Cleocin (Clindamycin) Contraindications and Precautions
- clindamycin hypersensitivity
- lincomycin hypersensitivity
- pseudomembranous colitis
- asthma
- atopy
- breast-feeding
- colitis
- diarrhea
- fungal infection
- hepatic disease
- inflammatory bowel disease
- neonatal prematurity
- neonates
- pregnancy
- tartrazine dye hypersensitivity
- ulcerative colitis
- viral infection
Cleocin Contraindications / Precautions
Clindamycin should not be used in patients with known clindamycin hypersensitivity. Because some cross-sensitivity may occur, patients with lincomycin hypersensitivity should not be treated with clindamycin. Use the drug with caution in patients with asthma or a significant history of allergy (atopy). Some oral preparations contain tartrazine dye and can precipitate bronchial asthma or other allergic reactions in patients with tartrazine dye hypersensitivity. Use the drug with caution in patients with asthma or a significant history of allergy (atopy).
This drug does not treat viral infections (e.g., common cold). Prescribing clindamycin in the absence of a proven or strongly suspected bacterial infection or a prophylactic indication is unlikely to provide benefit to the patient and increases the risk of the development of drug-resistant bacteria. Patients should be told to complete the full course of treatment, even if they feel better earlier.
Clindamycin should not be used in the treatment of meningitis as the drug does not adequately diffuse into the cerebrospinal fluid (CSF).
Clindamycin can cause the overgrowth of nonsusceptible bacteria resulting in superinfection, particularly yeast and fungal infections. Should superinfection occur, appropriate measures should be taken.
It is known that systemic use of clindamycin predisposes patients to development of pseudomembranous colitis. The drug should be reserved for serious infections where less toxic antimicrobials are inappropriate. Clindamycin should be prescribed with caution to patients with inflammatory bowel disease such as ulcerative colitis. If diarrhea develops during therapy with clindamycin, the drug should be discontinued. Practitioners should be aware that diarrhea, colitis and pseudomembranous colitis have been observed to begin up to several weeks following discontinuation of clindamycin therapy.
Clindamycin injection must not be administered by intravenous injection bolus. The injection is only to be used for intramuscular administration or may be delivered by slow intravenous infusion after appropriate dilution. The infusion should be administered over at least 10-60 minutes and at the recommended concentrations.
Clindamycin should be used cautiously in children. While the manufacturer notes that the drug may be administered in pediatric patients from birth and older, appropriate monitoring of organ system function is recommended during therapy. Neonatal prematurity results in a prolonged plasma half-life for clindamycin, probably due to an immature hepatic system; lower dosages may be required in premature neonates. Female children who are post-menarche may receive vaginal clindamycin dosage forms for bacterial vaginosis.
Clindamycin should be used with caution in patients with hepatic disease. Studies indicate that the clindamycin half-life is prolonged in patients with moderate to severe liver disease. However, extrapolation from these studies indicates that when the drug is given every 8 hours, accumulation should not occur and dosage modification for liver disease may not be necessary. Liver function tests (LFTs) should be monitored regularly during therapy in patients with severe liver disease.
The manufacturer states that dosage adjustment of clindamycin may not be necessary in patients with renal disease (including renal impairment and renal failure). Other experts have also recommended against dosage adjustment. Only 10% of clindamycin is eliminated renally.
Clindamycin is classified as FDA pregnancy risk category B when administered by any route. Placental concentrations are roughly 50% of maternal serum concentrations; animal studies have not revealed evidence of fetal harm and data do not support an association of clindamycin with congenital defects in humans. Parenteral clindamycin has long been used as prophylactic therapy for Caesarean section. Clindamycin vaginal cream has been studied for use during and after the second trimester of gestation for bacterial vaginosis. According to the CDC, use of clindamycin vaginal cream is not recommended during pregnancy because data from two randomized trials indicate an increase in the number of preterm deliveries with this medication. In women treated for 7 days, abnormal (premature) labor was reported more frequently in patients who received clindamycin vaginal cream versus those who received placebo (1.1 vs. 0.5% of patients, respectively).
Clindamycin is excreted into human breast milk after administration by the oral or parenteral routes, in concentrations of 0.7-3.8 mcg/ml. Because of the potential for adverse reactions in the neonatal-aged infant, the decision to discontinue the systemic drug during breast-feeding should be made, taking into account the importance of the drug to the mother. Clindamycin is generally considered compatible with breast-feeding by the American Academy of Pediatrics. Vaginally-administered clindamycin may be systemically absorbed, but it is unclear if a significant amount would pass to the infant. Three potential problems from clindamycin exposure via breast-milk that may occur in the infant are alterations in gut flora, direct effects from the drug, or interference with culture results in the infant should a clinical diagnosis of fever or infection be required. Only one event of diarrhea and bloody stools exists in the literature.
Clinical studies for clindamycin did not include sufficient numbers of subjects aged 65 and over to determine whether they respond differently from younger subjects. Other reported clinical experience has not identified differences in responses between the elderly and younger patients.
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