Clindamycin is an antibiotic that fights bacteria in the body.

Clindamycin is used to treat serious infections caused by bacteria.

Clindamycin is usually available as one of three salts: clindamycin phosphate, clindamycin hydrochloride, or clindamycin nicotinamide. These salt forms are all prodrugs of clindamycin but once inside the body or applied to the skin, they are rapidly converted to active clindamycin by hydrolysis. All three salt forms of clindamycin: clindamycin phosphate, clindamycin hydrochloride, and clindamycin nicotinamide have the same antimicrobial spectrum and effectiveness.

Clindamycin first gained FDA approval on February 22, 1970.

What is clindamycin phosphate?

Clindamycin phosphate is a salt of clindamycin that is usually used for injectable or topical formulations of clindamycin.

• Clindamycin phosphate is a prodrug of clindamycin that is rapidly converted to active clindamycin once inside the body or applied to the skin.
• Clindamycin phosphate has the same antimicrobial spectrum and effectiveness as clindamycin hydrochloride, clindamycin nicotinamide, and clindamycin.
• Clindamycin nicotinamide is another topical form of clindamycin.

What is clindamycin hydrochloride?

Clindamycin hydrochloride is a salt of clindamycin that is usually used for oral formulations of clindamycin.

• Clindamycin hydrochloride is a prodrug of clindamycin that is rapidly converted to active clindamycin once inside the body.
• Clindamycin hydrochloride has the same antimicrobial spectrum and effectiveness as clindamycin phosphate, clindamycin nicotinamide, and clindamycin.

What is clindamycin used to treat?

Clindamycin may be used to treat a wide range of infections, although it should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria to reduce the development of drug-resistant bacteria and to maintain its effectiveness.

Infections clindamycin treats in adults and children include serious:

• Infections caused by susceptible anaerobic bacteria
• Infections due to susceptible isolates of streptococci, pneumococci, and staphylococci, if a less toxic alternative (such as erythromycin) is not suitable
• Lower respiratory tract infections including pneumonia, empyema, and lung abscess caused by susceptible isolates of anaerobes, Streptococcus pneumoniae, other streptococci (except Enterococcus faecalis), and Staphylococcus aureus in adults and children
• Skin and skin structure infections caused by susceptible isolates of Streptococcus pyogenes, Staphylococcus aureus, and anaerobes in adults and children
• • Topical clindamycin 1% may be used to help treat and control severe acne.

• Gynecological infections including endometritis, nongonococcal tubo-ovarian abscess, pelvic cellulitis, and postsurgical vaginal cuff infection caused by susceptible anaerobes in adults and children
• Intra-abdominal infections including peritonitis and intra-abdominal abscesses caused by susceptible anaerobic organisms in adults and children
• Septicemia caused by susceptible isolates of Staphylococcus aureus, streptococci (except E. faecalis), and susceptible anaerobes in adults and children
• Bone and joint infections including acute hematogenous osteomyelitis caused by susceptible isolates of S. aureus and as adjunctive therapy in the surgical treatment of chronic bone and joint infections due to susceptible organisms in adults and children.

Clindamycin does not adequately penetrate the cerebrospinal fluid and should NOT be used to treat meningitis.

Clindamycin side effects

The most common clindamycin side effects include:

• nausea or vomiting
• stomach (abdominal) pain
• mild skin rash
• vaginal itching or discharge.

Clindamycin may also cause a metallic taste in your mouth. Talk to your healthcare provider about ways you can manage this.

Serious side effects and warnings

Clindamycin carries a Boxed Warning for Clostridium difficile-associated diarrhea (CDAD).

Clindamycin can cause diarrhea, which may range in severity from mild to fatal colitis. Diarrhea associated with clindamycin use is sometimes caused by an overgrowth of dangerous Clostridium difficile bacteria in the large intestine. Seniors especially should be monitored for diarrhea. If you have diarrhea that is watery or bloody, stop using clindamycin and call your doctor. Do not use anti-diarrhea medicine unless your doctor tells you to. Seek urgent medical attention.

Get emergency medical help if you have any signs of an allergic reaction to clindamycin: (hives, difficulty breathing, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning in your eyes, skin pain, red or purple skin rash that spreads and causes blistering and peeling).

