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DR.T.V.RAO MD
CLINDAMYCIN
Clindamycin rINN is a Lincosamides antibiotic. It is usually used to treat infections with anaerobic bacteria but can also be used to treat some protozoal diseases, such as malaria. It is a common topical treatment for acne and can be useful against some methicillin-resistant Staphylococcus aureus (MRSA) infections.
DR.T.V.RAO MD
ANTIBACTERIAL ACTIVITY Active against G+ cocci, including penicillin- resistant Staph. and many anaerobes, esp. Bacteroides sp. Not effective against G-ve aerobes.
DR.T.V.RAO MD
CLINDAMYCIN
Inhibits protein synthesis ( 50 s subunit )
Pharmacokinetics
May be given orally or parenterally Widely concentrated in tissues ( including bones ) & body fluids It diffuses across the placenta but not BBB 90% protein bound Metabolized in liver ( active )( enter hepatic circulation), 10 % excreted unchanged Excretion urine and bile
DR.T.V.RAO MD
CLINICAL USES
Staphylcoccal joint & bone infections such as osteomyelitis
Staph. Conjunctivitis ( eye drops )
DR.T.V.RAO MD
DR.T.V.RAO MD
The detection of its three resistance phenotypes (sensitive, resistant, inducible resistance) is crucial to guide antimicrobial therapy. Standard disk diffusion and broth micro dilution fail to detect inducible clindamycin resistance . Clinical and Laboratory Standards Institute (CLSI) recommends the double disk diffusion test (D-test) to detect the presence of inducible clindamycin resistance . Also, the incidence of clindamycin resistance varies with geographic area and therefore local statistics are crucial to guide empiric therapy
DR.T.V.RAO MD
CLINDAMYCIN-ERYTHROMYCIN DISCORDANT
Clindamycin-susceptible, erythromycin-resistant Staphylococcus aureus (clindamycin-erythromycin discordant) may develop clindamycin resistance. The erm gene product is a ribosome methylase whose expression is normally minimal. Erythromycin induces the production of this methylase, which is why these strains are erythromycin resistant, but mutations in the promoter region of erm allow production of methylase without an inducer
DR.T.V.RAO MD
DR.T.V.RAO MD
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A NEGATIVE D- TEST
A negative D-test observed for an erythromycin-resistant culture of S. aureus. The small discs labeled E & C represent disks containing either 15 g erythromycin (E) or 2 g clindamycin (C) placed 15 to 20 mm apart on an agar plate that has been inoculated with the clinical isolate (indicated by the green background). The lack of a zone of inhibition around the erythromycin disc indicates bacterial resistance to macrolides The large clear zone of inhibition around the clindamycin disc indicates sensitivity to clindamycin
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DR.T.V.RAO MD
A POSITIVE D- TEST
A positive D-test. Diffusion of erythromycin from the disc towards the clindamycin disc does not kill bacteria due to S. aureus resistance to macrolides. However, in this case the bacterial isolate contains a strain of S. aureus with an erythromycin-inducible methylase (iMLS-B) resulting in inhibited growth. The inhibition of bacterial growth in zone 2 but not zone 1 produces a D shape surrounding
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PERFORMING D- TEST
The D-test is performed by placing clindamycin and erythromycin disks at an edge-to-edge distance of 15 to 20 mm and looking for flattening of the clindamycin zone nearest the erythromycin disk . A positive D-test suggests the presence of an erm gene that could result in constitutive clindamycin resistance and clinical 14 failure.
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CLINDAMYCIN IN MALARIA
Given with chloroquine or quinine, clindamycin is effective and well-tolerated in treating Plasmodium falciparum malaria; the latter combination is particularly useful for children, and is the treatment of choice for pregnant women who become infected in areas where resistance to chloroquine is common. Clindamycin should not be used as an antimalarial by itself, although it appears to be very effective as such, because of its slow action. Patient-derived isolates of Plasmodium falciparum from the Peruvian Amazon have been reported to be resistant to clindamycin as evidenced by in vitro drug susceptibility testing.[
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Clindamycin has been reported to appear in breast milk. If therapy is prolonged, liver and renal function tests may be monitored periodically. May enhance the action of neuromuscular blocking agents. May counteract the effects of erythromycin
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Programme created by Dr.T.V.Rao MD for Medical and Health Care workers in the Developing world
Email
doctortvrao@gmail.com
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