Editing Clindamycin (section)

== Medical uses ==
Clindamycin is used primarily to treat [[anaerobic infection]]s caused by susceptible [[anaerobic organism|anaerobic]] [[bacteria]], including dental infections,<ref>{{cite journal |vauthors=Brook I, Lewis MA, Sándor GK, Jeffcoat M, Samaranayake LP, Vera Rojas J |title=Clindamycin in dentistry: more than just effective prophylaxis for endocarditis? |journal=Oral Surg Oral Med Oral Pathol Oral Radiol Endod |volume=100 |issue=5 |pages=550–8 |date=November 2005 |pmid=16243239 |doi=10.1016/j.tripleo.2005.02.086 }}</ref> and infections of the [[respiratory tract]], skin, and [[soft tissue]], and [[peritonitis]].<ref name=RxList1>{{cite web |url = http://www.rxlist.com/cgi/generic/clindamyciniv_ids.htm |title = Cleocin I.V. Indications & Dosage |year = 2007 |access-date = 1 December 2007 |publisher = RxList.com |url-status = dead |archive-url = https://web.archive.org/web/20071127021156/http://www.rxlist.com/cgi/generic/clindamyciniv_ids.htm |archive-date = 27 November 2007 }}</ref> In people with [[hypersensitivity]] to [[penicillin]]s, clindamycin may be used to treat infections caused by susceptible [[aerobic organism|aerobic]] bacteria, as well. It is also used to treat bone and joint infections, particularly those caused by ''[[Staphylococcus aureus]]''.<ref name=RxList1/><ref name="Darley">{{cite journal |vauthors=Darley ES, MacGowan AP |title=Antibiotic treatment of gram-positive bone and joint infections |journal=J Antimicrob Chemother |volume=53 |issue=6 |pages=928–35 |year=2004 |pmid=15117932 |doi=10.1093/jac/dkh191 |doi-access=free | title-link=doi }}</ref> [[Topical administration|Topical]] application of clindamycin phosphate can be used to treat mild to moderate acne.<ref name="Feldman">{{cite journal |vauthors=Feldman S, Careccia RE, Barham KL, Hancox J |title=Diagnosis and treatment of acne |journal=Am Fam Physician |volume=69 |issue=9 |pages=2123–30 |date=May 2004 |pmid=15152959 |url=https://www.aafp.org/afp/2004/0501/p2123.html |url-status=live |archive-url=https://web.archive.org/web/20110727113218/http://www.aafp.org/afp/2004/0501/p2123.pdf |archive-date=27 July 2011 }}</ref><ref name="pmid31613567">{{cite journal |vauthors=Oge' LK, Broussard A, Marshall MD |title=Acne Vulgaris: Diagnosis and Treatment |journal=Am Fam Physician |volume=100 |issue=8 |pages=475–84 |date=October 2019 |pmid=31613567 |doi= |url=https://www.aafp.org/afp/2019/1015/p475.html }}</ref>

=== Acne ===
[[File:Clindamycin**.jpg|thumb|Clindamycin phosphate topical solution]]

For the treatment of acne, in the long term, the combined use of topical clindamycin and [[benzoyl peroxide]] was similar to [[salicylic acid]] plus benzoyl peroxide.<ref name="pmid31613567" /><ref name=Sei2010/> Topical clindamycin plus topical benzoyl peroxide is more effective than topical clindamycin alone.<ref name="pmid31613567" /><ref name=Sei2010>{{cite journal |vauthors=Seidler EM, Kimball AB |title=Meta-analysis comparing efficacy of benzoyl peroxide, clindamycin, benzoyl peroxide with salicylic acid, and combination benzoyl peroxide/clindamycin in acne |journal=J. Am. Acad. Dermatol. |volume=63 |issue=1 |pages=52–62 |date=July 2010 |pmid=20488582 |doi=10.1016/j.jaad.2009.07.052 }}</ref>

=== 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]]) [[genus|genera]], but not [[Enterococcus|enterococci]].<ref name="Merck" />
* Anaerobic, [[Gram-negative]] [[Bacteria Morphology|rod-shaped bacteria]], including some ''[[Bacteroides]]'', ''[[Fusobacterium]]'', and ''[[Prevotella]]'', although resistance is increasing in ''[[Bacteroides fragilis]]''.<ref>{{cite journal | vauthors = Di Bella S, Antonello RM, Sanson G, Maraolo AE, Giacobbe DR, Sepulcri C, Ambretti S, Aschbacher R, Bartolini L, Bernardo M, Bielli A, Busetti M, Carcione D, Camarlinghi G, Carretto E, Cassetti T, Chilleri C, De Rosa FG, Dodaro S, Gargiulo R, Greco F, Knezevich A, Intra J, Lupia T, Concialdi E, Bianco G, Luzzaro F, Mauri C, Morroni G, Mosca A, Pagani E, Parisio EM, Ucciferri C, Vismara C, Luzzati R, Principe L | title = Anaerobic bloodstream infections in Italy (ITANAEROBY): A 5-year retrospective nationwide survey | journal = Anaerobe | volume = 75 | pages = 102583 | date = June 2022 | pmid = 35568274 | doi = 10.1016/j.anaerobe.2022.102583 | hdl = 11368/3020691 | s2cid = 248736289 | hdl-access = free }}</ref>