Serious skin and other reactions can occur with clindamycin. Seek medical treatment if you have symptoms of a drug reaction such as skin rash, fever, swollen glands, flu-like symptoms, muscle aches, severe weakness, unusual bruising, or yellowing of your skin or eyes. This reaction may occur several weeks after starting clindamycin.

Call your healthcare provider at once if you have:

• any change in bowel habits (for example, you start going to the toilet very frequently or don’t go at all)
• severe stomach pain
• diarrhea that is watery or bloody
• little or no urination.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

Before taking this medicine

Do not take clindamycin if you are allergic to clindamycin, lincomycin, Cleocin, Clindesse, ClindaMax, or any of the inactive ingredients in the clindamycin preparation you are taking (refer to the clindamycin Package Insert).

To make sure clindamycin is safe for you, tell your doctor if you have ever had:

• kidney or liver disease
• an intestinal disorder such as ulcerative colitis or Crohn’s disease
• eczema
• an allergic skin reaction
• asthma or a severe allergic reaction to aspirin
• an allergy to yellow food dye.

Also, tell your healthcare provider if you are pregnant or intend to become pregnant or are breastfeeding.

Pregnancy

Animal studies have not shown any harm during pregnancy, but it is not known whether clindamycin will harm an unborn baby in humans.

Breastfeeding

Clindamycin does pass into breast milk and may cause side effects in the nursing baby. If you are breastfeeding while taking this medicine, call your doctor if your baby has diaper rash, redness or white patches in the mouth or throat, stomach discomfort, or diarrhea that is watery or bloody. Let your doctor know if you are breastfeeding before taking clindamycin.

Young infants

Clindamycin injection may contain an ingredient that can cause serious side effects or death in very young or premature babies. Do not give this medicine to a child without medical advice.

How should I take clindamycin?

Take clindamycin exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets. Use the medicine exactly as directed.

Oral clindamycin capsules are taken by mouth.

Clindamycin injection is injected into a muscle, or as an infusion into a vein. A healthcare provider will give your first dose and may teach you how to properly use the medication by yourself.

Take the capsule with a full glass of water to keep it from irritating your throat.

Measure liquid medicine carefully. Use the dosing syringe provided, or use a medicine dose-measuring device (not a kitchen spoon).

You may need frequent medical tests during treatment.

If you need surgery, let your surgeon know you use clindamycin as it may interact with certain drugs used for anesthesia.

Use this medicine for the full prescribed length of time, even if your symptoms quickly improve. Skipping doses can increase your risk of infection that is resistant to medication. Clindamycin will not treat a viral infection such as the flu or a common cold.

Store at room temperature away from moisture and heat. Protect the injectable medicine from high heat.

Do not store the oral liquid in the refrigerator. Throw away any unused oral liquid after 2 weeks.

Take clindamycin for the full prescribed length of time. Your symptoms may improve before the infection is completely cleared. Skipping doses may also increase your risk of further infection that is resistant to antibiotics. Clindamycin will not treat a viral infection such as the common cold or flu.

What happens if I miss a dose?

Use the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not use extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

What should I avoid while using clindamycin?

Do not use clindamycin at the same time as erythromycin, another antibiotic.

What other drugs will affect clindamycin?

Other drugs may interact with clindamycin, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicines you start or stop using.

Clindamycin has been shown to have neuromuscular blocking properties that may enhance the action of other neuromuscular blocking agents, such as succinylcholine, rocuronium, or vecuronium. Use with caution.

Clindamycin is metabolized predominantly by CYP3A4 hepatic enzymes, and to a lesser extent by CYP3A5, to the major metabolite clindamycin sulfoxide and minor metabolite N‑desmethylclindamycin. Caution should be used when using with strong or moderate inhibitors of CYP3A4 and CYP3A5, such as clarithromycin, nefazodone, itraconazole, ketoconazole, atazanavir, darunavir, indinavir, lopinavir, nelfinavir, ritonavir, saquinavir, or tipranavir. Caution should also be used when used together with inducers of these enzymes such as phenobarbital, phenytoin, rifampicin, St. John’s Wort, and glucocorticoids because concentrations of clindamycin may be reduced and it may not be as effective.

