Clindamycin is a lincosamide antibiotic with excellent activity against anaerobic and Gram-positive infections. It is widely used in dental infections, severe acne, and surgical prophylaxis.
Also known as: Cleocin, Dalacin
Lincosamide + macrolide: bacteriological antagonism. Both bind to the 50S subunit — competition for the same site.
Clindamycin and erythromycin compete for the same binding site on the 70S bacterial ribosomal 50S subunit. Erythromycin (macrolide) is bacteriostatic and may reduce the bactericidal efficacy of clindamycin in concentration-dependent situations (synergistic combination). Documented exception: in Pneumocystis jirovecii, the combination may have synergy (both inhibit protein synthesis at different sites). In conventional clinical practice, the combination is avoided.
Lincosamide + macrolide: antagonism — competition for 50S subunit. Avoid.
Clindamycin and erythromycin compete for the same binding site on the 50S ribosomal subunit. Erythromycin (bacteriostatic) may reduce clindamycin efficacy (also bacteriostatic). Clinically, the combination is generally avoided, except in Pneumocystis (documented synergy).
Clinical response, cultures if available.
Avoid the combination for conventional bacterial infections. Exception: Pneumocystis jirovecii prophylaxis (synergy).
DailyMed/FDA (NIH/NLM) — approved Clindamycin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3f6b2c5a-e581-414f-bc9e-eaf66a5685cd
Food reduces oral clindamycin bioavailability by ~50%. Fasting improves absorption.
Take oral clindamycin on an empty stomach (1 h before or 2 h after meals).
Significant hepatic metabolism. Accumulation in severe hepatic impairment. Risk of additive hepatotoxicity.
No adjustment required in mild-moderate hepatic impairment. Avoid in severe hepatic impairment.
DailyMed/FDA (NIH/NLM) — approved Clindamycin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3f6b2c5a-e581-414f-bc9e-eaf66a5685cd
Category B: safe in pregnancy for approved indications (surgical prophylaxis).
All trimesters. Safe.
Excreted in low concentrations in breast milk. Compatible with breastfeeding.
No evidence of effects on fertility.
DailyMed/FDA (NIH/NLM) — approved Clindamycin label: https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=3f6b2c5a-e581-414f-bc9e-eaf66a5685cd
Clinical and educational support tool. The information does not replace a medical prescription or the opinion of a qualified healthcare professional.
Bacteriostatic (may be bactericidal at high doses): inhibits bacterial protein synthesis. Excellent activity against anaerobes and Gram-positives. Active against Toxoplasma gondii.
Binds to the 50S subunit of the 70S bacterial ribosome, blocking peptidyl-tRNA translocation. Prolonged post-antibiotic effect. Predominantly anti-anaerobic action.
Complete oral absorption (>90%), but reduced bioavailability with food. Peaks at 1 h (PO) and immediately (IV). Excellent tissue penetration (bone, soft tissues, abscess).
Hepatic metabolism via CYP3A4 (major) and glucuronidation. Mildly inhibits CYP3A4. Multiple inactive metabolites.
2-4 h (normal). 3-5 h in renal/hepatic impairment.
Medicines from the same therapeutic group (ATC classification) or the same pharmacological class.
