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CLINDAMYCIN

Drug Name                                    Nursing Path               
Generic Name : clindamycin, clindamycin hydrochloride, clindamycin palmitate hydrochloride, clindamycin phosphate
Brand Name:
§  Oral:  Cleocin, Dalacin C (CAN),Cleocin Pediatric
§  Oral, parenteral, topical dermatologic solution for acne, vaginal preparation: Cleocin Phosphate, Cleocin T, Cleocin Vaginal Ovules, Clinda-Derm (CAN), Clindagel, ClindaMax, Clindets, Dalacin C (CAN)

Classification: Lincosamide antibiotic

Pregnancy Category B

Dosage & Route                                   Nursing Path
Adults
Oral
§  150–300 mg q 6 hr, up to 300–450 mg q 6 hr in more severe infections.

Parenteral
§  600–2,700 mg/day in two to four equal doses; up to 4.8 g/day IV or IM may be used for life-threatening situations.

Vaginal
§  One applicator (100 mg clindamycin phosphate) intravaginally, preferably at bedtime for 7 consecutive days; or insert vaginal suppository, preferably at bedtime for 7 consecutive days; or insert vaginal suppository, preferably at bedtime for 3 days for Cleocin Vaginal Ovules.

Topical
§  Apply a thin film to affected area bid.

Pediatric
Oral
§  For clindamycin HCl, 8–20 mg/kg/day in three or four equal doses. For clindamycin palmitate HCl, 8–25 mg/kg/day in three or four equal doses; for children weighing < 10 kg, use 37.5 mg tid as the minimum dose.

Parenteral
§  Neonates: 15–20 mg/kg/day in three or four equal doses.
§  > 1 mo: 15–40 mg/kg/day in three or four equal doses or 350 mg/m2/day to 450 mg/m2/day.
Geriatric Patients or Patients with Renal Failure 

§  Reduce dose, and monitor patient’s serum levels carefully
Therapeutic actions               Nursing Path

§  Inhibits protein synthesis in susceptible bacteria, causing cell death.

Indications                       Nursing Path

§  Systemic administration: Serious infections caused by susceptible strains of anaerobes, streptococci, staphylococci, pneumococci; reserve use for penicillin-allergic patients or when penicillin is inappropriate; less toxic antibiotics (erythromycin) should be considered
§  Parenteral: Treatment of septicemia caused by staphylococci, streptococci; acute hematogenous osteomyelitis; adjunct to surgical treatment of chronic bone and joint infections due to susceptible organisms; do not use to treat meningitis; does not cross the blood–brain barrier.
§  Topical dermatologic solution: Treatment of acne vulgaris
§  Vaginal preparation: Treatment of bacterial vaginosis

Adverse effects                Nursing Path

§  Diarrhea, nausea, vomiting, abdominal pain; erythema multiforme, contact dermatitis, exfoliative and vesiculous dermatitis, urticaria; eosinophilia; local irritation, thrombophlebitis.
§  Potentially Fatal: Gasping syndrome (neonates); pseudomembranous colitis.

Contraindications                  Nursing Path

§  Hypersensitivity.

Nursing considerations
Assessment 

§  History: Allergy to clindamycin, history of asthma or other allergies, allergy to tartrazine (in 75- and 150-mg capsules); hepatic or renal dysfunction; lactation; history of regional enteritis or ulcerative colitis; history of antibiotic associated colitis
§  Physical: Site of infection or acne; skin color, lesions; BP; R, adventitious sounds; bowel sounds, output, liver evaluation; CBC, LFTs, renal function tests
Interventions
Systemic administration
§  Culture infection before therapy.
§  Administer oral drug with a full glass of water or with food to prevent esophageal irritation.
§  Do not give IM injections of more than 600 mg; inject deep into large muscle to avoid serious problems.
§  Do not use for minor bacterial or viral infections.
§  BLACK BOX WARNING: Be aware that serious to fatal colitis can occur; reserve use, and monitor patient closely.
§  Monitor LFTs and renal function tests, and blood counts with prolonged therapy.

Topical dermatologic administration
§  Keep solution away from eyes, mouth and abraded skin or mucous membranes; alcohol base will cause stinging. Shake well before use.
§  Keep cool tap water available to bathe eye, mucous membranes, abraded skin inadvertently contacted by drug solution.

Vaginal preparation
§  Give intravaginally, preferably at bedtime.
Teaching points

Systemic administration                            Nursing Path
§  Take oral drug with a full glass of water or with food.
§  Take full prescribed course of oral drug. Do not stop taking without notifying health care provider.
§  You may experience these side effects: Nausea, vomiting (eat frequent small meals); superinfections in the mouth, vagina (use frequent hygiene measures; request treatment if severe).
§  Report severe or watery diarrhea, abdominal pain, inflamed mouth or vagina, skin rash or lesions.

Topical dermatologic administration
§  Apply thin film of acne solution to affected area twice daily, being careful to avoid eyes, mucous membranes, abraded skin; if solution contacts one of these areas, flush with lots of cool water.
§  Report abdominal pain, diarrhea.

Vaginal preparation
§  Use vaginal preparation for 7 or 3 consecutive days, preferably at bedtime. Refrain from sexual intercourse during treatment with this product.
§  Report vaginal irritation, itching; diarrhea, no improvement in complaint being treated.

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