ections caused by susceptible strains of the designated organisms in the conditions listed below: lower respiratory tract infections including pneumonia, empyema, and lung abscess caused by anaerobes, streptococcus pneumoniae , other streptococci (except e. faecalis ), and staphylococcus aureus . skin and skin structure infections caused by streptococcus pyogenes, staphylococcus aureus , and anaerobes. gynecological infections including endometritis, nongonococcal tubo-ovarian abscess, pelvic cellulitis, and postsurgical vaginal cuff infection caused by susceptible anaerobes. intra-abdominal infections including peritonitis and intra-abdominal abscess caused by susceptible anaerobic organisms. septicemia caused by staphylococcus aureus, streptococci (except enterococcus faecalis ), and susceptible anaerobes. bone and joint infections including acute hematogenous osteomyelitis caused by staphylococcus aureus and as adjunctive therapy in the surgical treatment of chronic bone and joint infections due to susceptible organisms. to reduce the development of drug-resistant bacteria and maintain the effectiveness of clindamycin injection, usp and other antibacterial drugs, clindamycin injection, usp should be used only to treat or prevent infections that are proven or strongly suspected to be caused by susceptible bacteria. when culture and susceptibility information are available, they should be considered in selecting or modifying antibacterial therapy. in the absence of such data, local epidemiology and susceptibility patterns may contribute to the empiric selection of therapy.

d. appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of c. difficile , and surgical evaluation should be instituted as clinically indicated. anaphylactic and severe hypersensitivity reactions anaphylactic shock and anaphylactic reactions have been reported (see adverse reactions ). severe hypersensitivity reactions, including severe skin reactions such as toxic epidermal necrolysis (ten), drug reaction with eosinophilia and systemic symptoms (dress), and stevens-johnson syndrome (sjs), some with fatal outcome, have been reported (see adverse reactions ). in case of such an anaphylactic or severe hypersensitivity reaction, discontinue treatment permanently and institute appropriate therapy. a careful inquiry should be made concerning previous sensitivities to drugs and other allergens. benzyl alcohol toxicity in pediatric patients ("gasping syndrome") this product contains benzyl alcohol as a preservative. the preservative benzyl alcohol has been associated with serious adverse events, including the "gasping syndrome", and death in pediatric patients. although normal therapeutic doses of this product ordinarily deliver amounts of benzyl alcohol that are substantially lower than those reported in association with the "gasping syndrome", the minimum amount of benzyl alcohol at which toxicity may occur is not known. the risk of benzyl alcohol toxicity depends on the quantity administered and the liver and kidneys' capacity to detoxify the chemical. premature and low birth weight infants may be more likely to develop toxicity. usage in meningitis —since clindamycin does not diffuse adequately into the cerebrospinal fluid, the drug should not be used in the treatment of meningitis.

creased. doses of as much as 4,800 mg daily have been given intravenously to adults. see dilution for iv use and iv infusion rates section below. single intramuscular injections of greater than 600 mg are not recommended. alternatively, drug may be administered in the form of a single rapid infusion of the first dose followed by continuous iv infusion as follows: neonates (less than 1 month) : 15 to 20 mg/kg/day in 3 to 4 equal doses. the lower dosage may be adequate for small prematures. pediatric patients 1 month of age to 16 years : parenteral (im or iv) administration: 20 to 40 mg/kg/day in 3 or 4 equal doses. the higher doses would be used for more severe infections. as an alternative to dosing on a body weight basis, pediatric patients may be dosed on the basis of square meters body surface: 350 mg/m2/day for serious infections and 450 mg/m2/day for more severe infections. parenteral therapy may be changed to oral clindamycin flavored granules (clindamycin palmitate hydrochloride) or clindamycin capsules (clindamycin hydrochloride) when the condition warrants and at the discretion of the physician. in cases of β-hemolytic streptococcal infections, treatment should be continued for at least 10 days. dilution for iv use and iv infusion rates : the concentration of clindamycin in diluent for infusion should not exceed 18 mg per ml. infusion rates should not exceed 30 mg per minute . the usual infusion dilutions and rates are as follows: administration of more than 1200 mg in a single 1-hour infusion is not recommended. parenteral drug products should be inspected visually for particulate matter and discoloration prior to administration, whenever solution and container permit. dilution and compatibility : physical and biological compatibility studies monitored for 24 hours at room temperature have demonstrated no inactivation or incompatibility with the use of clindamycin injection (clindamycin phosphate) in iv solutions containing sodium chloride, glucose, calcium or potassium, and solutions containing vitamin b complex in concentrations usually used clinically. no incompatibility has been demonstrated with the antibiotics cephalothin, kanamycin, gentamicin, penicillin or carbenicillin. the following drugs are physically incompatible with clindamycin phosphate: ampicillin sodium, phenytoin sodium, barbiturates, aminophylline, calcium gluconate, and magnesium sulfate. the compatibility and duration of stability of drug admixtures will vary depending on concentration and other conditions. for current information regarding compatibilities of clindamycin phosphate under specific conditions, please contact the medical affairs department toll-free at 1-866-625-1618. physico-chemical stability of diluted solutions of clindamycin injection room temperature : 6, 9 and 12 mg per ml (equivalent to clindamycin base) in dextrose injection 5%, sodium chloride injection 0.9%, or lactated ringers injection in glass bottles or mini-bag containers, demonstrated physical and chemical stability for at least 16 days at 25°c. also, 18 mg per ml (equivalent to clindamycin base) in dextrose injection 5%, in mini-bag containers, demonstrated physical and chemical stability for at least 16 days at 25°c. refrigeration : 6, 9 and 12 mg per ml (equivalent to clindamycin base) in dextrose injection 5%, sodium chloride injection 0.9%, or lactated ringers injection in glass bottles or mini-bag containers, demonstrated physical and chemical stability for at least 32 days at 4°c. important: this chemical stability information in no way indicates that it would be acceptable practice to use this product well after the preparation time. good professional practice suggests that compounded admixtures should be administered as soon after preparation as is feasible. frozen : 6, 9 and 12 mg per ml (equivalent to clindamycin base) in dextrose injection 5%, sodium chloride injection 0.9%, or lactated ringers injection in mini-bag containers demonstrated physical and chemical stability for at least eight weeks at -10°c. frozen solutions should be thawed at room temperature and not refrozen. image3.jpg image4.jpg