Most aerobic Gram-negative bacteria (such as ''[[Pseudomonas]]'', ''[[Legionella]]'', ''[[Haemophilus influenzae]]'' and ''[[Moraxella]]'') are resistant to clindamycin,<ref name="Merck" /><ref name="Bell">{{cite web|url=http://www.pediatricsupersite.com/view.aspx?rid=35957 |title=Clindamycin: new look at an old drug |vauthors=Bell EA |date=January 2005 |access-date=1 December 2007 |work=Infectious Diseases in Children |url-status=dead |archive-url=https://web.archive.org/web/20111008040952/http://www.pediatricsupersite.com/view.aspx?rid=35957 |archive-date=8 October 2011 }}</ref> as are the [[facultative anaerobic organism|facultative anaerobic]] [[Enterobacteriaceae]].<ref name="Gold">{{cite book | vauthors = Gold HS, Moellering RC |chapter=Macrolides and clindamycin |chapter-url=https://books.google.com/books?id=zvCOpighJggC&pg=PA294 | veditors = Root RE, Waldvogel F, Corey L, Stamm WE |title=Clinical infectious diseases: a practical approach |publisher=Oxford University Press |location=Oxford |year=1999 |pages=291–7 |isbn=978-0-19-508103-9 |archive-url=https://web.archive.org/web/20180513203552/https://books.google.com/books?id=zvCOpighJggC&pg=PA294 |archive-date=13 May 2018 }} {{Retrieved|access-date=19 January 2009}}through [[Google Book Search]].</ref> A notable exception is ''[[Capnocytophaga canimorsus]]'', for which clindamycin is a first-line drug of choice.<ref>{{cite journal |vauthors=Jolivet-Gougeon A, Sixou JL, Tamanai-Shacoori Z, Bonnaure-Mallet M |title=Antimicrobial treatment of ''Capnocytophaga'' infections |journal=Int J Antimicrob Agents |volume=29 |issue=4 |pages=367–73 |date=April 2007 |pmid=17250994 |doi=10.1016/j.ijantimicag.2006.10.005}}</ref>

The following represents [[Minimum inhibitory concentration|MIC]] susceptibility data for a few medically significant pathogens.<ref>{{cite web |url=https://www.toku-e.com/content/product-documents/MIC_Clindamycin%20Phosphate.pdf |title=Clindamycin Phosphate Susceptibility and Minimum Inhibitory Concentration (MIC) Data |date=1 June 2020 |website=toku-e.com}}</ref>

*''Staphylococcus aureus'': 0.016&nbsp;μg/mL – >256&nbsp;μg/mL
*''Streptococcus pneumoniae'': 0.002&nbsp;μg/mL – >256&nbsp;μg/mL
*''Streptococcus pyogenes'': <0.015&nbsp;μg/mL – >64&nbsp;μg/mL

=== D-test ===
[[File:D test.jpg|thumb|upright=1.2|D-test]]

When testing a gram-positive culture for sensitivity to clindamycin, it is common to perform a "D-test" to determine if there is a sub-population of [[bacteria]] present with the [[phenotype]] known as {{not a typo|iMLS<sub>B</sub>}}. This phenotype of bacteria are resistant to the [[macrolide]]-[[lincosamide]]-[[streptogramin B]] group of antibiotics; however, the resistance mechanism is only induced by the presence of 14-membered ring macrolides, such as [[erythromycin]]. During a D-test, bacteria of the {{not a typo|iMLS<sub>B</sub>}} phenotype demonstrate ''in vitro'' erythromycin-induced ''in vitro'' resistance to clindamycin. This is because of the activity of the macrolide-inducible [[plasmid]]-encoded ''erm'' gene.<ref>{{cite journal |vauthors=Leclerq R |title=Mechanisms of Resistance to Macrolides and Lincosamides: Nature of the Resistance Elements and Their Clinical Implications |journal=Clinical Infectious Diseases |date=February 2002 |volume=34 |issue=4 |pages=482–92 |doi=10.1086/324626 |pmid=11797175 | doi-access=free | title-link=doi }}</ref>

