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chapter 18 Lincosamides 139
these isolates. A significant proportion of
organisms that are reported as clindamycinsusceptible
but erythromycin-resistant may
harbor a gene for resistance that may lead
to high-level clindamycin resistance during
therapy. Erythromycin-resistant, clindamycinsusceptible
strains should be screened with
a D-test (the microbiology lab will know what
you mean) before using clindamycin. If the
D-test is positive, then inducible clindamycin
resistance is present and clindamycin should
not be used.
• Clindamycin’s inhibition of protein synthesis
and activity against organisms in stationaryphase
growth has been utilized in the treatment
of necrotizing fasciitis and other toxin-mediated
diseases. Consider the addition of clindamycin
to beta-lactam–based therapy when treating
these types of infections.
• Clindamycin is nearly 100% orally bioavailable,
but oral doses are generally lower than
IV doses in order to improve GI tolerance.
What It’s Good For
Treatment of skin and soft-tissue infections,
infections of the oral cavity, and anaerobic intraabdominal
infections. It is used topically in the
treatment of acne. Clindamycin is a secondline
agent (in combination with primaquine) in
the treatment of P. jirovecii pneumonia. It is also
used to treat malaria in combination with other
drugs, to treat bacterial vaginosis, and in the prophylaxis
of bacterial endocarditis.