Clindamycin (Dalacin C®) STI Treatment

STI Standards

Midwives may independently prescribe, order, and administer drugs in the community, hospital or other sites of midwifery practice to treat sexually transmitted infections for clients in case, as designated under specialized practice certification. Midwives without specialized practice certification in sexually transmitted infections management are required to refer their clients to an appropriate health care practitioner for treatment. 

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

Indications and Clinical Use:

Used for the treatment of Bacterial Vaginosis (BV) in pregnant or nonpregnant women. The Centre for Disease Control (CDC) recommends treatment of BV in all symptomatic pregnant women. Asymptomatic pregnant women at high risk for premature labour should be screened for BV and treated. The goal is to reduce the risk of preterm prelabour rupture of the membranes and low birth weight. BV during pregnancy is associated with premature rupture of the membranes, chorioamnionitis, preterm labour, preterm birth and postcesarean delivery endometritis.

If symptoms persist after the prescribed course of treatment, a consultation with a physician is required.

Contraindications:

Known hypersensitivity or allergy to Clindamycin or Lincomycin.

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 an indication for physician consult. CDAD has been observed >2 months post-antibiotic treatment.

To reduce the incidence of drug-resistant bacteria, use only for the treatment of confirmed infections. Candidiasis may present during Clindamycin therapy, treatment with an appropriate antifungal is recommended.

Pregnancy:

Compatible: No reports linking use of Clindamycin with congenital defects have been located.

Lactation

Limited Data- Probably Compatible-
Clindamycin is considered suitable in lactation, as numerous reports have found few adverse effects in breastfed infants. The relative infant dose is 0.9-1.8% (less than 10% considered suitable). This medication is also considered suitable for use in both the neonatal and pediatric population.

Clindamycin, like all antibiotics, has the potential to cause adverse effects on the breastfed infant’s gastrointestinal flora. If oral or intravenous Clindamycin is required by a nursing mother, it is not a reason to discontinue breastfeeding. 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:

Nausea, vomiting, diarrhea, abnormal liver function, serious skin rashes and/or agranulocytosis.

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/or diarrhea.

Dosage and Administration:

Bacterial Vaginosis
Clindamycin: 300 mg orally twice daily for 7 days.
Alternate treatment – Clindamycin cream 2%, one applicator (5g) intravaginally once a day for 7 days.

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.

Onset of Action:

Peak plasma concentrations: 1 hour following dose.

Duration of Action:

Half-life elimination: 3 hours.
Excretion: Urine (10%), Feces (4%) as active drug and metabolites.