimens was quite small, however, and may vary with local antibiotic resistance patterns.
In conclusion, clindamycin combined with an aminoglycoside is an alternative to a metronidazole and aminoglycoside combination, or other single agents with aerobic and anaerobic antibacterial activity for both the prophylaxis and treatment of intra-abdominal infection. Regimens containing metronidazole in combination with another agent that provides aerobic Gram-negative coverage are generally preferred due to equal efficacy, lower costs and reduced rates of C difficile colitis. Clindamycin is indicated for the treatment of pelvic infections including pelvic inflammatory disease, pelvic abscesses, endometritis and bacterial vaginosis 3 , 30 , It has been used in pregnancy, and is classified as fetal risk factor B.
There are no reports of congenital defects or other fetal toxicity It crosses the placenta and is present in breast milk. For all but bacterial vaginosis, it is usually combined with an aminoglycoside. Separate coverage for C trachomatis is not required because clindamycin has activity against this organism. Early cohort studies showed that the addition of clindamycin to regimens consisting of penicillin and gentamicin decreased the rate of abscess formation. No comparative studies exist of clindamycin versus metronidazole for pelvic infections.
Similar regimens to those employed for abdominal infections generally are effective, except that doxycycline is often added if clindamycin is not part of the treatment regimen for pelvic inflammatory disease and other conditions in which C trachomatis may be present.
A study of ampicillin-sulbactam, cefoxitin and doxycycline, or clindamycin and gentamicin for pelvic inflammatory disease or endometritis found all regimens had similar efficacy Clindamycin is an alternative to erythromycin for the treatment of C trachomatis cervicitis in pregnancy Failure of treatment was associated with poor compliance.
Clindamycin, in an oral dose or as a vaginal gel, is effective for the treatment of bacterial vaginosis in both pregnant and non-pregnant patients 3 , 34 — In addition to its efficacy in eradicating symptomatic bacterial vaginosis, it may improve pregnancy outcome.
Bacterial vaginosis has been correlated with premature labour 38 , although the studies of the efficacy of treatment in prolonging gestation are contradictory.
In a randomized study of pregnant women with bacterial vaginosis and premature labour, clindamycin was more effective than placebo in prolonging gestation 36 days versus 19 days , with a nonsignificant increase in birth weight In Indonesia a larger study of intravaginal gel, however, was unable to demonstrate any effect on rates of premature labour or low birth weight babies among women treated in midtrimester A recent randomized study demonstrated the safety and efficacy of metronidazole with erythromycin versus placebo in pregnant women with bacterial vaginosis.
Preterm labour was significantly reduced in the treated group Thus, metronidazole with or without erythromycin should be considered the preferred treatment of bacterial vaginosis in pregnancy. There is level 1 evidence for clindamycin as a preferred or alternative therapy for pelvic infections, and as alternative therapy for bacterial vaginosis after metronidazole and C trachomatis in pregnancy after erythromycin and amoxicillin.
Clindamycin has been used in randomized trials for the treatment of Pneumocystis carinii pneumonia in HIV-infected patients. Clindamycin has also been studied for use against toxoplasmosis, particularly for ophthalmitis For cerebral toxoplasmosis, case reports suggest clindamycin is effective 44 , although the pharmacokinetic properties of poor distribution in the central nervous system should temper the enthusiasm for this approach until the effectiveness is demonstrated in clinical trials.
Malaria 45 and babesiosis 46 have been treated with clindamycin, in combination with quinine sulphate. In conclusion, clindamycin combined with primaquine is an accepted and effective alternative in the treatment of P carinii pneumonia level 1 evidence. Experience with its use in toxoplasmosis and malaria remains limited level 3. Common side effects of clindamycin use include rash, hepatotoxicity and diarrhea.
Nuisance side effects include nausea, anorexia, vomiting, flatulence and metallic taste 1 — 3. All forms of clindamycin, including topical ointments, have been temporally related with C difficile -associated diarrhea, including pseudomembranous colitis. While prompt antibiotic cessation, avoidance of antimotility agents and treatment with metronidazole or vancomycin will virtually always successfully treat this complication, hemicolectomy and fatalities may result.
The incidence of C difficile -associated diarrhea occurs with virtually all antibiotics, and the excess number of cases attributable to clindamycin is controversial. Nevertheless, some 0. The overall rate of clinically significant diarrhea in patients with soft tissue infections may be very low, particularly in an out-patient setting. In a review of 15, out-patients treated for soft tissue infections conducted over five years in Leeds, United Kingdom, passive and active follow-up of all cases of severe diarrhea was undertaken Thirteen patients developed diarrhea and two required hospitalization for pseudomembranous colitis.
Both made an uneventful recovery 5. The rate of acquiring C difficile -associated diarrhea is much higher in in-patients. Although the Canadian Metronidazole-Clindamycin Study Group 26 found similar rates of diarrhea in those treated with clindamycin three cases versus those treated with metronidazole six cases , other investigators have found higher rates of C difficile -associated diarrhea in patients treated with clindamycin.
Efficacy was similar, whereas a higher rate of C difficile diarrhea developed in those treated with clindamycin. Pear et al 49 reported a nosocomial epidemic of C difficile -associated diarrhea that resolved only after restriction of clindamycin use by that hospital Thus, in conclusion, there is evidence from time series level 3 and subgroup analyses of randomized studies level 2 for the association of C difficile -associated diarrhea and the use of clindamycin.
Where safer antibiotic regimens exist, such as the combination of an aminoglycoside with metronidazole for abdominal sepsis, such regimens are preferred. Reviewers classify clindamycin as the agent of choice for abdominal and pelvic infection, although cheaper and safer regimens exist that are often preferred.
Nevertheless, clindamycin remains a valuable drug for allergic patients and for use against certain clearly defined syndromes. It is especially valuable for out-patients, but should be used sparingly in in-patients because of its association with C difficile colonization and diarrhea.
Clindamycin is an alternative to the penicillins and cephalosporins for the treatment of skin and soft tissue infections. Clindamycin is the drug of choice, combined with penicillin, for severe group A streptococcal infection and possibly C perfringens infections.
Clindamycin is the drug of choice for moderate to severe diabetic foot infections, usually combined with a quinolone, although cephalexin is equally effective for mild to moderate infections.
Clindamycin is an alternative to penicillins and cephalosporins for the treatment of septic arthritis and osteomyelitis, but is the drug of choice in diabetic osteomyelitis, combined with a quinolone. Clindamycin is an alternative to penicillins for dental infections and endocarditis prophylaxis. Clindamycin is the treatment of choice for anaerobic lung infections, including anaerobic lung abscess and necrotizing pneumonia.
Side effects can be frightening. A drug is supposed to cure a problem, not cause another, right? Remember that there are always options for treating bacterial vaginosis. Try natural remedies and you may just be amazed at their lack of side effects. Source: Dr. Genital Itching and Burning. This needs to be stopped immediately so call or visit your doctor. Source: OECD.
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