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Klindamisin – Linkomisin

Clinical Effects:

LINCOMYCIN AND RELATED AGENTS
  • USES: Lincomycin and clindamycin are antibiotic agents approved for treatment of infections due to susceptible strains of streptococci, pneumococci, and staphylococci. Clindamycin is also used topically to treat acne vulgaris and bacterial vaginosis. PHARMACOLOGY: Clindamycin and lincomycin bind exclusively to the 50S bacterial ribosomal subunit and suppress bacterial protein synthesis. EPIDEMIOLOGY: Overdose from lincomycin and clindamycin is rare. OVERDOSE: Overdose effects are anticipated to be an extension of adverse effects observed following therapeutic doses. A 12 gram bolus intravenous lincomycin dose produced cardiac arrest immediately following intubation. ADVERSE EFFECTS: Diarrhea has been reported following the administration of lincomycin and clindamycin. Pseudomembranous colitis is a widely reported adverse effect of lincomycin and clindamycin therapy when administered orally and/or parenterally. It may range in severity from mild to life-threatening. OTHER EFFECTS: Nausea, vomiting, abdominal pain, stomatitis, esophagitis, glossitis, tinnitus, vertigo, and dermatitis. RARE: Steven’s-Johnson syndrome, toxic epidermal necrolysis, elevated liver enzymes, jaundice, acute allergic reactions, sideroblastic anemia, thrombocytopenia, granulocytopenia, and nephrotoxicity (eg, azotemia, oliguria, and proteinuria). Rapid administration of large doses has resulted in ventricular dysrhythmias, hypotension, and cardiac arrest.

Range of Toxicity:

LINCOMYCIN AND RELATED AGENTS
  • TOXICITY: The minimal toxic or lethal dose is not well established in the literature. Lincomycin- or clindamycin-induced diarrhea and pseudomembranous colitis have occurred following therapeutic doses. An IV bolus of 12 grams of lincomycin produced cardiac arrest in an adult. THERAPEUTIC DOSES: Varies by indication. CLINDAMYCIN: ADULTS: Oral: varies by severity; 150 mg to 450 mg every 6 hours. Parenteral: 600 to 4800 mg/day IV in 2 to 4 equal doses. CHILDREN: Oral: 29 days and older: 8 to 40 mg/kg/day orally divided every 6 to 8 hours; maximum 600 mg/dose. Parenteral: greater than 1 month old: 20 to 40 mg/kg/day IV or IM in 3 or 4 equal doses, depending on the severity of infection. If dosed based on body surface area: 350 mg/m(2)/day to 450 mg/m(2)/day. Maximum dose: 2.7 g/day; up to 4.8 g/day has been used for life-threatening. LINCOMYCIN: ADULTS: IM: 600 mg every 12 to 24 hours; IV: 600 mg to 1 g every 8 to 12 hours to a maximum recommended dose of 8 g/day in life-threatening infections. CHILDREN (greater than 1 month old): IM: 10 mg/kg every 12 to 24 hours. IV: 10 to 20 mg/kg/day, depending on severity of infection, in divided doses.

Treatment:

LINCOMYCIN AND RELATED AGENTS
  • Support: MANAGEMENT OF MILD TO MODERATE TOXICITY: Treatment is symptomatic and supportive. Acute toxicity, other than gastrointestinal discomfort, is not common. Rapid administration of large doses has resulted in hypotension. Manage mild hypotension with IV fluids. MANAGEMENT OF SEVERE TOXICITY: Treatment is symptomatic and supportive. The primary toxic effects involve the gastrointestinal tract and may include severe diarrhea and pseudomembranous colitis. Metronidazole for mild to moderate disease and vancomycin for severe disease are recommended in the treatment of Clostridium difficile infection. Treat severe hypotension with IV fluids, dopamine, or norepinephrine. In patients with acute allergic reaction, oxygen therapy, bronchodilators, diphenhydramine, corticosteroids, vasopressors and epinephrine may be required.
  • Decontamination: PREHOSPITAL: Prehospital gastrointestinal decontamination is generally NOT necessary. HOSPITAL: Severe toxicity is not expected after an overdose. Gastrointestinal decontamination is not routinely warranted. Consider activated charcoal after extremely large ingestions or those involving toxic co-ingestants.
  • Airway management: Airway management is unlikely to be needed following an overdose; however, ensure adequate ventilation and perform endotracheal intubation early in patients with life-threatening cardiac dysrhythmias or severe allergic reactions.
  • Antidote: None.
  • Monitoring of patient: Plasma concentrations are not readily available or clinically useful in the management of overdose. Monitor serum electrolytes in patients with significant vomiting and/or diarrhea. Monitor vital signs, CBC with differential with platelet count, renal function, and liver enzymes in symptomatic patients. Obtain an ECG, and institute continuous cardiac monitoring in patients with significant overdose. Monitor for clinical evidence of colitis. Evaluate for C, difficile toxin if colitis develops.
  • Enhanced elimination procedure: In several studies, hemodialysis and peritoneal dialysis were not effective in reducing lincomycin or clindamycin levels significantly.
  • Patient disposition: HOME CRITERIA: Patient with inadvertent ingestions who have minimal symptoms can be observed at home. OBSERVATION CRITERIA: All patients with deliberate self-harm ingestions should be evaluated in a health care facility and monitored until symptoms resolve. Patients with unintentional ingestions who are symptomatic should be observed in a healthcare facility. ADMISSION CRITERIA: Patients who remain symptomatic despite adequate treatment should be admitted. CONSULT CRITERIA: Consult a Poison Center for assistance in managing patients with severe toxicity or in whom the diagnosis is unclear.
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