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[Open comparative study between the combination clyndamicin/gentamycin and penicillin/gentamycin in septic abortion]

[Article in Spanish]

French AR, Kennion G.

PIP: Septic abortion is not uncommon in countries where abortion is illegal, and antibiotics are second only to uterine evacuation in the treatment of such cases. Although the combination of penicillin and gentamycin has given excellent results, the high incidence of Bacteroides fragilis and other anerobics in septic abortion prompted a comparison of penicillin and gentamycin with clindamycin and gentamycin at the Hospital Santo Tomas in Panama City, Panama, beginning in May 1984. Among 30 febrile patients with diagnoses of septic abortion, 14 were treated with penicillin/gentamycin and 16 with clindamycin/gentamycin. The penicillin group ranged in age from 17-29 with an average age of 21.9, while the clindamycin group ranged from 18-32 years with an average of 24.3. The average gestational ages were 10.2 weeks for the penicillin group and 10.7 for the clindamycin group. The average body temperature of both groups was 38.9 degrees Celsius. 1 patient had a blood pressure of 80/60 without clinical evidence of shock. The average duration of fever was 43 hours in the penicillin group and 40.6 hours in the clindamycin group. The hospital stay ranged from 3-7 days with an average of 5.4 in the penicillin group and from 3-6 days with an average of 4.2 in the clindamycin group. Patients recovered rapidly after uterine curettage and initiation of antibiotic therapy. Bacteremia was not detected in any patient. Tolerance to the drugs was similar in both groups.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12280266&dopt=Abstract clindamycin antibiotic Cleocin-T



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Clindamycin vaginal cream vs oral metronidazole in the treatment of bacterial vaginosis.

Arredondo JL, Higuera F, Hidalgo H, Narcio L, Casanova G, Beltran M, Sanchez CJ.

PIP: This study was designed to compare the safety/efficacy of the treatment of 2% clindamycin vaginal cream and oral metronidazole in 184 women with bacterial vaginosis. This was a randomized, prospective, multicenter, double-blind, controlled study. Patients were randomized to either Clindamycin phosphate vaginal cream 2%, 5 gm intravaginally at bedtime, and placebo oral metronidazole capsules taken twice daily, or oral metronidazole capsules, 500 mg, taken twice daily, and placebo clindamycin vaginal cream, 5 gm to be administered intravaginally at bedtime. All treatments were for 7 days. Patients were seen for followup at 4-13 days and 20-43 days after completion of protocol therapy. 2 investigators in Mexico City enrolled a total of 184 patients (91 clindamycin and 93 metronidazole). 1 patient never received drugs after enrollment, leaving 183 valuable for safety. A total of 114 were valuable for efficacy. Protocol regimens were comparable in efficacy (p=0.22) and the percentage of cure/improvement was 87% in the clindamycin group compared to 79% in the metronidazole group. No relapse was observed in the clindamycin group, as opposed to 7% in the metronidazole group. The clindamycin group had a failure of 13% while this was 15% in the metronidazole group. Both treatments were well-tolerated. Most of the events were either vulvovaginal irritation upon application of the study drug, or the development of vaginitis/cervicitis. The 1 event classified as serious in this study (metronidazole group) was generalized rash which, in the opinion of the investigator, was related to the study drug. There were 4 nongenital tract side effects (1 gastrointestinal, 2 dermatologic, and 1 allergy) all in the metronidazole group. The authors can conclude that clindamycin 2% vaginal cream is at least as effective as orally administered metronidazole for the treatment of bacterial vaginosis in nonpregnant women.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12317784&dopt=Abstract clindamycin antibiotic Cleocin-T



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Inhibition of lipase activity in antibiotic-resistant propionibacterium acnes strains.

Gloor M, Wasik B, Becker A, Hoffler U.

Department of Dermatology, Klinikum der Stadt Karlsruhe, Germany. mgloor onlinehome.de

BACKGROUND AND OBJECTIVE: Erythromycin-sensitive and/or clindamycin-sensitive strains of Propionibacterium acnes show a reduced lipase production at levels below the minimal growth-inhibitory concentration (MIC). The objective of this study was to determine whether erythromycin and clindamycin concentrations far below the MIC inhibit lipase production in P. acnes strains resistant to these antibiotics. METHODS: Of 42 P. acnes strains, 10 showed an MIC >256 micro g/ml for erythromycin. Two strains showed MICs of 0.19 and 0.25 micro g/ml, while the MIC of the remaining strains was <or=0.016 micro g/ml. Lipase activity was determined up to a concentration of 192 micro g/ml by cultivation on spirit blue agar + lipase reagent. The 10 strains whose erythromycin MIC was >256 micro g/ml were also tested for lipase inhibition by clindamycin. While this method fails to differentiate between inhibition of lipase production and inhibition of lipase activity, the absence of inhibition of lipase activity rules out inhibition of lipase production. RESULTS: Inhibition of lipolysis by sub-MIC concentrations was demonstrated only for clindamycin in 3 P. acnes strains. However, lipase inhibition was seen only at the dilution level immediately below the MIC. CONCLUSIONS: Resistant P. acnes strains with high erythromycin and/or clindamycin MICs can be ruled out to show in vitro inhibition of lipase production at antibiotic concentrations far below the MIC. Copyright 2002 S. Karger AG, Basel

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In vitro activity of quinupristin/dalfopristin, linezolid, telithromycin and comparator antimicrobial agents against 13 species of coagulase-negative staphylococci.

