Lincomycin and Clindamycin

The in vitro susceptibility of various anaerobic bacteria to lincomycin was initially demonstrated in 1965 (56). Subsequently, the 7-chloro-7-deoxylincomycin analog, clindamycin, was found to be even more active against anaerobes than the parent compound (13). Lincomycin is highly active against a variety of anaerobic bacteria; however, clostridia, B. fragilis, and F. varium are relatively resistant to lincomycin (13).

Clindamycin has a broad range of activity against anaerobic organisms and has proven its efficacy in clinical trials. Approximately 96% of anaerobic bacteria isolated in clinical practice were susceptible to easily achievable levels of clindamycin (13,21). B. fragilis is generally sensitive to levels below 3 ng/mL. There are, however, increasing reports and surveys of an increase in resistant strains associated with clinical infections. Among the other resistant anaerobes are various species of clostridia. Approximately 20% of C. ramosum are resistant to clindamycin, as are a smaller number of C. perfringens. Many strains of F. varium are resistant, but this organism is uncommon in clinical infections. Recently, a few strains of peptostrepto-cocci were found to be resistant (57).

Clindamycin is rapidly removed from serum to body tissues and fluids and it penetrates well into saliva, sputum, respiratory tissue, pleural fluid, soft tissues, prostate, semen, bones, and joints (62), as well as into fetal blood and tissues. No data exist to show that significant concentrations are achievable in the human brain, cerebrospinal fluid, or eye.

Several reports (58-63) described the successful use of this drug in the treatment of anaerobic infection. Clindamycin does not cross efficiently the blood-brain barrier and should not be administered in CNS infections (61,62). Because of the effectiveness of its activity against anaerobes, it is frequently used in combination with aminoglycosides for the treatment of mixed aerobic-anaerobic infection of the abdominal cavity and obstetric infection (63). The side effect of most concern with clindamycin is colitis (64). It should be noted that colitis has been associated with a number of other antimicrobial agents, and has been described in seriously ill patients in the absence of previous antimicrobial therapy. Colitis following clindamycin therapy was associated with recovery of C. difficile strains in adults and children (65). The occurrence of colitis in pediatric patients is very rare, however (66). Clinical studies using clindamycin in a pediatric population showed it to be effective in the treatment of intraabdominal infections (67), aspiration pneumonia (68), chronic otitis media (69), and chronic sinutis (70). Clindamycin has also an important role in treating dental infections (71).

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