Clindamycin: MedlinePlus Drug Information

pronounced as (klin” da mye’ sin)

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Many antibiotics, including clindamycin, may cause overgrowth of dangerous bacteria in the large intestine. This may cause mild diarrhea or may cause a life-threatening condition called colitis (inflammation of the large intestine). Clindamycin is more likely to cause this type of infection than many other antibiotics, so it should only be used to treat serious infections that cannot be treated by other antibiotics. Tell your doctor if you have or have ever had colitis or other conditions that affect your stomach or intestines.

You may develop these problems during your treatment or up to several months after your treatment has ended. Call your doctor if you experience any of the following symptoms during your treatment with clindamycin or during the first several months after your treatment has finished: watery or bloody stools, diarrhea, stomach cramps, or fever.

Talk to your doctor about the risks of taking clindamycin.

Clindamycin is used to treat certain types of bacterial infections, including infections of the lungs, skin, blood, female reproductive organs, and internal organs. Clindamycin is in a class of medications called lincomycin antibiotics. It works by slowing or stopping the growth of bacteria.

Antibiotics such as clindamycin will not work for colds, flu, or other viral infections. Using antibiotics when they are not needed increases your risk of getting an infection later that resists antibiotic treatment.

Clindamycin comes as a capsule and a solution (liquid) to take by mouth. It is usually taken three to four times a day. The length of your treatment depends on the type of infection you have and how well you respond to the medication. Take clindamycin at around the same times every day. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Take clindamycin exactly as directed. Do not take more or less of it or take it more often than prescribed by your doctor.

Shake the liquid well before each use to mix the medication evenly.

Take the capsules with a full glass of water so that the medication will not irritate your throat.

You should begin to feel better during the first few days of treatment with clindamycin. If your symptoms do not improve or if they get worse, call your doctor.

Take clindamycin until you finish the prescription, even if you feel better. If you stop taking clindamycin too soon or skip doses, your infection may not be completely treated and the bacteria may become resistant to antibiotics.

Clindamycin is also sometimes used to treat acne and is used along with other medications to treat anthrax (a serious infection that may be deliberately spread as part of a terror attack) and malaria (a serious infection that is spread by mosquitoes in certain parts of the world). Clindamycin is also sometimes used to treat ear infections, tonsillitis (infection that causes swelling of the tonsils), pharyngitis (infection that causes swelling in the back of the throat), and toxoplasmosis (an infection that may cause serious problems in people who do not have healthy immune systems or in unborn babies whose mothers are infected) when these conditions cannot be treated with other medications. Clindamycin is also sometimes used to treat bacterial vaginosis (an infection caused from too much of certain bacteria in the vagina). Clindamycin is also sometimes used to prevent endocarditis (infection of the heart valves) in certain people who are at risk of developing this infection as a result of a dental procedure. Talk to your doctor about the risks of using this medication for your condition.

This medication may be prescribed for other uses; ask your doctor or pharmacist for more information.

Before taking clindamycin,

• tell your doctor and pharmacist if you are allergic to clindamycin, lincomycin (Lincocin), any other medications, or any of the ingredients in clindamycin capsules or solution. Ask your pharmacist for a list of the ingredients. If you will be taking clindamycin capsules, tell your doctor if you are allergic to aspirin or tartrazine (a yellow dye found in some medications).
• tell your doctor and pharmacist what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are taking or plan to take. Be sure to mention clarithromycin (Biaxin, in PrevPac), erythromycin (E.E.S, E-Mycin, Erythrocin, others), indinavir (Crixivan), itraconazole (Sporanox), ketoconazole (Nizoral), nefazodone, nelfinavir (Viracept), rifampin (Rifadin, in Rifamate, in Rifater, Rimactane), and ritonavir (Norvir, in Kaletra). Your doctor may need to change the doses of your medications or monitor you carefully for side effects. Many other medications may also interact with clindamycin, so be sure to tell your doctor about all the medications you are taking, even those that do not appear on this list.
• tell your doctor if you have or have ever had asthma, allergies, eczema (sensitive skin that often becomes itchy or irritated) or kidney or liver disease.
• tell your doctor if you are pregnant, plan to become pregnant, or are breastfeeding. If you become pregnant while taking clindamycin, call your doctor.
• if you are having surgery, including dental surgery, tell the doctor or dentist that you are taking clindamycin.

