Clindamycin inhibits protein synthesis by the ribosome. It has important antianaerobic activity, including 90 per cent of strains of Bacteroides species and Clostridium species, and it is active against streptococci and staphylococci susceptible to erythromycin and methicillin. Enterobacteriacae are not susceptible. Clindamycin penetrates tissues well, particularly bone and pleural fluid (but not the meninges) and is excreted by the liver. The dose should be reduced in liver failure. It is an alternative to metronidazole for abdominal sepsis and is used to treat osteomyelitis caused by susceptible organisms. Its most common use in the ICU is for aspiration pneumonia or lung abscess. Necrotizing fasciitis and other severe infections caused by Streptococcus pyogenes can be treated with clindamycin. Clindamycin plus primaquine is an alternative treatment for Pneumocystis pneumonia. Diarrhea is a well-recognized adverse effect.
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