Bactrim and Bactrim DS are antibiotics used to treat ear infections, urinary tract infections, bronchitis, traveler’s diarrhea, shigellosis, and Pneumocystis jiroveci pneumonia. Bactrim and Bactrim DS contain a combination of two antibiotics, sulfamethoxazole and trimethoprim, that treat different types of infection caused by bacteria. Bactrim DS (double strength) tablets are twice as strong as Bactrim tablets.

Sulfamethoxazole is a sulfonamide antibiotic that prevents the growth of susceptible bacteria by interfering with their ability to make folic acid. Trimethoprim is an antifolate antibiotic that works by inhibiting an enzyme, resulting in bacteria’s inability to make DNA and survive. Sulfamethoxazole and trimethoprim are combined because they are complementary and have a greater effect when used together.

To help reduce the development of drug-resistant bacteria and maintain sulfamethoxazole-trimethoprim effectiveness, this medicine should be used only to treat infections proven or strongly suspected to be caused by susceptible bacteria.

Bactrim side effects

Common Bactrim side effects

Common Bactrim DS and Bactrim side effects are nausea, vomiting, loss of appetite, and skin rash.

Serious Bactrim and Bactrim DS side effects

Get emergency medical help if you have signs of an allergic reaction to this medicine (hives, cough, chest pain, shortness of breath, swelling in your face or throat) or a severe skin reaction (fever, sore throat, burning eyes, skin pain, red or purple skin rash with blistering and peeling).

Seek medical treatment if you have a serious drug reaction that can affect many parts of your body. Symptoms may include skin rash, fever, swollen glands, joint pain, muscle aches, severe weakness, pale skin, unusual bruising, or yellowing of your skin or eyes.

Call your doctor at once if you have:

• severe stomach pain, diarrhea that is watery or bloody (even if it occurs months after your last dose);
• any skin rash, no matter how mild;
• yellowing of your skin or eyes;
• a seizure;
• new or unusual joint pain;
• increased or decreased urination;
• swelling, bruising, or irritation around the IV needle;
• increased thirst, dry mouth, fruity breath odor;
• new or worsening cough, fever, trouble breathing;
• high blood potassium – nausea, weakness, tingly feeling, chest pain, irregular heartbeats, loss of movement;
• low blood sodium – headache, confusion, problems with thinking or memory, weakness, feeling unsteady; or
• low blood cell counts – fever, chills, mouth sores, skin sores, easy bruising, unusual bleeding, pale skin, cold hands and feet, feeling light-headed or short of breath.

Also, see the Warnings section.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects.

Warnings

You should not use this medicine if you have severe liver disease, kidney disease that is not being monitored, anemia caused by folic acid deficiency, if you take dofetilide, or if you have had low platelets caused by using trimethoprim or a sulfa drug.

You should not take this medicine if you are pregnant or breastfeeding.

Use this medicine only as directed. Tell your doctor if you use other medicines or have other medical conditions or allergies.

Before taking this medicine

You should not use this medicine if you are allergic to sulfamethoxazole or trimethoprim, or if you have:

• severe liver disease;
• kidney disease that is not being treated or monitored;
• anemia (low red blood cells) caused by folic acid deficiency;
• a history of low blood platelets after taking trimethoprim or any sulfa drug; or
• if you take dofetilide.

Sulfamethoxazole and trimethoprim may cause birth defects. Do not use Bactrim if you are pregnant. Tell your doctor if you become pregnant.

Do not breastfeed.

This medicine should not be given to a child younger than 2 months old.

To make sure you can safely take this medicine, tell your doctor if you have ever had:

• kidney or liver disease;
• a folate (folic acid) deficiency;
• asthma or severe allergies;
• HIV or AIDS;
• a thyroid disorder;
• malnourishment;
• alcoholism;
• an electrolyte imbalance (such as low blood sodium or high potassium);
• porphyria, or glucose-6-phosphate dehydrogenase (G6PD) deficiency; or
• if you use a blood thinner (such as warfarin) and you have routine “INR” or prothrombin time tests.

How should I use Bactrim?

Take Bactrim exactly as prescribed by your doctor. Follow all directions on your prescription label and read all medication guides or instruction sheets.

