Clindamycin
antibiotic
Third-party optionBy the Layer Nutrition editorial team
What this medicine is for
Sur le plan pharmacologique, Clindamycine se rattache à la catégorie « antibiotique ». Les antibiotiques traitent les infections dues à des bactéries. Ils se prennent en cure, sur une durée définie, jusqu'au bout de la prescription.
Pour Clindamycine en pratique : Traite une infection bactérienne. Il s'emploie plutôt de façon ponctuelle ou en cure courte, le temps de passer un épisode.
Under which brands it is found
En France, on recense environ 8 présentations remboursables contenant Clindamycine. Elle se présente sous divers noms commerciaux et sous forme de génériques.
- Clindamycine Kabi
- Clindamycine Kalceks
- Clindamycine Substipharm
- Clindamycine Viatris
- Dalacine
- Encallik
- Zanea
- Zindacline
Generics and the original brand are equivalent for the active substance; only the appearance, the name or the excipients may differ.
On the plate: gut flora and vitamin K
Clindamycin acts on bacteria, including some of those that populate the gut. Yet these bacteria produce vitamin K2, and the flora contributes to digestive balance. Food helps support this flora and cover vitamin K intake.
Vitamin K1 is concentrated in leafy green vegetables, where it takes part in photosynthesis: spinach, kale, broccoli. Adding them to your meals provides this plant form of the vitamin, alongside your treatment.
Plain yoghurt with live cultures supplies lactic acid bacteria and is easily added to a meal or a snack. Varying green vegetables and fermented foods keeps the plate favourable to the flora during and after the antibiotic.
How clindamycin works
Clindamycin belongs to the lincosamide family. It binds reversibly to the 50S subunit of the bacterial ribosome, specifically at the 23S ribosomal RNA. There it prevents the formation of the peptide bond, the step that assembles amino acids into proteins. Deprived of this machinery, the bacterium no longer produces its proteins and stops growing.
Its action is mainly bacteriostatic: it blocks the multiplication of bacteria rather than destroying them, although high concentrations can be slowly bactericidal against susceptible strains. This binding site is the same as that of macrolides such as erythromycin and of streptogramin B. This shared target explains so-called MLSB cross-resistance, where a bacterium resistant to one of these antibiotics may also be resistant to clindamycin.
Why clindamycin is prescribed
Clindamycin treats serious bacterial infections caused by susceptible organisms: staphylococci, whether or not they produce penicillinase, streptococci, pneumococci and anaerobic bacteria. It is described in bone and joint, intra-abdominal and gynaecological infections, in lower respiratory infections, and in skin and soft tissue infections. The choice rests with the physician, according to the organism involved.
Taken by mouth, clindamycin is absorbed rapidly and almost completely, with a bioavailability of about 90 per cent and a serum peak reached around 60 minutes. Its plasma half-life is roughly 2 to 3 hours in adults. This half-life can lengthen in the very preterm infant and in severe renal impairment, two situations in which elimination of the drug is slower.
How to take it day to day
Oral clindamycin is most often taken three to four times a day, at regular intervals through the day. The capsule is swallowed whole, without opening or crushing it, with a large glass of water of about 180 to 240 mL. It is best taken at least 30 minutes before lying down: a capsule that lingers in the oesophagus can irritate it and even cause an ulcer there.
Taking food does not appreciably change the amount of drug absorbed: a meal may only slow the rate of absorption. Clindamycin is therefore taken with or without food, and the patient keeps their usual diet unless the physician advises otherwise. The antibiotic is continued until the end point set by the physician, without stopping it on one's own initiative even when symptoms improve.
The effects to know about
The most common side effects are digestive. Diarrhoea and abdominal pain occur in at least 1 person in 100 and fewer than 1 in 10. Nausea and vomiting are uncommon, between 1 case in 1,000 and 1 in 100. These disturbances often accompany the passage of the antibiotic through the digestive tract.