ciated with clindamycin. anaphylactic shock, anaphylactic reaction and hypersensitivity have also been reported (see warnings ). skin and mucous membranes : pruritus, vaginitis, angioedema and rare instances of exfoliative dermatitis have been reported (see hypersensitivity reactions ). liver : jaundice and abnormalities in liver function tests have been observed during clindamycin therapy. renal : although no direct relationship of clindamycin to renal damage has been established, renal dysfunction as evidenced by azotemia, oliguria, and/or proteinuria has been observed. hematopoietic: transient neutropenia (leukopenia) and eosinophilia have been reported. reports of agranulocytosis and thrombocytopenia have been made. no direct etiologic relationship to concurrent clindamycin therapy could be made in any of the foregoing. immune system : drug reaction with eosinophilia and systemic symptoms (dress) cases have been reported. local reactions : injection site irritation, pain, induration and sterile abscess have been reported after intramuscular injection and thrombophlebitis after intravenous infusion. reactions can be minimized or avoided by giving deep intramuscular injections and avoiding prolonged use of indwelling intravenous catheters. musculoskeletal : polyarthritis cases have been reported. cardiovascular : cardiopulmonary arrest and hypotension have been reported following too rapid intravenous administration (see dosage and administration ). to report suspected adverse reactions, contact sagent pharmaceuticals, inc. at 1-866-625-1618 or fda at 1-800-fda-1088 or www.fda.gov/medwatch.

esence of inflamed meninges. metabolism in vitro studies in human liver and intestinal microsomes indicated that clindamycin is predominantly metabolized by cytochrome p450 3a4 (cyp3a4), with minor contribution from cyp3a5, to form clindamycin sulfoxide and a minor metabolite, n-desmethylclindamycin. excretion biologically inactive clindamycin phosphate disappears from the serum with 6 minutes of the average elimination half-life; however, the average serum elimination half-life of active clindamycin is about 3 hours in adults and 2½ hours in pediatric patients. specific populations patients with renal/hepatic impairment the elimination half-life of clindamycin is increased slightly in patients with markedly reduced renal or hepatic function. hemodialysis and peritoneal dialysis are not effective in removing clindamycin from the serum. dosage schedules need not be modified in the presence of mild or moderate renal or hepatic disease. elderly patients pharmacokinetic studies in elderly volunteers (61 to 79 years) and younger adults (18 to 39 years) indicate that age alone does not alter clindamycin pharmacokinetics (clearance, elimination half-life, volume of distribution, and area under the serum concentration-time curve) after iv administration of clindamycin phosphate. after oral administration of clindamycin hydrochloride, the average elimination half-life is increased to approximately 4 hours (range 3.4 to 5.1 h) in the elderly, compared to 3.2 hours (range 2.1 to 4.2 h) in younger adults. the extent of absorption, however, is not different between age groups and no dosage alteration is necessary for the elderly with normal hepatic function and normal (age-adjusted) renal function 1 . microbiology mechanism of action clindamycin inhibits bacterial protein synthesis by binding to the 23s rna of the 50s subunit of the ribosome. clindamycin is bacteriostatic. resistance resistance to clindamycin is most often caused by modification of specific bases of the 23s ribosomal rna. cross-resistance between clindamycin and lincomycin is complete. because the binding sites for these antibacterial drugs overlap, cross-resistance is sometimes observed among lincosamides, macrolides and streptogramin b. macrolide-inducible resistance to clindamycin occurs in some isolates of macrolide-resistant bacteria. macrolide-resistant isolates of staphylococci and beta-hemolytic streptococci should be screened for induction of clindamycin resistance using the d-zone test. antimicrobial activity clindamycin has been shown to be active against most of the isolates of the following microorganisms, both in vitro and in clinical infections (see indications and usage ): gram-positive bacteria staphylococcus aureus (methicillin-susceptible strains) streptococcus pneumoniae (penicillin-susceptible strains) streptococcus pyogenes anaerobic bacteria clostridium perfringens fusobacterium necrophorum fusobacterium nucleatum peptostreptococcus anaerobius prevotella melaninogenica the following in vitro data are available, but their clinical significance is unknown. at least 90 percent of the following bacteria exhibit an in vitro minimum inhibitory concentration (mic) less than or equal to the susceptible breakpoint for clindamycin against isolates of a similar genus or organism group. however, the efficacy of clindamycin in treating clinical infections due to these bacteria has not been established in adequate and well-controlled clinical trials. gram-positive bacteria staphylococcus epidermidis (methicillin-susceptible strains) streptococcus agalactiae streptococcus anginosus streptococcus mitis streptococcus oralis anaerobic bacteria actinomyces israelii clostridium clostridioforme eggerthella lenta finegoldia (peptostreptococcus) magna micromonas (peptostreptococcus) micros prevotella bivia prevotella intermedia propionibacterium acnes susceptibility testing for specific information regarding susceptibility test interpretive criteria and associated test methods and quality control standards recognized by fda for this drug, please see: https://www.fda.gov/stic. image2.jpg