Clindamycin is a lincosamide antibiotic (lincosamides, oxazolidinones and streptogramins), which is primarily bacteriostatic. It binds to the 50S subunit of the ribosome, thereby inhibiting protein synthesis. Pharmacology Clindamycin is well absorbed after oral administration and can be administered parenterally. Clindamycin diffuses well in all body fluids except cerebrospinal fluid and accumulates in phagocytes. Most of the substance is metabolized; the metabolites are excreted via the bile and urine. Indications The spectrum of action of clindamycin comparable with that of erythromycin (see table: Some clinical applications of macrolides), except that clindamycin even with Anaerobierinfektion (especially Bacteroides sp, including B. fragilis), methicillin-resistant community acquired Staphylococcus aureus, and macrolide-resistant, clindamycin-susceptible Streptococcus pneumoniae is effective. It will not work reliably against mycoplasma, chlamydia, Chlamydia sp and legionella aerobic gram-negative bacteria and enterococci are resistant. Clindamycin is usually used in anaerobic infections; However, resistance to clindamycin in these organisms has increased in some regions. Since Anaerobierinfektionen often also involve aerobic gram-negative rods, additional antibiotics are used. Clindamycin is part of a combination therapy with the following infections: when caused by toxigenic Streptococcus infections, as it can reduce toxin production of the pathogen in cerebral toxoplasmosis babesiosis Malaria tropica pneumonia due to Pneumocystis jirovecii clindamycin can be used in infections (e.g., skin and soft tissue infections.) in communities where a communitiy-associated methicillin-resistant Staphylococcus aureus (CA MRSA) is common; whether clindamycin is useful depends on local resistance patterns. Clindamycin can be used in infections caused by clindamycin and erythromycin-susceptible strains. However, some CA-MRSA strains are clindamycin-sensitive and erythromycin-resistant; Erythromycin resistance may result in these strains, or by an active efflux mechanism by erythromycin-inducible modification of the ribosomal target sequence. If the infection-causing strain of clindamycin-sensitive CA-MRSA is resistant due to the efflux mechanism to erythromycin, patients react in all likelihood, however, still on clindamycin. However, if the strain is resistant to erythromycin due to erythromycin-inducible modification of the ribosomal target frequency, patients may not respond to clindamycin because certain mutants may occur during clindamycin therapy clinically; these mutants are resistant due to constitutive modification of the ribosomal target rate to clindamycin and erythromycin. (Constitutive means that resistance is always, regardless of whether a causative agent such as erythromycin is present or not.) Erythromycin resistance due to efflux may be a resistance, which is produced by inducible ribosomal target modification, by means of a commonly used double disk diffusion assay (D-test) can be distinguished. A clindamycin tile is placed in a standard distance from an erythromycin plate on an agar plate which is traversed with said respective standard inoculum of CA-MRSA strain Zone of growth inhibition (shaped like the letter “D”) to clindamycin the plate around, with a flattened near the erythromycin plate shows the inducible ribosomal resistance. Patients with moderate to severe infection caused by an inducible, ribosomal-resistant CA-MRSA strain and a positive D test, should not be treated with clindamycin. Clindamycin can not be used in CNS infections (with the exception of cerebral toxoplasmosis) because it poorly penetrates into the brain and cerebrospinal fluid. Topical clindamycin is used in acne. Contraindications Clindamycin is contraindicated in patients who have had an allergic reaction to it, is contraindicated and should be used in those with a history of regional enteritis, ulcerative colitis or antibiotic-associated colitis with caution. Use during pregnancy and lactation Clindamycin is in pregnancy category B (animal studies show no risk, but human experience are insufficient or animal studies show risk, and studies in humans). Clindamycin is excreted in breast milk. Use during lactation is not recommended. Side Effects The principal adverse reaction is Clostridium difficile associated diarrhea (pseudomembranous Kolitis- Clostridium difficile -induced diarrhea) clindamycin, penicillins, cephalosporins, fluoroquinolones, and finally also have been associated with C. difficile-associated diarrhea. Clindamycin was independent (topically) associated with C. difficile associated diarrhea in the context of administration at up to 10% of patients hypersensitivity reactions may occur. If it is not swallowed with water, clindamycin can cause esophagitis. Considerations Dosage Dosage adjustment in renal impairment is not required. Clindamycin is q 6-8 h given.