Unless your doctor tells you otherwise, continue your normal diet.

Take the missed dose as soon as you remember it. However, if it is almost time for the next dose, skip the missed dose and continue your regular dosing schedule. Do not take a double dose to make up for a missed one.

Clindamycin may cause side effects. Tell your doctor if any of these symptoms are severe or do not go away:

• nausea
• vomiting
• unpleasant or metallic taste in the mouth
• joint pain
• pain when swallowing
• heartburn
• white patches in the mouth
• thick, white vaginal discharge
• burning, itching, and swelling of the vagina

Some side effects can be serious. If you experience any of these symptoms or those listed in the IMPORTANT WARNING section, call your doctor immediately or get emergency medical treatment:

• peeling or blistering skin
• rash
• hives
• itching
• difficulty breathing or swallowing
• hoarseness
• swelling of the face, throat, tongue, lips, eyes, hands, feet, ankles, or lower legs
• yellowing of the skin or eyes
• decreased urination

Clindamycin may cause other side effects. Call your doctor if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your doctor may send a report to the Food and Drug Administration’s (FDA) MedWatch Adverse Event Reporting program online (http://www.fda.gov/Safety/MedWatch) or by phone (1-800-332-1088).

Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture (not in the bathroom). Do not refrigerate clindamycin liquid because it may thicken and become hard to pour. Dispose of any unused clindamycin liquid after 2 weeks.

It is important to keep all medication out of sight and reach of children as many containers (such as weekly pill minders and those for eye drops, creams, patches, and inhalers) are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location – one that is up and away and out of their sight and reach. http://www.upandaway.org

Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website (http://goo.gl/c4Rm4p) for more information if you do not have access to a take-back program.

In case of overdose, call the poison control helpline at 1-800-222-1222. Information is also available online at https://www.poisonhelp.org/help. If the victim has collapsed, had a seizure, has trouble breathing, or can’t be awakened, immediately call emergency services at 911.

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Last Revised – 05/15/2018

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Clindamycin – StatPearls – NCBI Bookshelf

Continuing Education Activity

Clindamycin is a medication used for the treatment of numerous infections, including but not limited to septicemia, intra-abdominal infections, lower respiratory infections, gynecological infections, bone and joint infections, and skin and skin structure infections. Clindamycin is also used in the treatment of streptococcal pharyngitis, acne vulgaris, bacterial vaginosis, and severe pelvic inflammatory disease. This activity reviews the indications, action, and contraindications for clindamycin as a valuable agent in managing various infections.

Objectives:

• Identify the indications for clindamycin use.

• Describe the various routes of administration of clindamycin.

• Review the contraindications of clindamycin usage.

• Summarize the importance of antibiotic stewardship and how it affects antimicrobial selection as it pertains to improving care coordination among the interprofessional team when initiating antibiotic therapy with clindamycin.

Access free multiple choice questions on this topic.

Indications

Clindamycin is FDA-approved to treat septicemia, intra-abdominal infections, lower respiratory infections, gynecological infections, bone, and joint infections, and skin and skin structure infections. Clindamycin is also used to treat streptococcal pharyngitis, acne vulgaris, bacterial vaginosis, and severe pelvic inflammatory disease. Although not a first-line treatment, The Infectious Diseases Society of America (IDSA) has published guidelines for using intravenous (IV) clindamycin for the inpatient treatment of community-acquired pneumonia and aspiration pneumonia. Dentists will use clindamycin for prophylactic coverage against endocarditis. Anesthesiologists and surgeons will often administer clindamycin per The American Society of Health-System Pharmacists (ASHP) and IDSA guidelines as prophylaxis in the operating room. Gynecologists use clindamycin in combination with gentamycin +/- ampicillin for covering their patients with endometritis. It can also be an alternative to metronidazole for treating Gardnerella vaginosis, which presents with gray, fishy vaginal odor with clue cells on wet prep.[1][2][1]

