Clindamycin

Lincosamide·Infectious Diseases - Other Antibiotics

Staph/Strep infections in penicillin-allergic patients, anaerobic infections (above the diaphragm), Necrotising Fasciitis, osteomyelitis

Authority requiredPBSLINCOSAMIDEDalacin C150 mg+2

Max Dose

1.8 g/day

Half-life

2-3 h

C. Difficile

CRITICAL RISK

Toxin Blocker

NEC FASC

Rapid Summary

Overview

Highly tissue-penetrating lincosamide. Exceptional against Gram-positive aerobes (Staph/Strep) and deep anaerobes. The absolute worst offender for causing C. difficile colitis.

Maximum Dose

Max 1.8 g/day (e.g., 600 mg TDS) for adults.

Clinical Focus

Used in Necrotising Fasciitis and Toxic Shock Syndrome because it halts the bacterial ribosomes from synthesizing deadly flesh-eating exotoxins.

Bottom Line

Clindamycin is a lincosamide with excellent bone and soft tissue penetration for staphylococcal and anaerobic infections, but carries the highest risk of C. difficile-associated diarrhoea among antibiotics.

Formulation & Access

Brand Names

Dalacin C

Oral Routes

Capsules (150 mg). Oral liquid.

Parenteral

Ampoules (600 mg/4 mL) for IV / IM.

Topical

Vaginal cream, topical acne lotion.

Prescribing & PBS

Authority Required (PBS).

Indications & Use

Primary

PBSTGA

Staph/Strep infections in penicillin-allergic patients, anaerobic infections (above the diaphragm), Necrotising Fasciitis, osteomyelitis.

Clinical Place

Niche role for toxin-mediated diseases or severe penicillin allergy. Outstanding bone and joint penetration.

Quick reference

Class & Role

Lincosamide — Highly tissue-penetrating lincosamide.

Route / Formulation

Capsules (150 mg). Oral liquid. (Dalacin C)

Usual Dose & Max

PO 300-450 mg QID. Max 1.8 g/day (e.g., 600 mg TDS) for adults.

Key Indication Doses

Severe Skin/Soft Tissue Infection: PO 300-450 mg QID. Necrotising Fasciitis (Adjunct): IV 600 mg TDS (Alongside high-dose Penicillin and surgical debridement). Renal Impairment: Hepatically metabolised. No dose adjustment required in CKD.

Best Uses

Avoid / Cautions

History of C. difficile colitis or inflammatory bowel disease. Pregnancy Category A.

Key Risks

Gastrointestinal: Clostridioides difficile-associated diarrhea (CDAD) and pseudomembranous colitis. Can be fatal, especially in the elderly. HIGH — Standard antibiotic diarrhea, esophageal ulceration (if swallowed without water). Dermatological: Maculopapular rash, rare SJS. Cardiovascular: Cardiac arrest if IV push is too rapid. Must infuse over 10-30 mins.

Key Interactions

Neuromuscular blocking agents (Anaesthetics). Clindamycin has intrinsic neuromuscular blocking properties and will dangerously prolong the paralysis of surgical muscle relaxants.

Monitoring

Warn the patient: 'If you develop severe, watery, or bloody diarrhea, stop taking the capsules immediately and contact us.' Do NOT prescribe anti-diarrheals (Loperamide) as this traps the C. diff toxin in the gut, causing megacolon.

Clinical Pearl

In severe Necrotising Fasciitis ('flesh-eating disease'), Penicillin alone fails because it only works on actively dividing bacteria (the 'Eagle effect'), and the tissue is already dying from pre-formed toxins. Clindamycin ignores this and shuts down the toxin factories instantly.

Access

Authority requiredDalacin C150 mg

Brand: Dalacin C
PBS status: Authority required
Formulation: Capsules (150 mg)