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Lincosamides

The group of lincosamides includes natural antibacterial preparation lincomycin and its half-synthetic analogue clindamycin, possessing a broad spectrum of antibacterial activity. These medications are used for the treatment of infections caused by gram-positive cocci (as second line preparations) and nonspore-forming anaerobic flora. Pathogenic microorganisms easily develop crossed resistance to both preparations.
Action mechanism
Lincosamides exert bacteriostatic action associated with inhibiting protein synthesis by ribosomes. In high concentration lincosamides may exert bactericidal action.
Spectrum of activity
Lincosamides are narrow-spectrum antibiotics which act on staphylococci, streptococci, pneumococci, nonspore-forming anaerobic flora - peptostreptococcus, peptococcus, fusobacterium, bacteroides (including B.fragilis), moderately active against toxoplasma, P.falciparum, pneumocystis.

Indications

  • Streptococcal tonsillopharyngitis
  • Infections of lower respiratory tract: aspiration pneumonia, lung abscess, empyema
  • Skin and soft tissues infections including diabetic foot
  • Bone and joints infections
  • Intra-abdominal infections: peritonitis, abscess
  • Pelvic infections: endometritis, adnexitis, salpingoophoritis, non gonorrheal abscess of the fallopian tubes and ovaries, pelvic cellulitis, postoperative anaerobic vaginal infections
  • Chlorochine resistant tropical malaria (clindamycin combined with quinine)
  • Toxoplasmosis (only clindamycin in combination with pyrimethamine)
  • Bacterial vaginosis (locally)
  • Severe acne (locally)

Taking into consideration low spectrum of antibacterial activity, in case of severe infections they should be combined with antibacterial preparations acting on gram-positive flora (aminoglycosides, fluorquinolones).
Lincosamides contraindications

  • Gastrointestinal diseases in anamnesis (non-specific ulcerous colitis, enteritis, colitis associated with antibacterial therapy)
  • Allergic reactions or reactions of hypersensitivity to lincosamides
  • Pregnancy
  • Breastfeeding
  • Hematological reactions: neutropenia (sore throat and fever), thrombocytopenia (bleedings)

Lincosamides side effects

  • Digestive system: stomach pain, diarrhea, nausea, vomiting, pseudomembranous colitis
  • Allergic reactions: skin rash, itching
  • Hematological reactions: neutropenia (sore throat and fever), thrombocytopenia (bleedings)

Lincosamides cautions

  • Pregnancy. Lincosamides can pass through the placenta and concentrate in fetus liver.
  • Breastfeeding. Lincosamides penetrate into breast milk and may affect intestinal flora, child's.
  • Pediatric use. Clindamycin should be used with caution in children. Clindamycin phosphate for injection contains benzyl alcohol, which is associated with the development of fatal asphyxia syndrome in newborn infants
  • Pseudomembranous colitis. In case of patients complaints on diarrhea mixed with blood, it is necessary to cancel the application and carry proctosigmoidoscope
  • Urinary system. In patients with renal failure the dose of lincosamides should be adjusted
  • Hepatic system: Lincosamides are metabolized in the liver. Therefore the dose should be adjusted in patients with hepatic failure

Lincosamides drugs interactions
In concomitant application with inhalational analgetics and muscle relaxant drugs lincosamide increase the risk of neuro-muscular blockage leading to muscular weakness, respiratory arrest.
In concomitant application with opioid analgetics there is an increased risk of respiratory suppression and even apnoea.
Calolin decrease the absorption of lincosamides.
It is not recommended to combine lincosamides with chloramphenicol or macrolides because of their antagonism.

Information for patients
Oral forms of lincosamides should be taken by mouth washing down with a glass of water. Lincomycin should be taken one hour before food. It is necessary to follow strictly dosage regimen according to doctors instructions.

Talk to your doctor if the symptoms of infections do not improve within 7-10 days. Do not use absorbing anti-diarrheal drug within 3-4 hours before and after oral application of lincosamides.