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Antibiotics - Lincosamides: Nursing Pharmacology

Notes

Notes

ANTIBIOTICS: LINCOSAMIDES
DRUG NAME
clindamycin (Cleocin), lincomycin (Lincocin)
CLASS
Lincosamides
MECHANISM OF ACTION
  • Bacteriostatic effect: bind to the bacterial 50S ribosomal subunit, interfering with protein synthesis and limiting bacterial growth
  • Bactericidal effect at high concentrations
INDICATIONS
  • Skin and soft tissue infections caused by Gram-positive bacteria
  • Anaerobic bacterial infections
  • Prophylaxis of endocarditis in valvular heart disease
  • Treatment of Pneumocystis jirovecii pneumonia, acne, and bacterial vaginosis
ROUTE(S) OF ADMINISTRATION
PO, IM, IV, TOP, intravaginal
SIDE EFFECTS
  • Nausea, vomiting, diarrhea, abdominal cramps, Clostridioides difficile infection (CDI)
  • Boxed warning: CDI and pseudomembranous colitis
  • Serious hypersensitivity reactions: Stevens-Johnson syndrome, exfoliative dermatitis
  • Injection site reactions
  • Intravaginal administration: redness, burning, itching, vaginal candidiasis
CONTRAINDICATIONS AND CAUTIONS
  • Pregnancy and breastfeeding
  • Gastrointestinal or hepatic disease
NURSING CONSIDERATIONS
Assessment and monitoring: clindamycin
Assessment
  • Affected area: size of abscess, drainage, redness, warmth, swelling, odor, pain
  • Laboratory test results: CBC, hepatic and renal function, culture and sensitivity

Monitoring
  • Patient IV
  • Signs of infiltration
  • Hypersensitivity reaction
  • CDI
  • Evaluate therapeutic response: signs of infection resolving; decreased drainage, redness, or pain

Client education
  • Purpose of medication: to treat infection
  • Self-administration
    • Take four times a day, with at least eight ounces of water, with or without food
      • Decreases esophageal irritation
    • With oral solution
      • Shake well before use; use oral solution dispenser
  • Side effects
    • Nausea, vomiting, bitter taste
      • Take medication with food
  • Notify healthcare provider immediately
    • Fever, abdominal pain; severe or bloody diarrhea
Transcript

Lincosamides are a class of antibiotics used to treat severe infections caused by gram positive and anaerobic bacteria. The lincosamide family of antibiotics includes both clindamycin and lincomycin, however, lincomycin has been widely replaced by clindamycin in almost all of its uses.

Now, clindamycin is most often used to treat skin and soft tissue infections caused by staphylococci and streptococci. It can be active against community-acquired strains of methicillin resistant Staphylococcus aureus, or MRSA for short, an increasingly common cause of cutaneous infections. Additionally, clindamycin is indicated for the treatment of anaerobic infections caused by Bacteroides species and other anaerobes that often participate in mixed flora infections.

Consequently, it is often used in combination with cephalosporins or aminoglycosides to treat penetrating wounds of the abdomen and gut, infections originating in the female reproductive tract, and lung abscesses.

Finally, clindamycin may be used for the prophylaxis of endocarditis in clients with underlying valvular heart disease, as well as to treat Pneumocystis jirovecii pneumonia in clients with HIV infection.

For the treatment of systemic infections, clindamycin can be administered orally or by intravenous or intramuscular injection. Additionally, clindamycin can be used topically for the treatment of acne and rosacea, as well as intravaginally for the treatment of bacterial vaginosis.

All right now, once administered, clindamycin targets the 50S ribosomal subunit of the bacteria, thereby inhibiting protein synthesis and ultimately limiting the growth of bacteria. Although clindamycin has a primarily bacteriostatic effect, it can also act as a bactericidal antibiotic at higher concentrations.

Since clindamycin tastes extremely bitter, it is not commonly prescribed to children. The most common side effects of clindamycin include gastrointestinal disturbances like nausea, vomiting, diarrhea, and abdominal cramps.

Long-term use can disrupt the normal intestinal flora, which can allow certain bacteria like Clostridioides difficile to survive and overgrow within the gastrointestinal tract, rarely but potentially leading to Clostridioides difficile infection or CDI for short. If CDI involves the colon, it is known as pseudomembranous colitis, and that’s a boxed warning for clindamycin. Another severe side effect of clindamycin is the potential for serious hypersensitivity reactions, such as Stevens-Johnson syndrome or exfoliative dermatitis.

Clients on intravenous or intramuscular administration can experience induration, irritation, or abscess formation at the injection site. Finally, with intravaginal administration, there may be redness, burning, and itching, as well as increased risk of vaginal candidiasis.

As far as contraindications go, clindamycin should be stopped if the client develops pseudomembranous colitis. Additionally, it should be used with caution in clients who are pregnant or breastfeeding, as well as in clients with gastrointestinal or hepatic disease.

All right, when caring for a client who has been prescribed a lincosamide like clindamycin for a skin abscess after incision and drainage, first perform a baseline assessment of the affected area, making note of the size of the abscess, redness, warmth, swelling, odor, and presence of pain, as well as the amount and color of drainage. Then, review your client’s recent laboratory results, including CBC, hepatic and renal function, as well as culture and sensitivity results.

Sources
  1. "Focus on Nursing Pharmacology" LWW (2019)
  2. "Pharmacology" Elsevier Health Sciences (2014)
  3. "Mosby's 2021 Nursing Drug Reference" Mosby (2020)
  4. "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2016)