Small molecule
PubChem CID 446598
Clindamycin
Cleocin
- Mechanism of action
- Lincosamide, inhibits bacterial protein synthesis via the 50S ribosomal subunit
- In plain language
- Jams the machinery bacteria use to build proteins, stopping them from growing.
- How it works
- Clindamycin inhibits bacterial protein synthesis by binding to the 23S RNA of the 50S subunit of the ribosome, and the label characterizes clindamycin as bacteriostatic. Resistance is most often caused by modification of specific bases of the 23S ribosomal RNA at this binding site; because the binding sites overlap, cross-resistance is complete with lincomycin and is sometimes observed among lincosamides, macrolides, and streptogramin B, and macrolide-resistant staphylococci and beta-hemolytic streptococci should be screened for inducible clindamycin resistance using the D-zone test. After oral dosing, clindamycin is rapidly and almost completely absorbed (about 90%), reaching peak serum concentrations around 45 minutes, and is widely distributed into body fluids and tissues, including bone, though it does not reach significant concentrations in cerebrospinal fluid even with inflamed meninges. It is predominantly metabolized by the hepatic enzyme CYP3A4 to clindamycin sulfoxide and a minor active metabolite, with an average biological half-life of 2.4 hours.
- Therapeutic applications
- Indicated for the treatment of serious infections caused by susceptible anaerobic bacteria, and for serious infections due to susceptible strains of streptococci, pneumococci, and staphylococci, with use reserved for penicillin-allergic patients or others for whom, in the physician's judgment, a penicillin is inappropriate, given the risk of colitis described in the boxed warning. Anaerobic indications include serious respiratory tract infections (empyema, anaerobic pneumonitis, lung abscess), serious skin and soft-tissue infections, septicemia, intra-abdominal infections such as peritonitis and intra-abdominal abscess, and infections of the female pelvis and genital tract such as endometritis, tubo-ovarian abscess, pelvic cellulitis, and postsurgical vaginal cuff infection. Streptococcal, staphylococcal, and pneumococcal indications include serious respiratory tract and skin/soft-tissue infections. Because clindamycin carries a boxed warning for Clostridioides difficile-associated diarrhea, ranging from mild diarrhea to fatal colitis, the label directs prescribers to weigh the nature of the infection and the suitability of less toxic alternatives before selecting it.
- Class
- Small molecule
- Therapeutic area
- Antibiotic
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