Clindamycin

Section 1.1

Midwives may independently prescribe, order and administer this drug.

Clindamycin is a lincosamide antibiotic that works by inhibiting bacterial protein synthesis.

Indications and Clinical Use:

Second-line choice for treatment of mastitis if penicillin allergic or if sensitivities indicate resistance to cephalexin or cloxacillin. Clindamycin is one of the best alternatives for the gram positive cocci most often causing mastitis as it also covers methicillin-resistant Staphylococcus aureus; (MRSA). It is active against gram-positive aerobes and most anaerobes.

Contraindications:

Known hypersensitivity

Warnings and Precautions:

Prolonged use may result in fungal or bacterial superinfection, including C. difficile-associated diarrhea (CDAD) and pseudomembranous colitis. With any diarrhea after taking Clindamycin, maternal stool should be tested for C. difficile. A positive test for C. difficile is a reason for physician consult. CDAD has been observed >2 months post-antibiotic treatment.

Pregnancy:

Compatible

Lactation

Category L2 – Limited Data – Probably Compatible

Clindamycin has the potential to cause adverse effects on the breastfed infant’s gastrointestinal flora. If clindamycin is required during breastfeeding, it is not a reason to discontinue breastfeeding, but an alternate drug may be preferred. Monitor the infant for possible effects on the gastrointestinal flora, such as diarrhea, candidiasis (thrush, diaper rash) or rarely, blood in the stool indicating possible antibiotic-associated colitis.

Adverse Reactions:

Upset stomach, diarrhea, vomiting, vaginal infection and mild skin rash.

The following side effects should be reported to a medical practitioner immediately: severe skin rash, itching, hives, difficulty breathing or swallowing, wheezing, unusual bleeding or bruising, sore throat, painful mouth or throat sores, jaundice and diarrhea (in particular with Clindamycin).

Dosage and Administration:

Mastitis: 450mg q6 hours (QID) for 5-7 days if the response is rapid and complete or 10-14 days as indicated.

Clindamycin can be taken with or without food. However, since clindamycin may cause an upset stomach, taking it with food or milk is recommended.

Onset of Action:

Absorption is rapid; widely distributed into most body tissues and fluids, including gallbladder, liver, kidneys, bone, sputum, bile, and pleural and synovial fluids. Time of serum level peak within 60 minutes.

Half-life:

Adults – 2-3 hours.