Wednesday, November 18, 2009
Monday, November 9, 2009
CLINDAMYCIN IN RESPIRATORY DISEASE
Clindamycin is a lincosamide antibiotic.
I found this drug really good perticularly in respiratory tract diseases.
Indications
Used primarily to treat infections caused by
· Susceptible anaerobic bacteria, including infections of the respiratory tract, skin and soft tissue infections, and peritonitis.
· In patients with hypersensitivity to penicillins, clindamycin may be used to treat infections caused by susceptible aerobic bacteria as well.
· It is also used to treat bone and joint infections, particularly those caused by Staphylococcus aureus.
· Topical application of clindamycin phosphate can be used to treat mild to moderate acne.[5]
Roale in Respiratory infections
Susceptible bacteria
It is most effective against infections involving the following types of organisms:
Aerobic Gram-positive cocci, including some members of the Staphylococcus and Streptococcus (e.g. pneumococcus) genera, but not enterococci.
Anaerobic, Gram-negative rod-shaped bacteria, including some Bacteroides, Fusobacterium, and Prevotella, although resistance is increasing in Bacteroides fragilis.
These are the common bactrias in aAc. Exacerbation of COPD,Community Acquired pneumonia, and Upper respiratory tract infection.
But one has to remember that most aerobic Gram-negative bacteria (such as Pseudomonas, Legionella, Haemophilus influenzae and Moraxella) are resistant to clindamycin, as are the facultative anaerobic Enterobacteriaceae.
Other
1.It can also be useful in skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus (MRSA); many strains of MRSA are still susceptible to clindamycin.
Clindamycin is used in cases of suspected toxic shock syndrome, often in combination with a bactericidal agent such as vancomycin. The rationale for this approach is a presumed synergy between vancomycin, which causes the death of the bacteria by breakdown of the cell membrane, and clindamycin, which is a powerful inhibitor of toxin synthesis. Both in vitro and in vivo studies have shown that clindamycin reduces the production of exotoxins by staphylococci; it may also induce changes in the surface structure of bacteria that make them more sensitive to immune system attack (opsonization and phagocytosis)
Clindamycin has been proven to decrease the risk of premature births in women diagnosed with bacterial vaginosis during early pregnancy to about a third of the risk of untreated women.
Parasitic
Plasmodium falciparum malaria
Clindamycin is effective and well-tolerated in treating Plasmodium falciparum malaria. It is to be used along with Chloroquinine or quinine for this perpouse.Quinine plus clindamycin combination is particularly useful for children, and is the treatment of choice for pregnant women who become infected in areas where resistance to chloroquine is common.
Clindamycin should not be used as an antimalarial by itself, although it appears to be very effective as such, because of its slow action.
Other Parasitic infection
The combination of clindamycin and quinine is the standard treatment for severe babesiosis
Clindamycin may also be used to treat toxoplasmosis, in combination with primaquine, is effective in treating mild to moderate Pneumocystis jirovecii pneumonia.
Adverse effects
Common adverse drug reactions (ADRs) associated with clindamycin therapy—found in over 1% of patients—
Diarrhea, pseudomembranous colitis, nausea, vomiting, abdominal pain or cramps, rash, and/or itch. High doses (both intravenous and oral) may cause a metallic taste, and topical application may cause contact dermatitis
Pseudomembranous colitis is a potentially-lethal condition commonly associated with clindamycin, but which also occurs with other antibiotics. Overgrowth of Clostridium difficile, which is inherently resistant to clindamycin, results in the production of a toxin that causes a range of adverse effects, from diarrhea to colitis and toxic megacolon
Rarely—in less than 0.1% of patients—clindamycin therapy has been associated with anaphylaxis, blood dyscrasias, polyarthritis, jaundice, raised liver enzyme levels and/or hepatotoxicity.
Pharmacology
Pharmacokinetics
Approximately 90% of an oral dose of clindamycin is absorbed from the gastrointestinal tract, and it is widely distributed throughout the body, excluding the central nervous system. Adequate therapeutic concentrations can be achieved in bone. There is also active uptake into white blood cells, most importantly neutrophils.
Clindamycin is extensively metabolised in the liver, probably by CYP3A4; some of its metabolites are active, such as N-dimethyl clindamycin and clindamycin sulfoxide. The elimination half-life is 1.5 to 5 hours. Clindamycin is primarily eliminated by hepatic metabolism; after an intravenous dose of clindamycin phosphate, about 4.5% of the dose is excreted in urine as clindamycin and about 0.35% as the phosphate salt The metabolites are excreted primarily in the urine.
Mechanism of action
Clindamycin has a bacteriostatic effect. It is a bacterial Protein synthesis inhibitor by inhibiting ribosomal translocation, in a similar way to macrolides. It does so by binding preferentially to the 23S subunit of the bacterial ribosome.
Interactions
Clindamycin may prolong the effects of neuromuscular-blocking drugs. Its similarity to the mechanism of action of macrolides and chloramphenicol means they should not be given simultaneously, as this causes antagonism and possible cross-resistance.
I found this drug really good perticularly in respiratory tract diseases.