Additionally, clindamycin can be used to treat babesiosis, anthrax, and malaria. Clindamycin is also commonly used in skin and soft tissue infections that are uncomplicated. Clindamycin is used in soft tissue infections due to its efficacy against MRSA. Clindamycin is also a choice for outpatient treatment because of its cost, availability, and effectiveness against methicillin-resistant Staphylococcus aureus.[3]

Mechanism of Action

Clindamycin prevents peptide bond formation, thereby inhibiting protein synthesis by reversibly binding to 50S ribosomal subunits. Depending on the organism, infection site, and drug concentration, clindamycin may be a bacteriostatic or bactericidal antibiotic. When taken orally, absorption cannot occur until clindamycin palmitate becomes hydrolyzed in the gastrointestinal (GI) tract. It then distributes across the body in tissue and other regions containing blood. Clindamycin cannot efficiently penetrate meninges very well and is therefore not an antibiotic of choice for infections of the cerebrospinal fluid (CSF). As it travels through the bloodstream, clindamycin is primarily bound to protein. Clindamycin is primarily metabolized in the liver by CYP 3A4 (major) and CYP 3A5, which oxidizes the antibiotic into clindamycin sulfoxide (primary metabolite) and N-desmethyl clindamycin, respectively. When administered orally, the antibiotic peaks within 60 minutes. When given intramuscularly (IM), the drug achieves peak concentrations in 1 to 3 hours. The half-life of clindamycin is approximately 3 hours in adults and approximately 2.5 hours in children. At this point, it is excreted in the urine (major) and feces (minor) as active and inactive metabolites.[4][5][6][7]

Administration

Clindamycin can be administered into the body by multiple routes. It is available topically as a foam, gel, lotion, or solution for the treatment of acne vulgaris. A thin film needs to be applied twice a day. For the treatment of bacterial vaginosis, it is available in cream and suppository for intravaginal administration. Systemic infections can be treated orally with a capsule (75 mg, 150 mg, 300 mg) or in solution (75 mg/5 mL). It is also available as an intramuscular injection (9 g/60 mL, 300 mg/2 mL, 600 mg/4 mL, 900 mg/6 mL). Intravenous formulations are available as follows: clindamycin phosphate (300 mg/2 mL, 600 mg/4 mL, 900 mg/6 mL), and clindamycin phosphate in D5W or NaCl (300 mg/50 mL, 600 mg/50 mL, 900 mg/50 mL).

To minimize esophageal ulceration, administer orally with a full glass of water. The absorption of clindamycin flavored granules is not adversely affected by co-administration with food. When administered intramuscularly, the sites must require rotation with no dose exceeding 600 mg in a single injection. Clindamycin is administered by intravenous (IV) intermittent infusion over at least 10 to 60 minutes at a maximum rate of 30 mg/minutes. The final concentration of the IV solution should not exceed 18 mg/mL. Pediatric dosing for neonates is 15 to 20 mg/kg per day, given IM/IV divided over 6 to 8 hours. Infants, children, and adolescents are treated with 8 to 40 mg/kg per day orally divided over 3 to 4 doses. For IM/IV administration, 20 to 40 mg/kg per day can be given over 3 to 4 doses.[8]

Adverse Effects

The adverse effects of clindamycin vary based on how its mode of administration. The most common side effects experienced with topical use include pruritis, xeroderma, erythema, burning, exfoliation, or oily skin. The most common side effects of intravaginal administration are vaginal candidiasis, pruritis, vulvovaginal disease, and vulvovaginitis. The primary adverse effects of clindamycin with systemic administration are pseudomembranous colitis, nausea, vomiting, and diarrhea, resulting from clindamycin destroying much of the GI tract’s healthy flora. Clostridium difficile is allowed to overgrow in this environment. Toxins A and B, which are produced by C. difficile, cause Clostridium difficile-associated diarrhea (CDAD). If suspected, a stool antigen test should is in order. Severe cases that result from hypertoxic-producing strains occur in an increase in morbidity and mortality, which may require colectomy for definitive treatment. Other adverse effects include thrombophlebitis or metallic taste with IV administration, azotemia, agranulocytosis, anaphylactic shock, abscess formation, induration, or irritation at the site of IM injection.[9][10][11][12]

