Use of Clindamycin in Pediatric Infections

Marcia L. Buck, Pharm.D., FCCP

Disclosures

Pediatr Pharm. 2008;14(2) 

In This Article

Mechanism of Action/Antimicrobial Spectrum

Clindamycin reversibly binds to the 50S subunit of bacterial ribosomes preventing peptide bond formation, resulting in inhibition of bacterial protein synthesis. It is bacteriostatic against a variety of Gram positive aerobic and anaerobic organisms, as well as some Gram negative anaerobes and protozoa.[1,2,3] Clindamycin has demonstrated both in vitro and in vivo evidence of activity against the following organisms:

Gram positive aerobes
Staphylococcus aureus
Streptococcus pneumoniae
Strep pyogenes

Anaerobes
Clostridium perfringens
Fusobacterium necrophorum
Fusobacterium nucleatum
Peptostreptococcus anaerobius
Prevotella melaninogenica

In addition, clindamycin has been shown to have in vitro activity against the following organisms:

Gram positive aerobes
Bacillus spp
Corynebacterium diphtheriae
Nocardia spp
Strep agalactiae
Strep anginosus
Strep mitis
Strep oralis
Strep viridans

Anaerobes
Actinomyces israelii
Bacteroides spp
Bifidobacterium spp
Clostridium clostridioforme
Eubacterium lentum
Finegoldia magna
Micromoas micros
Prevotella bivia
Prevotella intermedia
Propionibacterium acnes

Clindamycin has also been shown to be effective in the treatment of Chlamydia trachomatis and Gardnerella vaginalis infections in women as well as Helicobacter pylori infections.[2] In addition to its antibacterial effects, clindamycin may also have immunomodulating effects. In laboratory studies, it reduces bacterial adhesion to mucosal surfaces and facilitates white blood cell chemotaxis, opsonization, and phagocytosis. Clindamycin may also inhibit production of pro-inflammatory cytokines such as tumor necrosis factor-α, interleukin-1β (IL-1β), and inducible nitric oxide, while increasing levels of IL-6.[1,4]

Clindamycin may also be useful in the treatment of protozoal infections, where it appears to interrupt target protein synthesis in the apicoplast, a parasite-specific organelle necessary for survival. Susceptible organisms include Toxoplasma gondii, Babesia spp, and Plasmodium falciparum.[1]

Because of the increasing incidence of bacterial resistance to clindamycin,[5,6] these lists serve only as a general guideline. Institution-specific or regional evaluations of antibiotic resistance patterns should be consulted prior to initiating therapy for serious infections.

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