Indications
Used primarily to treat infections caused by
· Susceptible anaerobic bacteria, including infections of the respiratory tract, skin and soft tissue infections, and peritonitis.
· In patients with hypersensitivity to penicillins, clindamycin may be used to treat infections caused by susceptible aerobic bacteria as well.
· It is also used to treat bone and joint infections, particularly those caused by Staphylococcus aureus.
· Topical application of clindamycin phosphate can be used to treat mild to moderate acne.[5]
Roale in Respiratory infections
Susceptible bacteria
It is most effective against infections involving the following types of organisms:
Aerobic Gram-positive cocci, including some members of the Staphylococcus and Streptococcus (e.g. pneumococcus) genera, but not enterococci.
Anaerobic, Gram-negative rod-shaped bacteria, including some Bacteroides, Fusobacterium, and Prevotella, although resistance is increasing in Bacteroides fragilis.
These are the common bactrias in aAc. Exacerbation of COPD,Community Acquired pneumonia, and Upper respiratory tract infection.
But one has to remember that most aerobic Gram-negative bacteria (such as Pseudomonas, Legionella, Haemophilus influenzae and Moraxella) are resistant to clindamycin, as are the facultative anaerobic Enterobacteriaceae.
Other
1.It can also be useful in skin and soft tissue infections caused by methicillin-resistant Staphylococcus aureus (MRSA); many strains of MRSA are still susceptible to clindamycin.
Clindamycin is used in cases of suspected toxic shock syndrome, often in combination with a bactericidal agent such as vancomycin. The rationale for this approach is a presumed synergy between vancomycin, which causes the death of the bacteria by breakdown of the cell membrane, and clindamycin, which is a powerful inhibitor of toxin synthesis. Both in vitro and in vivo studies have shown that clindamycin reduces the production of exotoxins by staphylococci; it may also induce changes in the surface structure of bacteria that make them more sensitive to immune system attack (opsonization and phagocytosis)
Clindamycin has been proven to decrease the risk of premature births in women diagnosed with bacterial vaginosis during early pregnancy to about a third of the risk of untreated women.
Parasitic
Plasmodium falciparum malaria
Clindamycin is effective and well-tolerated in treating Plasmodium falciparum malaria. It is to be used along with Chloroquinine or quinine for this perpouse.Quinine plus clindamycin combination is particularly useful for children, and is the treatment of choice for pregnant women who become infected in areas where resistance to chloroquine is common.
Clindamycin should not be used as an antimalarial by itself, although it appears to be very effective as such, because of its slow action.
Other Parasitic infection
The combination of clindamycin and quinine is the standard treatment for severe babesiosis
Clindamycin may also be used to treat toxoplasmosis, in combination with primaquine, is effective in treating mild to moderate Pneumocystis jirovecii pneumonia.
Adverse effects
Common adverse drug reactions (ADRs) associated with clindamycin therapy—found in over 1% of patients—
Diarrhea, pseudomembranous colitis, nausea, vomiting, abdominal pain or cramps, rash, and/or itch. High doses (both intravenous and oral) may cause a metallic taste, and topical application may cause contact dermatitis
Pseudomembranous colitis is a potentially-lethal condition commonly associated with clindamycin, but which also occurs with other antibiotics. Overgrowth of Clostridium difficile, which is inherently resistant to clindamycin, results in the production of a toxin that causes a range of adverse effects, from diarrhea to colitis and toxic megacolon
Rarely—in less than 0.1% of patients—clindamycin therapy has been associated with anaphylaxis, blood dyscrasias, polyarthritis, jaundice, raised liver enzyme levels and/or hepatotoxicity.
Pharmacology
Pharmacokinetics
Approximately 90% of an oral dose of clindamycin is absorbed from the gastrointestinal tract, and it is widely distributed throughout the body, excluding the central nervous system. Adequate therapeutic concentrations can be achieved in bone. There is also active uptake into white blood cells, most importantly neutrophils.
Clindamycin is extensively metabolised in the liver, probably by CYP3A4; some of its metabolites are active, such as N-dimethyl clindamycin and clindamycin sulfoxide. The elimination half-life is 1.5 to 5 hours. Clindamycin is primarily eliminated by hepatic metabolism; after an intravenous dose of clindamycin phosphate, about 4.5% of the dose is excreted in urine as clindamycin and about 0.35% as the phosphate salt The metabolites are excreted primarily in the urine.
Mechanism of action
Clindamycin has a bacteriostatic effect. It is a bacterial Protein synthesis inhibitor by inhibiting ribosomal translocation, in a similar way to macrolides. It does so by binding preferentially to the 23S subunit of the bacterial ribosome.
Interactions
Clindamycin may prolong the effects of neuromuscular-blocking drugs. Its similarity to the mechanism of action of macrolides and chloramphenicol means they should not be given simultaneously, as this causes antagonism and possible cross-resistance.
Now the most important thing is that it is less costly drug we are using these days for similar pathogenic spectrum. For Eg. Co-Amoxy Clavulanic Acid, Third gen. Cephalosporin.higher quinolones.
Be carful about Side efects.
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