Contraindications

Clindamycin is contraindicated in patients with a history of pseudomembranous colitis or ulcerative colitis. Care is also necessary for antibiotic use as bacterial and fungal superinfections may occur. It is also contraindicated in patients with hypersensitivity to clindamycin, lincomycin, or any of their components. Special care must also be taken in patients with atopic dermatitis as colonization is more prevalent in this patient population. The pathogenicity of skin infections is higher in this population; this is important for future infections as antibiotic resistance is a problematic complication. [13]

Monitoring

Monitor for changes in bowel frequency, colitis, and resolution of symptoms.[13] Monitor liver function tests periodically in patients with severe liver disease. In prolonged therapy, monitor complete blood cell count (CBC), liver, and renal function. It is vital to manage fluid and electrolyte replacement in this patient population adequately.

Toxicity

The most common adverse effects that occur with clindamycin toxicity are GI or allergic. There is no antidote for clindamycin toxicity, and the adverse effects will resolve with dose adjustment or discontinuation of the antibiotic. The treatment is supportive. The recommendation is to measure serum electrolytes in patients with vomiting and/or diarrhea. Vital signs need to be monitored along with CBC with differential, platelets, LFTs, and renal function in symptomatic patients. It is also essential to get an ECG and maintain continuous cardiac monitoring as cardiac arrhythmias, although rare, may occur. Evaluation for C. difficile toxin will be needed when colitis is suspected.

It is important to look out for severe allergic reactions like DRESS or Steven-Johnson syndrome. In these situations, immediate discontinuation of the antibiotic is imperative, along with supportive management that includes: IV fluids, oxygen therapy, diphenhydramine, and corticosteroids. In cases of severe hypotension, it may be necessary to administer fluid boluses and start vasopressors. Airway management is likely not needed, but severe anaphylactic reactions will require airway management with endotracheal intubation. Rarely clindamycin toxicity will lead to cardiac arrhythmias and cardiac arrest, in which case advanced cardiovascular life support will be required.[14]

Enhancing Healthcare Team Outcomes

Clindamycin is a widely prescribed drug by many healthcare professionals, including the nurse practitioner, primary care provider, internist, infectious disease consultant, and emergency department physician. All healthcare workers who prescribe this agent should monitor the patient for changes in bowel frequency, colitis, and resolution of symptoms. Clindamycin is well known to cause Clostridium colitis, which extends hospital stays and increases healthcare costs. If diarrhea develops, it is essential to manage fluid and electrolyte replacement in this patient population adequately. Healthcare workers should limit the duration of clindamycin therapy and abstain from the empirical prescribing of this agent.

Management of clindamycin therapy will benefit from the efforts of an interprofessional healthcare team that includes the prescribing/order clinician (including mid-level practitioners), nursing staff, and pharmacists, all coordinating activity and engaging in open communication about the case and monitoring of the drug to optimize patient outcomes. [Level 5]

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References

1.

Al Khaja KAJ, Sequeira RP. Drug treatment and prevention of malaria in pregnancy: a critical review of the guidelines. Malar J. 2021 Jan 23;20(1):62. [PMC free article: PMC7825227] [PubMed: 33485330]

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Mohammed L, Javed M, Althwanay A, Ahsan F, Oliveri F, Goud HK, Mehkari Z, Rutkofsky IH. Live Bacteria Supplementation as Probiotic for Managing Fishy, Odorous Vaginal Discharge Disease of Bacterial Vaginosis: An Alternative Treatment Option? Cureus. 2020 Dec 29;12(12):e12362. [PMC free article: PMC7842843] [PubMed: 33527045]

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Nagarkoti D, Prajapati K, Sharma AN, Gyawali A, Manandhar S. Distribution of Macrolide-Lincosamide-Streptogramin B Antibiotics Resistance Genes in Clinical Isolates of Staphylococci. J Nepal Health Res Counc. 2021 Jan 21;18(4):734-740. [PubMed: 33510520]

