Clindamycin (Dalacin C®)

Section 1.1

Midwives may independently prescribe, order and administer this drug.

Clindamycin is a lincosamide which is a type of antibiotic that works by inhibiting bacterial protein synthesis. Used as the second choice for mastitis. Clindamycin is one of the best alternatives for the gram positive cocci most often causing mastitis as it also covers methicillin-resistant Staph Aureus (MRSA) (76% ). It is active against gram-positive aerobes and most anaerobes. The concern with clindamycin is that it may predispose to C. difficile diarrhea, which is why it is a second choice agent.

Indications and Clinical Use:

Used as a second choice treatment for GBS or mastitis if penicillin allergic or if sensitivities indicate resistance to cephalexin or cloxacillin. Intravenous Clindamycin is recommended if at high risk for anaphylaxis and the GBS is confirmed to be sensitive to Clindamycin. It is also used in other skin, soft tissue, and pelvic infections which are not in the Midwives Regulation – Schedule A and B.

Contraindications:

Known hypersensitivity or allergy.

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 oral or intravenous 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:

IV: 900 mg every 8 hours until delivery.
Clindamycin: 450 mg orally every 6 hours (qid) for 10-14 days

Clindamycin can be taken with or without food. However, since Clindamycin may cause an upset stomach, taking it with food or milk is recommended. Taking an active probiotic concurrently may help minimize changes to GI flora.

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 is: Oral: Within 60 minutes.

Half-life:

2-3 hours.