What is the classification of clindamycin?

Classification of Clindamycin

Clindamycin is classified as a lincosamide antibiotic that acts by binding to the 50S ribosomal subunit of susceptible bacteria, thereby suppressing protein synthesis. 1, 2

Mechanism of Action and Antimicrobial Properties

• Clindamycin exhibits a concentration-dependent mechanism of antimicrobial activity by inhibiting bacterial protein synthesis through binding to the 23S RNA of the 50S subunit of the ribosome 1, 2
• It is primarily bacteriostatic but may be bactericidal at higher concentrations that can be achieved in vivo 3
• Clindamycin demonstrates a narrow spectrum of microbiologic activity, primarily against gram-positive cocci and anaerobic bacteria 4
• It is not active against Haemophilus influenzae and Moraxella catarrhalis but is effective against many gram-negative anaerobes 1

Pharmacological Classification and Properties

• Clindamycin is a semisynthetic antibiotic produced by a 7(S)-chloro-substitution of the 7(R)-hydroxyl group of the parent compound lincomycin 2
• The chemical name for clindamycin hydrochloride is Methyl 7-chloro-6,7,8-trideoxy-6-(1-methyl-trans-4-propyl-L-2-pyrrolidinecarboxamido)-1-thio-L-threo-α-D-galacto-octopyranoside monohydrochloride 2
• It is predominantly metabolized by Cytochrome P450 3A4 (CYP3A4), with minor contribution from CYP3A5 2
• The average biological half-life of clindamycin is 2.4 hours, with approximately 10% of bioactivity excreted in urine and 3.6% in feces 2

Clinical Applications

• Clindamycin is recommended for the treatment of infections caused by:
  • Staphylococcus aureus (including methicillin-resistant strains) 1, 2
  • Streptococcus pneumoniae and Streptococcus pyogenes 2
  • Anaerobic bacteria including Clostridium perfringens, Fusobacterium species, and Prevotella melaninogenica 2
• It has excellent tissue penetration, particularly in bone and abscesses, making it suitable for bone and joint infections 1
• In dermatology, clindamycin is used in both topical and oral formulations for the treatment of acne vulgaris 1, 4
• It serves as an alternative to sulfonamides in patients with toxoplasmosis who develop sulfonamide hypersensitivity 5

Important Considerations and Adverse Effects

• Cross-resistance between clindamycin and lincomycin is complete, and cross-resistance can sometimes occur among lincosamides, macrolides, and streptogramin B antibiotics 2
• Clindamycin may cause diarrhea in up to 20% of patients and is associated with a risk of Clostridium difficile-associated disease 1
• It is contraindicated in patients with a history of hypersensitivity to clindamycin or lincomycin, and in those with a history of regional enteritis, ulcerative colitis, or antibiotic-associated colitis 1
• Clindamycin is classified as Category B in pregnancy according to Clinical Infectious Diseases guidelines 1
• Rare adverse effects have been reported, including polyarthritis and monoarthritis 6