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Nodzo SR, Boyle KK, Frisch NB. Nationwide Organism Susceptibility Patterns to Common Preoperative Prophylactic Antibiotics: What Are We Covering? J Arthroplasty. 2019 Jul;34(7S):S302-S306. [PubMed: 30745218]

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Park KH, Kim DY, Lee YM, Lee MS, Kang KC, Lee JH, Park SY, Moon C, Chong YP, Kim SH, Lee SO, Choi SH, Kim YS, Woo JH, Ryu BH, Bae IG, Cho OH. Selection of an appropriate empiric antibiotic regimen in hematogenous vertebral osteomyelitis. PLoS One. 2019;14(2):e0211888. [PMC free article: PMC6368303] [PubMed: 30735536]

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Struzycka I, Mazinska B, Bachanek T, Boltacz-Rzepkowska E, Drozdzik A, Kaczmarek U, Kochanska B, Mielczarek A, Pytko-Polonczyk J, Surdacka A, Tanasiewicz M, Waszkiel D, Hryniewicz W. Knowledge of antibiotics and antimicrobial resistance amongst final year dental students of Polish medical schools-A cross-sectional study. Eur J Dent Educ. 2019 Aug;23(3):295-303. [PubMed: 30729642]

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Ma D, Chen Y, Chen T. Vaginal microbiota transplantation for the treatment of bacterial vaginosis: a conceptual analysis. FEMS Microbiol Lett. 2019 Feb 01;366(4) [PubMed: 30715301]

8.

Greenberg RG, Wu H, Maharaj A, Cohen-Wolkowiez M, Tomashek KM, Osborn BL, Clark RH, Walter EB. A Pharmacoepidemiologic Study of the Safety and Effectiveness of Clindamycin in Infants. Pediatr Infect Dis J. 2020 Mar;39(3):204-210. [PMC free article: PMC7137351] [PubMed: 31725114]

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García-Solache M, Rice LB. The Enterococcus: a Model of Adaptability to Its Environment. Clin Microbiol Rev. 2019 Mar 20;32(2) [PMC free article: PMC6431128] [PubMed: 30700430]

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Xu H, Li H. Acne, the Skin Microbiome, and Antibiotic Treatment. Am J Clin Dermatol. 2019 Jun;20(3):335-344. [PMC free article: PMC6534434] [PubMed: 30632097]

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Reiter S, Kellogg Spadt S. Bacterial vaginosis: a primer for clinicians. Postgrad Med. 2019 Jan;131(1):8-18. [PubMed: 30424704]

12.

Savaris RF, Fuhrich DG, Duarte RV, Franik S, Ross JDC. Antibiotic therapy for pelvic inflammatory disease: an abridged version of a Cochrane systematic review and meta-analysis of randomised controlled trials. Sex Transm Infect. 2019 Feb;95(1):21-27. [PMC free article: PMC6580736] [PubMed: 30341232]

13.

Schröder O, Gerhard R, Stein J. [Antibiotic-associated diarrhea]. Z Gastroenterol. 2006 Feb;44(2):193-204. [PubMed: 16456762]

14.

Paradis N, Marois L, Paradis L, Graham F, Bégin P, Des Roches A. Anaphylaxis to clindamycin following cutaneous exposure. Allergy Asthma Clin Immunol. 2020;16:51. [PMC free article: PMC7304217] [PubMed: 32577121]

Disclosure: Patrick Murphy declares no relevant financial relationships with ineligible companies.

Disclosure: Karlyle Bistas declares no relevant financial relationships with ineligible companies.

Disclosure: Jacqueline Le declares no relevant financial relationships with ineligible companies.

Use of clindamycin in the treatment of children with cancer

Antibiotic

Brand names:

Cleocin®, Clindacin®, Clindagel®, Clindesse®, Evoclin®

Often used for:

Infections

Clindamycin is an antibiotic used to prevent and treat infections caused by bacteria. Clindamycin is available in various dosage forms. This medication can also be applied to the skin to treat acne.

During therapy, the patient may need to donate blood to check the content of blood cells and to monitor the functioning of the liver and kidneys.

