Clindamycin – A Complete Guide

Clindamycin is a medication used for the treatment of infections, including but not limited to septicemia, gynecological infections, joint and bone infections, intra-abdominal infections, lower respiratory infections, and skin and skin structure infections. Clindamycin is also used in the treatment of bacterial vaginosis, acne vulgaris, streptococcal pharyngitis, and severe pelvic inflammatory disease.

Although not a first-line treatment, intravenous clindamycin can be used for the inpatient treatment of community-acquired pneumonia and aspiration pneumonia. Dentists will use clindamycin for prophylactic coverage against endocarditis. Anesthesiologists and surgeons will often administer clindamycin as prophylaxis in the operating room. Gynecologists use clindamycin in combination with gentamycin +/- ampicillin for covering their patients with endometritis. It can also be an alternative to metronidazole for treating Gardnerella vaginosis.

Additionally, clindamycin can be used to treat anthrax, babesiosis, and malaria. Clindamycin is also commonly used in skin and soft tissue infections that are uncomplicated. Clindamycin is used in soft tissue infections due to its efficacy against MRSA. Clindamycin is also a choice for outpatient treatment because of its cost, availability, and effectiveness against methicillin-resistant Staphylococcus aureus.

Clindamycin can be administered in many ways. It is available topically as a gel, foam, lotion, or solution for the treatment of acne vulgaris. A thin layer needs to be applied twice a day. For the treatment of bacterial vaginosis, it is available in suppositories and cream for intravaginal administration. Systemic infections can be treated with oral clindamycin. It is also available as an intramuscular injection.

The side effects of clindamycin depend on how it is administered. The most common side effects of clindamycin include redness, burning, exfoliation, pruritis, xeroderma, or oily skin. The most common side effects of intravaginal administration are vaginal candidiasis, vulvovaginitis, pruritus, and vulvovaginal disease. The primary adverse effects of clindamycin with systemic administration are colitis, pseudomembranous, nausea, vomiting, and diarrhea, resulting from clindamycin destroying much of the GI tract’s healthy flora. It could cause Clostridium difficile-associated diarrhea (CDAD). If suspected, a stool antigen test should be in order. Severe cases may require colectomy for definitive treatment. Other adverse effects include metallic taste with IV administration, anaphylactic shock, agranulocytosis, induration, azotemia, abscess formation, or irritation at the site of IM injection.

Clindamycin shouldn’t be used in patients with a history of ulcerative colitis or pseudomembranous colitis. It also shouldn’t be used in patients with hypersensitivity to lincomycin, clindamycin, or any of its components. Special care must also be taken in patients with atopic dermatitis as colonization is more prevalent in this patient population. The pathogenicity of skin infections is higher in this population; this is important for future infections as antibiotic resistance is a problematic complication.

Changes in colitis, liver function tests, bowel frequency, and resolution of symptoms should be monitored. In prolonged therapy, complete blood cell count (CBC), liver, and renal function should be monitored. It is vital to manage electrolyte and fluid replacement in this patient population adequately.

Clindamycin can irritate and erode the lining of the esophagus, leading to esophagitis or ulcers. This can cause heartburn, chest pain, and difficulty swallowing.

Treatment for clindamycin-induced esophageal injury includes: swallowing clindamycin with at least 8 ounces of a clear liquid, the person should remain upright for at least 30 min following ingestion of clindamycin, and in people with potential underlying increased risk for pill-induced injury (eg, inability to follow the previous instructions, anatomic compromise of the esophageal lumen, and poor esophageal motility), one should search for alternative safer medications.

Another treatment is using a proton pump inhibitor (PPI) and sucralfate.

Yes, clindamycin can be used to treat perianal abscesses when taken orally.

Yes, clindamycin can be used to treat perioral dermatitis and is entirely safe. It might dry your skin, so make sure to use a moisturizer.

Yes, clindamycin can be used to treat seborrheic dermatitis but might work for only some people.

Yes, clindamycin can be used to treat rosacea and is entirely safe. Make sure to use a moisturizer also.

Yes, clindamycin can be used to treat cellulitis. Still, it is better to generally avoid it due to the risk of Clostridioides difficile infection and the possibility of streptococcal and staphylococcal resistance.

Yes, clindamycin can be used to treat peritonsillar abscesses including deep neck space abscesses.

No, clindamycin does not purging because it is an antibiotic and won’t increase cell turnover.

Yes, clindamycin can be used to treat acne scars but not on its own. You should use it with other topicals like adapalene, tretinoin, or benzoyl peroxide to effectively treat acne scars along with any active acne.

Clindamycin is generally considered safe during pregnancy but you should still consult your doctor about this.

Yes, clindamycin can be used to treat hormonal acne but it’s better to use it along with other topicals like adapalene, tretinoin, or benzoyl peroxide to effectively treat hormonal acne.

Yes, clindamycin gel or lotion can be applied topically to treat folliculitis on the skin or scalp. Clindamycin consumed orally also might help folliculitis.

Yes, clindamycin can be used to treat wound infections and is completely safe. For treatment of bacterial infections: Adults—150 to 300 milligrams (mg) every 6 hours. For more severe infections, 300 to 450 mg every 6 hours.

Yes, clindamycin can be used to treat warts and is entirely safe.

Yes, you can take clindamycin with an antacid. However, you might want to space the timing so that the antacid won’t block the body’s ability to absorb clindamycin.

Yes, it is safe to drink milk while taking clindamycin. This helps to lessen stomach upset.

Yes, clindamycin can cause heartburn, chest pain, and difficulty swallowing because of esophagitis or ulcers.

Yes, clindamycin can be used to treat UTIs but only in rare cases where the person has allergies to the standard UTI treatment.

Yes, clindamycin can be used to treat chlamydia but more appropriate antibiotics such as tetracyclines, azithromycin, or erythromycin can help treat this condition.

It can take 7 days for clindamycin to treat chlamydia.

Clindamycin can help treat syphilis but is not that effective.

Yes, clindamycin can be used to treat hidradenitis suppurativa and is the first-line treatment.