More rarely, between 1 case in 10,000 and 1 in 1,000, oesophagitis or an oesophageal ulcer appears. A maculopapular rash or urticaria may also occur. The risk of oesophageal injury justifies the instruction to swallow the capsule with plenty of water and to remain sitting or standing for a while after taking it. A rash that spreads or comes with other signs should lead to a consultation.
Gut flora and colitis
Like any antibiotic, clindamycin does not reach only the targeted bacterium: it also affects part of the flora of the large intestine. This imbalance can let dangerous bacteria proliferate, in particular Clostridioides difficile, and cause diarrhoea that can go as far as life-threatening colitis. This colitis can occur during treatment, but also up to about two months after it is stopped.
Clindamycin is among the antibiotics most associated with this risk, alongside penicillins, cephalosporins and fluoroquinolones. Copious, watery or bloody diarrhoea, during or after treatment, warrants prompt medical advice. The gut flora renders other services to the body: its bacteria produce vitamin K2, one of the two forms of vitamin K, with vitamin K1 coming mainly from leafy green vegetables.
Interactions and monitoring
Clindamycin is metabolised mainly by the enzyme CYP3A4, and to a lesser extent by CYP3A5. Drugs that inhibit these enzymes raise its concentrations in the blood, while inducers such as rifampicin lower them. It also has neuromuscular blocking properties that can strengthen the action of curare-type agents, which calls for caution and monitoring when they are combined.
In patients treated at the same time with a vitamin K antagonist, such as warfarin, acenocoumarol or fluindione, increases in coagulation tests (PT and INR) and bleeding have been reported. These tests must therefore be monitored frequently during the combination. Medical follow-up accompanies the treatment from beginning to end, from the choice of dose to vigilance over digestive signs.
Sources
Related molecules
To explore in the « Anti-infectives » family and its neighbours.
See the whole « Anti-infectives » family · Back to the atlas
Supplements to consider
Beyond the plate, a single isolated nutrient can be worth discussing, to confirm with your doctor or pharmacist. Here is which one and in which form.
Probiotics
Probiotics are live micro-organisms, mainly lactobacilli and bifidobacteria. The CFU count and the number of strains are among the selection criteria; gastro-resistant capsules protect the bacteria from stomach acidity.
Preferred form gastro-resistant capsules, several strains, CFU count stated
Frequently asked questions
What is clindamycin used for and what family does it belong to?
Clindamycin is an antibiotic in the lincosamide family, prescribed for certain bacterial infections, particularly dental, skin or bone infections. The precise indications and duration are set out in your medication's package leaflet and by the decision of your doctor or pharmacist.
What are the side effects of clindamycin?
The package leaflet frequently lists digestive problems such as diarrhea, nausea and abdominal pain, as well as skin reactions. For the complete list and what to do, refer to your medication's package leaflet and talk to your doctor or pharmacist.
Why can clindamycin cause diarrhea?
Like other antibiotics, clindamycin can disrupt the balance of gut bacteria, an effect noted in the package leaflet. Severe or persistent diarrhea, during or after treatment, should prompt you to contact your doctor or pharmacist promptly, without delay.
Can you drink alcohol while taking clindamycin?
This depends on your individual situation and on the information in your medication's package leaflet. For advice tailored to your treatment, speak to your doctor or pharmacist.
Clindamycin and pregnancy or breastfeeding: what precautions apply?
Use during pregnancy or breastfeeding is covered by specific information in the package leaflet. Tell your doctor or pharmacist about any pregnancy, plans to become pregnant, or breastfeeding before taking it.
Clindamycin and gut flora: should you consider probiotics?
Antibiotics such as clindamycin alter the balance of the gut flora, and studies link taking probiotics to better digestive comfort during antibiotic treatment. The active ingredient to consider falls under probiotics, in the form of documented strains such as Saccharomyces boulardii or Lactobacillus rhamnosus. Ask your doctor or pharmacist for advice, in particular on the timing of the dose relative to the antibiotic.
Ces réponses portent sur le volet nutritionnel. Pour toute question sur votre médicament, la notice et votre médecin ou pharmacien font foi.