To perform a D-test, an [[agar]] plate is inoculated with the bacteria in question and two drug-impregnated disks (one with [[erythromycin]], one with clindamycin) are placed 15–20&nbsp;mm apart on the plate. If the area of inhibition around the clindamycin disk is D-shaped, the test result is positive. Despite the apparent susceptibility to clindamycin in the absence of erythromycin, a positive D-test precludes therapeutic use of clindamycin. This is because the erythromycin-inducible ''erm'' gene is prone to [[mutations]] causing the inducible activity to switch to constitutive (permanently switched on).<ref name="Macrolide-inducible resistance to c">{{cite journal |vauthors=Woods CR |title=Macrolide-inducible resistance to clindamycin and the D-test |journal=The Pediatric Infectious Disease Journal |date=December 2009 |volume=28 |issue=12 |pages=1115–8 |doi=10.1097/INF.0b013e3181c35cc5 |pmid=19935273 | doi-access= | title-link=doi }}</ref> This, in turn, may lead to the therapeutic failure of clindamycin.

If the area of inhibition around the clindamycin disk is circular, the test result is negative and clindamycin can be used.<ref name="Macrolide-inducible resistance to c"/>

=== Malaria ===
Given with [[chloroquine]] or [[quinine]], clindamycin is effective and well tolerated in treating ''[[Plasmodium falciparum]]'' malaria; the latter combination is particularly useful for children, and is the treatment of choice for pregnant women who become infected in areas where [[drug resistance|resistance]] to chloroquine is common.<ref name=Lell2002>{{cite journal |vauthors=Lell B, Kremsner PG |title=Clindamycin as an antimalarial drug: review of clinical trials |journal=[[Antimicrobial Agents and Chemotherapy]] |issn=0066-4804 |volume=46 |issue=8 |pages=2315–20 |year=2002 |pmid=12121898 |doi=10.1128/AAC.46.8.2315-2320.2002 |pmc=127356 | doi-access=free | title-link=doi }}</ref><ref name="Griffith">{{cite journal |vauthors=Griffith KS, Lewis LS, Mali S, Parise ME |title=Treatment of malaria in the United States: a systematic review |journal=JAMA |volume=297 |issue=20 |pages=2264–77 |year=2007 |pmid=17519416 |doi=10.1001/jama.297.20.2264 |doi-access=free | title-link=doi }}</ref> Clindamycin should not be used as an antimalarial by itself, although it appears to be very effective as such, because of its slow action.<ref name=Lell2002 /><ref name="Griffith" /> Patient-derived isolates of ''[[Plasmodium falciparum]]'' from the [[Peruvian Amazonia|Peruvian Amazon]] have been reported to be resistant to clindamycin as evidenced by ''in vitro'' drug susceptibility testing.<ref name="Dharia">{{cite journal |vauthors=Dharia NV, Plouffe D, Bopp SE, González-Páez GE, Lucas C, Salas C, Soberon V, Bursulaya B, Kochel TJ, Bacon DJ, Winzeler EA |title=Genome scanning of Amazonian Plasmodium falciparum shows subtelomeric instability and clindamycin-resistant parasites |journal=[[Genome Research]] |volume=20 |issue=11 |pages=1534–44 |year=2010 |pmid=20829224 |doi=10.1101/gr.105163.110 |pmc=2963817 }}</ref>

=== Other ===
Clindamycin may be useful in skin and [[soft tissue]] infections caused by [[methicillin-resistant Staphylococcus aureus|methicillin-resistant ''Staphylococcus aureus'']] (MRSA).<ref name="Daum2007" /> Many strains of MRSA are still susceptible to clindamycin; however, in the United States spreading from the West Coast eastwards, MRSA is becoming increasingly resistant.{{medical citation needed|date=December 2019}}

While it has been used in [[intraabdominal infections]], such use is generally not recommended due to resistance.<ref name=AHFS2015/>