Drink plenty of fluids to prevent kidney stones.

Antibiotic medicines can cause diarrhea. Tell your doctor if you have diarrhea that is watery or bloody.

Keep using this medicine even if your symptoms quickly improve. Skipping doses could make your infection resistant to medication. This antibiotic will not treat a viral infection (flu or a common cold).

You may need blood and urine tests, and this medicine may be stopped based on the results.

Store tablets at room temperature away from moisture, heat, and light. Do not refrigerate.

Bactrim Dosing Information

Bactrim is contraindicated in pediatric patients less than 2 months of age.

Bactrim tablets are available as

• Bactrim DS (double strength) tablets: 800 mg sulfamethoxazole and 160 mg trimethoprim
• Bactrim tablets: 400 mg sulfamethoxazole and 80 mg trimethoprim

Usual Bactrim dose for Urinary Tract Infections

Adults dose for UTI

• Bactrim DS tablets (800mg/160mg): one tablet every 12 hours for 10 to 14 days
• Bactrim tablets (400mg/80mg): two tablets every 12 hours for 10 to 14 days

Children (2 months and older) dose for UTI

• Dose is based on weight: 40 mg/kg sulfamethoxazole and 8 mg/kg trimethoprim per 24 hours, given in two divided doses every 12 hours for 10 days.
• Use: For the treatment of urinary tract infections due to susceptible strains of the following organisms: Escherichia coli, Klebsiellaspecies, Enterobacterspecies, Morganella morganii, Proteus mirabilis and Proteus vulgaris. It is recommended that initial episodes of uncomplicated urinary tract infections be treated with a single effective antibacterial agent rather than the combination.

Usual Bactrim dose Acute Otitis Media Children (2 months and older)

• Dose is based on weight: 40 mg/kg sulfamethoxazole and 8 mg/kg trimethoprim per 24 hours, given in two divided doses every 12 hours for 10 days.
• Use: For the treatment of acute otitis media in pediatric patients due to susceptible strains of Streptococcus pneumoniae or Haemophilus influenzae when sulfamethoxazole and trimethoprim offer some advantage over the use of other antimicrobial agents, in the judgment of the physician.

Usual Adult Bactrim Dose for Bronchitis

• Bactrim DS tablets (800mg/160mg): one tablet every 12 hours 14 days
• Bactrim tablets (400mg/80mg): two tablets every 12 hours 14 days
• Use: For the treatment of acute exacerbations of chronic bronchitis due to susceptible strains of Streptococcus pneumoniae or Haemophilus influenzae when the physician deems that this drug could offer some advantage over the use of a single antimicrobial agent.

Usual Adult Bactrim Dose for Traveler’s Diarrhea

• Bactrim DS tablets (800mg/160mg): one tablet every 12 hours 5 days
• Bactrim tablets (400mg/80mg): two tablets every 12 hours for 5 days
• Use: For the treatment of traveler’s diarrhea due to susceptible strains of enterotoxigenic E coli.

For Patients with Impaired Renal Function

• When renal function is impaired, a reduced dosage should be employed.
• This is not all the dosing information available. For more detailed dosing information, click on the link below.

What happens if I miss a dose?

Use the medicine as soon as you can, but skip the missed dose if it is almost time for your next dose. Do not use two doses at one time.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line .

Overdose symptoms may include loss of appetite, vomiting, fever, blood in your urine, yellowing of your skin or eyes, confusion, or loss of consciousness.

What should I avoid while using Bactrim?

This medicine could make you sunburn more easily. Avoid sunlight or tanning beds. Wear protective clothing and use sunscreen (SPF 30 or higher) when you are outdoors.

What other drugs will affect Bactrim?

You may need more frequent check-ups or medical tests if you also use medicine to treat depression, diabetes, seizures, or HIV.

Tell your doctor about all your current medicines. Many drugs can interact with sulfamethoxazole and trimethoprim, especially:

• amantadine, digoxin, cyclosporine, indomethacin, leucovorin, methotrexate, procainamide, pyrimethamine;
• an “ACE inhibitor” heart or blood presure medication (benazepril, enalapril, lisinopril, quinapril, ramipril, and others); or
• a diuretic or “water pill”.