John MA, Pletch C, Hussain Z.

Department of Microbiology & Infection Control, London Health Sciences Centre and University of Western Ontario, Canada.

OBJECTIVES: To determine in vitro susceptibilities of a large series of speciated coagulase-negative staphylococci (CNS) against three new antibiotics, linezolid, quinupristin/dalfopristin and telithromycin. METHODS: Susceptibilities to three new antibiotics and oxacillin, vancomycin, clindamycin and erythromycin were determined by the agar dilution method, as described by the NCCLS. RESULTS: Resistance to linezolid was not observed in any isolates, although MIC90 values varied between species. Fifteen of 658 (2.3%) isolates were resistant to quinupristin/dalfopristin, but < 1% of the clinically most important isolates of Staphylococcus epidermidis, Staphylococcus haemolyticus and Staphylococcus hominis demonstrated resistance to this agent. Susceptibility to clindamycin correlated with susceptibility to quinupristin/dalfopristin; however, resistance to clindamycin did not predict quinupristin/dalfopristin resistance. Telithromycin was the least active of the new agents tested, showing activity similar to that of clindamycin. Susceptibility and resistance to clindamycin were predictive of susceptibility and resistance to telithromycin. CONCLUSION: Clindamycin susceptibility can be used as a surrogate marker for susceptibility to quinupristin/dalfopristin and telithromycin. Quinupristin/dalfopristin and linezolid show good activity against both mecA-positive and -negative CNS.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12461014&dopt=Abstract clindamycin antibiotic Cleocin-T



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Quantitative analysis of clindamycin in human plasma by liquid chromatography/electrospray ionisation tandem mass spectrometry using d1-N-ethylclindamycin as internal standard.

Rechberger GN, Fauler G, Windischhofer W, Kofeler H, Erwa W, Leis HJ.

University Children's Hospital, Division of Analytical Biochemistry and Mass Spectrometry, Auenbruggerplatz 30, 8036 Graz, Austria.

A new method for the quantitative analysis of clindamycin in human plasma by liquid chromatography/electrospray ionisation tandem mass spectrometry (LC/ESI-MS/MS) is presented. Recently published methods possess a disadvantage because of their use of internal standards with extraction and ionisation properties different from those of clindamycin. To avoid these problems, d(1)-N-ethylclindamycin was synthesised for use as internal standard by N-demethylation and subsequent d(1)-N-ethylation. Plasma sample preparation was done by an easy and rapid liquid-liquid extraction using ethyl acetate. The method was validated in the expected concentration range for a pharmacokinetic study. Calibration graphs were linear within the range 0.05-3.2 microg/mL plasma. Intra-day precision was between 0.90% (2.8 microg/mL) and 3.25% (0.05 microg/mL), inter-day variability was found to be between 1.33% (0.7 microg/mL) and 2.60% (0.05 microg/mL). Inter-day accuracy showed deviations between 0.4% (0.05 microg/mL) and -4.8% (0.2 microg/mL). The method is simple and robust, and has been applied to the batch analysis of clindamycin during a pharmacokinetic study. Copyright 2002 John Wiley & Sons, Ltd.

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Changes in sensitivity patterns to selected antibiotics in Clostridium difficile in geriatric in-patients over an 18-month period.

Drummond LJ, McCoubrey J, Smith DG, Starr JM, Poxton IR.

Division of Medical Microbiology, University of Edinburgh, Edinburgh EH8 9AG, UK.

Clostridium difficile-associated disease continues to be a major problem in hospitals and long-term care facilities throughout the developed world. Administration of certain antibiotics such as amoxycillin, oral cephalosporins and clindamycin is associated with the greatest risk of developing C. difficile disease. The two antibiotics used for treatment of C. difficile disease are vancomycin and metronidazole, to which there is currently very little resistance. Randomly selected isolates (186) from 90 patients being investigated during an 18-month epidemiological study into the disease were tested for their susceptibility to vancomycin, metronidazole, amoxycillin, clindamycin, cefoxitin and ceftriaxone by the NCCLS agar dilution method. There was a narrow range of MIC for the two treatment agents (vancomycin and metronidazole), from 0.5 to 4 microg ml(-1), with no evidence of resistance. All strains were resistant to cefoxitin (MIC 64-256 microg ml(-1)), the antibiotic used in most selective media. All strains were of similar sensitivity to amoxycillin (MIC(90)= 4 microg ml(-1)). Most strains were resistant to ceftriaxone (MIC > or = 64 microg ml(-1)) or of intermediate resistance (MIC > or = 32 microg ml(-1)), with only two sensitive strains (MIC 16 microg ml(-1)). Clindamycin resistance was common, with 67 % of strains resistant (MIC > or = 8 microg ml(-1)), 25 % with intermediate resistance (MIC > or = 4 microg ml(-1)) and only 8 % sensitive (MIC < or = 2 microg ml(-1)). Twelve isolates from six different patients had very high resistance to clindamycin (MIC > or = 128 microg ml(-1)). Multiple isolates from the same patient, taken at different times, showed changes in susceptibility patterns over time. The only major change in susceptibility over the time-period was in clindamycin resistance; some strains appeared to become more resistant while others became less resistant. No differences were seen in the MIC(50) and MIC(90) of the different S-types of C. difficile identified, although some S-types were present in very small numbers. There was no correlation between the antibiotics prescribed and susceptibility.

Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12621092&dopt=Abstract clindamycin antibiotic Cleocin-T