Clindamycin

• Brand names: Dalacin C, Cleocin
• Route: Oral, intravenous and topical

Clindamycin treats MRSA skin infection and is one of the few oral MRSA options licensed for children, with a good suspension formulation.

It also suppresses the toxins produced by Staphylococcus aureus, which is why it is added in necrotising soft-tissue infection and toxic shock.

Local MRSA resistance rates matter: some strains carry inducible resistance, so the laboratory D-test result should be checked before relying on it.

Clindamycin binds the 50S ribosomal subunit at a site overlapping the macrolide binding site and blocks peptide chain elongation.

Even at sub-inhibitory concentrations it switches off production of toxins such as Panton-Valentine leukocidin and alpha-haemolysin, which is why it is added in severe toxin-mediated disease.

Some MRSA strains carry inducible resistance (erm genes). A D-test in the laboratory is used to detect this before clindamycin is relied upon.

• Adults: 300–450 mg orally every 6–8 hours for skin and soft-tissue infection, or 600–900 mg intravenously every 8 hours for severe infection.
• Children: 20–40 mg/kg/day divided into three or four doses — a common choice because it is available as a liquid.
• Typical courses run 5–14 days depending on severity and response.
• No routine dose change for kidney impairment; caution in significant liver disease.

Doses listed are typical adult regimens quoted for reference. The actual dose, route and duration are decided by a clinician for the individual patient.

Lincomycin was isolated from Streptomyces lincolnensis, found in soil near Lincoln, Nebraska, and introduced by Upjohn in 1963.

Chemical modification — replacing a hydroxyl group with chlorine — produced clindamycin in 1966, with much better absorption and potency.

Its association with Clostridioides difficile colitis, described in the 1970s, permanently shaped how cautiously broad-spectrum antibiotics are prescribed.

• Clostridioides difficile colitis — clindamycin carries one of the highest risks of any antibiotic.
• Diarrhoea, nausea, metallic taste and abdominal pain.
• Rash, including rare severe skin reactions, and raised liver enzymes.

• Dental and oral infections, particularly in penicillin allergy.
• Anaerobic infections such as intra-abdominal abscess and aspiration pneumonia.
• Topical treatment of acne and bacterial vaginosis; adjunct in toxic shock syndrome and necrotising fasciitis.