Clindamycin is used in cases of suspected [[toxic shock syndrome]],<ref name="Annane">{{cite journal |vauthors=Annane D, Clair B, Salomon J |title=Managing toxic shock syndrome with antibiotics |journal=Expert Opin Pharmacother |volume=5 |issue=8 |pages=1701–10 |year=2004 |pmid=15264985 |doi=10.1517/14656566.5.8.1701|s2cid=24494787 }}</ref> 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 [[lysis|breakdown of the cell wall]], and clindamycin, which is a powerful inhibitor of [[toxin]] synthesis. Both ''[[in vitro]]'' and ''[[in vivo]]'' studies have shown clindamycin reduces the production of [[exotoxin]]s by staphylococci;<ref>{{cite journal |vauthors=Coyle EA |title=Targeting bacterial virulence: the role of protein synthesis inhibitors in severe infections. Insights from the Society of Infectious Diseases Pharmacists |journal=Pharmacotherapy |volume=23 |issue=5 |pages=638–42 |date=May 2003 |pmid=12741438 |doi=10.1592/phco.23.5.638.32191 |s2cid=29061418 }}</ref> it may also induce changes in the surface structure of bacteria that make them more sensitive to [[immune system]] attack ([[opsonin|opsonization]] and [[phagocytosis]]).<ref>{{cite journal |vauthors=Gemmell CG, O'Dowd A |title=Regulation of protein A biosynthesis in Staphylococcus aureus by certain antibiotics: its effect on phagocytosis by leukocytes |journal=J Antimicrob Chemother |volume=12 |issue=6 |pages=587–97 |year=1983 |pmid=6662837|doi=10.1093/jac/12.6.587}}</ref><ref>{{cite journal |vauthors=Gemmell CG, Peterson PK, Schmeling D, Kim Y, Mathews J, Wannamaker L, Quie PG |title=Potentiation of opsonization and phagocytosis of Streptococcus pyogenes following growth in the presence of clindamycin |journal=[[Journal of Clinical Investigation|J Clin Invest]] |volume=67 |issue=5 |pages=1249–56 |date=May 1981 |pmid=7014632 |doi=10.1172/JCI110152 |pmc=370690}}</ref>

Clindamycin has been proven to decrease the risk of [[premature birth]]s in women diagnosed with [[bacterial vaginosis]] during early pregnancy to about a third of the risk of untreated women.<ref name="Lamont">{{cite journal |vauthors=Lamont RF |title=Can antibiotics prevent preterm birth—the pro and con debate |journal=BJOG |volume=112 |issue= Suppl 1 |pages=67–73 |year=2005 |pmid=15715599 |doi=10.1111/j.1471-0528.2005.00589.x|s2cid=25572794 }}</ref>

The combination of clindamycin and quinine is the standard treatment for severe [[babesiosis]].<ref name="Homer">{{cite journal |vauthors=Homer MJ, Aguilar-Delfin I, Telford SR, Krause PJ, Persing DH |title=Babesiosis |journal=Clin Microbiol Rev |volume=13 |issue=3 |pages=451–69 |date=July 2000 |pmid=10885987 |doi=10.1128/CMR.13.3.451-469.2000 |pmc=88943 |doi-access=free | title-link=doi }}</ref>

Clindamycin may also be used to treat [[toxoplasmosis]],<ref name="Merck" /><ref name="Pleyer">{{cite journal |vauthors=Pleyer U, Torun N, Liesenfeld O | title = Okuläre Toxoplasmose |trans-title=Ocular toxoplasmosis |language=de |journal=Ophthalmologe |volume=104 |issue=7 |pages=603–16 |year=2007 |pmid=17530262 |doi=10.1007/s00347-007-1535-8| s2cid = 36696180 }}</ref><ref name="Jeddi">{{cite journal |vauthors=Jeddi A, Azaiez A, Bouguila H, Kaoueche M, Malouche S, Daghfous F, Ayed S | title = Intérêt de la clindamycine dans le traitement de la toxoplasmose oculaire |trans-title=Value of clindamycin in the treatment of ocular toxoplasmosis |language=fr |journal=Journal Français d'Ophtalmologie |volume=20 |issue=6 |pages=418–22 |year=1997 |pmid=9296037 | issn = 0181-5512 }}</ref> and, in combination with [[primaquine]], is effective in treating mild to moderate [[Pneumocystis pneumonia|''Pneumocystis jirovecii'' pneumonia]].<ref>{{cite journal |vauthors=Fishman JA |title=Treatment of infection due to Pneumocystis carinii |journal=[[Antimicrobial Agents and Chemotherapy]] |volume=42 |issue=6 |pages=1309–14 |date=June 1998 |pmid=9624465 |doi= 10.1128/AAC.42.6.1309|pmc=105593 | doi-access=free | title-link=doi }}</ref>

Clindamycin, either applied to skin or taken by mouth, may also be used in [[hidradenitis suppurativa]].<ref>{{cite journal|vauthors=Saunte DM, Jemec GB |date=November 2017|title=Hidradenitis Suppurativa: Advances in Diagnosis and Treatment|journal=JAMA|volume=318|issue=20|pages=2019–32|doi=10.1001/jama.2017.16691|pmid=29183082|s2cid=5017318 }}</ref>