Oral capsules

Oral liquid form

Intramuscular injection in liquid form

Intravenous administration (drip) in liquid form

Skin application (topical application)

• Nausea and vomiting
• Diarrhea
• Bad or metallic taste in the mouth
• Heartburn
• Abdominal pain
• Joint pain
• Skin rash, itching, redness or irritation
• Itching, burning in the vagina or discharge from the vagina
• Low blood pressure (when administered intravenously)
• Changes in liver function

Symptoms of an allergic reaction may occur: rash, hives, itching, chills, fever, headache, muscle pain, shortness of breath, cough, tightness in the throat, swelling of the face or neck. The most common side effects are highlighted in bold, but others are not excluded. Report all possible side effects to your doctor or pharmacist.

Be sure to discuss these and other recommendations with your doctor or pharmacist.

• Tell your doctor if you have severe diarrhea while taking this drug.
• Therapy with clindamycin may reduce the effectiveness of birth control pills and other hormonal methods of contraception. Sexually active patients should also use other methods of contraception, such as condoms.
• Pregnant or breastfeeding patients should notify their physician.
• The course of taking the drug must be completed completely in accordance with the recommendations of the attending physician or pharmacist.

Home use of clindamycin:

• Liquid form: shake well before use, measure with measuring device provided. Store at room temperature. It is forbidden to store the drug in the refrigerator. After opening, store no more than 14 days.
• Capsules: recommended to take with a full glass of water. This will help to avoid heartburn and irritation of the walls of the throat. If the drug causes stomach upset, it must be taken with food. Store at room temperature.
• Skin applied lotion, gel, liquid or foam: Use strictly as directed by your healthcare professional or pharmacist. Apply to clean, dry skin. Avoid contact with eyes, nose or mouth. Possible bleaching of hair or dyed fabrics. Wash your hands before and after applying the drug. Store at room temperature.
• Take your dose as soon as possible if you miss it. Do not do this only if there is little time left until the next appointment. In no case do not double the dose at the next dose!
• Do not use an expired drug.
• Follow instructions for safe handling, storage and disposal.

Learn more about clindamycin

Clindamycin in external antibiotic therapy of acne vulgaris

Acne vulgaris (acne) is quite common – in 60-80% of people aged 12 to 24 years, while ¹ / ₃ of them require treatment [1]. Of course, acne and its consequences adversely affect the psyche of patients. Manifestations of acne in visible areas of the skin significantly reduce the self-esteem of patients, give rise to anxiety and depression. The idea of ​​external unattractiveness leads to dysmorphophobia – a painful state of the psyche, accompanied by a fear of imaginary external deformity. There is isolation of patients, irritability, difficulties in adapting in the social and intimate spheres of life. In this regard, the treatment of acne is an extremely urgent medical and social problem.

Appointment of adequate effective therapy is largely due to its influence on the pathogenetic mechanisms of the development of the disease. According to modern concepts, the occurrence of acne occurs against the background of several interrelated pathogenetic mechanisms. The most significant of them are the violation of keratinization processes, pathological follicular hyperkeratosis, excess production of sebaceous secretion, accompanied by lipid imbalance, reproduction of Propionibacterium acnes [2]. In addition, one of the predisposing factors in the development of acne vulgaris is considered to be an increase in the sensitivity of the cells of the sebaceous hair follicles to androgens.

In the clinical picture of the disease, the predominant symptom is an inflammatory reaction. As is known, in the area of ​​hair follicles there are various saprophytic microorganisms – fungi of the genus Malassezia, Staphylococcus epidermidis and Propionibacterium acnes [3]. The latter play the most important role in the development of inflammation. P. acnes (or Acne Corynebacterium) are gram-positive non-motile lipophilic rods and facultative anaerobes. Blockage of the mouth of the hair follicle and the accumulation of sebum inside it creates the preconditions for the reproduction of these microorganisms inside the hair follicle.

Constant reproduction of P. acnes leads to an increase in the activity of metabolic processes, resulting in the release of various chemicals – inflammation mediators. These substances include lipases P. acnes that break down sebum triglycerides into free fatty acids, which also irritate the epithelium of the walls of the hair follicle. Proteolytic enzymes P. acnes also have a damaging effect on the epithelium.

