Abstract

CLINICAL PHARMACOLOGY OF CLINDAMYCIN IN INFANTS AND CHILDREN

Gian Maria Pacifici*

ABSTRACT

Clindamycin is a tetracycline which binds exclusively to the 50S subunit of bacterial ribosomes and suppresses bacterial protein synthesis. Clindamycin is active against Strains of pneumococci, Streptococcus pyogenes, viridians streptococci, strains of Actinomyces israelii, and Nocardia species. This antibiotic is completely absorbed by the gastrointestinal-tract, widely distributes in many body fluids and tissues, and is cleared from the body by metabolism due to CYP1A2, CYP2C9 and CYP3A4 and the resulting metabolites are N-demethylclindamycin and clindamycin sulfoxide. Clindamycin is administered thrice-daily or 4 times-daily at doses of 5 mg/kg to
infants and 5 to 13 mg/kg to children. Clindamycin elimination half-life is about 6 to 2 hours in infants and about 2 hours in children. Clindamycin is effective and safe and cured meningitis caused by group B Streptococcus, Staphylococcus aureus, and Bacteroides, but it may induce diarrhoea, skin rashes, blood dyscrasias and hepatic dysfunctions. Treatment with this antibiotic has been extensively studied and it should be optimized in order to assure effective dosing-regimens. Clindamycin crosses the placenta, is transferred to the foetus, and migrates into breast-milk but clindamycin does not cause foetal malformations and toxicity in the nursing infant. Prophylaxis with clindamycin has been used before surgery in order to decrease the bacterial load. Some organisms may become resistant to clindamycin and extensive consumption of clindamycin induces bacterial-resistance. The aim of this study is to review the published data on clindamycin dosing, efficacy, safety, tissue concentration, metabolism, pharmacokinetics, adverse-effects, treatment, cerebrospinal fluid, treatment-optimization, drug-interactions, prophylaxis, meningitis, placental-transfer, milk-migration, infants, and children.

Keywords: clindamycin, dosing, pharmacokinetics, treatment, placental-transfer, breast-milk.