Lincomycin derivatives

Generic Name: Lincomycin derivatives
Drug Class: Lincomycin derivatives (Lincosamides)
Examples of Generic Names:
Clindamycin
Lincomycin

Brand Names:
Clindamycin – Dalacin, Cleocin, Clindatec, ClindaMax
Lincomycin – Lincocin

Formulation:
Oral capsules
Topical gels, creams, solutions
Vaginal suppositories or creams
Injectable solution (intramuscular, intravenous)

Available Presentation:
Capsules (150 mg, 300 mg)
Oral solutions (for pediatric use)
Topical (1% gel or solution)
Injectable (300 mg/mL or 600 mg/4 mL vials)
Vaginal cream (2% clindamycin)

Route of Administration:
Oral
Topical (skin or vaginal use)
Parenteral (IV/IM injection)

Mechanism of Action:
Lincomycin derivatives inhibit bacterial protein synthesis by binding to the 50S ribosomal subunit, preventing the translocation step in peptide elongation. This halts bacterial growth.
They are primarily bacteriostatic but can be bactericidal at higher concentrations or against highly susceptible organisms.

Therapeutic Use / Indications:
Treatment of anaerobic, gram-positive, and some protozoal infections, including:
– Skin and soft tissue infections (cellulitis, abscesses, acne)
– Respiratory tract infections (aspiration pneumonia)
– Pelvic inflammatory disease
– Bacterial vaginosis
– Bone and joint infections (osteomyelitis)
– Intra-abdominal infections (used with other agents)
– Dental infections and prophylaxis for endocarditis
– Malaria (as part of combination therapy with quinine)

Common Side Effects:
– Diarrhea
– Abdominal pain
– Nausea
– Metallic taste (oral forms)
– Skin rash
– Pain at injection site (IM/IV)
– Dryness or irritation with topical use

Serious Adverse Effects:
– Clostridioides difficile-associated diarrhea (CDAD)
– Pseudomembranous colitis
– Stevens-Johnson syndrome
– Blood dyscrasias (rare)
– Anaphylaxis (rare)

Precautions:
– Avoid in patients with a history of antibiotic-associated colitis
– Use cautiously in elderly patients (higher CDAD risk)
– Monitor liver and kidney function in prolonged therapy
– Use only when clearly needed in pregnancy and lactation

Contraindications:
– Known hypersensitivity to lincomycin, clindamycin, or excipients
– History of severe colitis associated with antibiotic use

Drug Interactions:
– Neuromuscular blocking agents (may enhance blockade)
– Erythromycin (antagonistic effect; avoid co-use)
– Warfarin (may increase INR and bleeding risk)
– Oral contraceptives (efficacy may be reduced; advise backup contraception)

Monitoring Parameters:
– Monitor for signs of gastrointestinal upset or colitis
– Liver function tests in prolonged IV use
– Complete blood count in long-term therapy
– Local skin reaction in topical use

Special Populations:
Pediatrics – Adjust dose carefully; oral solution available
Elderly – Higher risk of antibiotic-associated colitis
Pregnancy – Clindamycin may be used if clearly needed (Category B for oral/topical)
Breastfeeding – Small amounts pass into milk; monitor infant for GI disturbance

Storage:
Store oral and topical forms at room temperature
Injectable solutions may require refrigeration or protection from light as per manufacturer
Do not freeze topical gels

Examples of Commonly Used Agents:
Clindamycin 150–450 mg orally every 6 to 8 hours
Clindamycin IV 600–900 mg every 8 hours
Clindamycin 1% topical gel once or twice daily
Clindamycin vaginal cream once daily at bedtime for 3 to 7 days