According to our studies [4], the qualitative composition of the microflora in pustular elements in patients with acne vulgaris was very diverse. So, in the study of eruptive elements in 40 patients suffering from acne, P. acnes was identified in 31 (77.5%) patients; .0%), greening streptococcus – in 2 (5.0%), non-fermenting gram-negative rods – in 3 (7.5%), yeast-like fungi – in 6 (15.0%). At the same time, the results of the studies showed that the species composition of the microflora largely correlated with the features of the clinical course of acne (see table).

As can be seen from the table, with papulopustular and indurative forms of acne, the species composition of the flora was limited to 3-4 microbial agents, while with abscessing and conglobate their number reached 8. The predominant pathogen in all forms was P. acnes , which confirms its important pathogenetic role in the development of the disease.

The presented data are a strong reason for the expediency of using antibacterial agents in the complex and monotherapy of acne. At the same time, one important circumstance should be noted – the possibility of developing resistance of the bacterial flora of acne to antibiotics. Until the end of the 70s P. acnes were susceptible to all topical antimicrobials. Currently, the number of resistant strains is increasing, but it remains unclear whether this resistance is the result of long-term general antimicrobial therapy or topical treatment. Thus, 35-40% of propionibacteria strains are resistant to one or more antibiotics, 8% of strains are resistant to 3 or more antibiotics. Currently, 26.5% of strains P. acnes are resistant to erythromycin, 13% – to tetracycline and doxycycline. No strains resistant to minocycline have been reported; few strains resistant to clindamycin.

Clindovit (1% clindamycin phosphate gel ) is a topical antibiotic for patients with moderate acne who have not responded to other topical treatments. When applied to the skin, Clindamycin phosphate is hydrolyzed in the excretory ducts of the sebaceous glands, turning into clindamycin , which is the active substance.

The mechanism of action of Clindamycin is to inhibit the synthesis of bacterial proteins, which leads to a decrease in the amount of P. acnes and has an indirect anti-inflammatory effect. In addition, Clindamycin has the ability to inhibit the chemotaxis of polymorphonuclear leukocytes.

It should be noted that P. acnes produce a lipase that breaks down sebum triglycerides, thus promoting the formation of free fatty acids, which in turn are both pro-inflammatory factors and comedogenic factors. Clindamycin at the same time inhibits induced P. acnes extracellular production of lipase, thereby providing an anti-comedogenic effect.

Thus, as part of acne therapy , clindamycin has antibacterial, anti-inflammatory and anti-comedogenic effects.

The effectiveness of the drug in the treatment of acne has been confirmed in numerous studies. Thus, D. Kuhlman and J. Callen [5] convincingly showed the effectiveness of 1% Clindamycin phosphate in a randomized, double-blind comparative study in the treatment of moderately severe acne in 46 patients for 12 weeks.

According to A. Katsambas [6], topical Clindamycin is not only effective, but also an alternative to oral tetracycline in the treatment of moderate acne.

As Combination Therapy Clindamycin can be combined with topical benzoyl peroxide or tretinoin, but other topical or systemic antibiotics should not be coadministered. Combination with 5% benzoyl peroxide reduces the risk of microflora resistance when used Clindamycin .

According to A.Yu. Sergeeva et al. [7], external combined treatment of mild to moderate acne with a combination of 0. 1% adapalene cream and 1% clindamycin gel with a frequency of 1 time per day with a transition to maintenance therapy with adapalene no later than the 8th week of treatment seems to be effective.

In the Russian Federation, a new topical antibacterial drug Klindovit 1% gel has recently appeared in the arsenal of dermatologists. The active ingredient of the gel is clindamycin , and the base contains allantoin, a dermatoprotector with regenerating and anti-inflammatory effects, and Vital ET, an emollient with anti-erythema action. The drug meets the basic requirements for antibacterial agents for the treatment of acne: it quickly accumulates in the comedones of acne patients, and its average concentration in their contents after application significantly exceeds the minimum inhibitory concentration for all strains of P. acnes (0.4 μg / ml). The treatment regimen for acne with Klindovit is simple: the drug is applied daily with a thin layer on the affected skin 2-3 times a day.