Why is clindamycin the antibiotic treatment of choice for necrotizing fasciitis?

Updated: Sep 02, 2020
  • Author: Steven A Schulz, MD; Chief Editor: Michael Stuart Bronze, MD  more...
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Although some necrotizing infections may still be susceptible to penicillin, clindamycin is the treatment of choice for necrotizing infections, for the following reasons [69] :

  • Unlike penicillin, the efficacy of clindamycin is not affected by the inoculum size or stage of bacterial growth [91, 92]

  • Clindamycin is a potent suppressor of bacterial toxin synthesis [93, 94]

  • Subinhibitory concentrations of clindamycin facilitate the phagocytosis of GABS [60]

  • Clindamycin reduces the synthesis of penicillin-binding protein, which, in addition to being a target for penicillin, is also an enzyme involved in cell wall synthesis and degradation [92]

  • Clindamycin has a longer postantibiotic effect than β-lactins such as penicillin [94]

  • Clindamycin suppresses lipopolysaccharide-induced mononuclear synthesis of tumor necrosis factor-α (TNF-α) [95]

Consequently, the success of clindamycin also may be related to its ability to modulate the immune response. [96]

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