克林霉素说明书（Clindamycin manual）

克林霉素说明书（Clindamycin manual） 克林霉素说明书(Clindamycin manual) clindamycin hydrochloride injection Indication: Department of Obstetrics and Gynecology, Department of general surgery, neurology, cardiothoracic surgery, respiratory medicine, aspiration pneumonia, empyema, pulmonary abscess, osteomyelitis, peritonitis, pelvic inflammation usage and dosage Intramuscular injection or intravenous drip. Adults: 0.6 to 1.2g a day, divided into 2~4 applications; serious infection: 1.2 to 2.4G a day, divided into 2~4 intravenous drip. Children over 4 weeks and 4 weeks: 15 to 25mg/kg per day, divided into 3~4 applications; severe infection: 25 to 40mg/kg per day, and divided into 3~4 applications. The dosage of intramuscular injection of this product should not exceed 1 600mg, more than this dosage should be changed to intravenous administration. The speed of intravenous administration should not be too fast. 600mg should be added to the infusion of no less than 100ml, with at least 20 minutes' infusion. 1 hours, enter the dose of not more than 1200mg. Adverse reaction 1, gastrointestinal reactions: common nausea and vomiting, abdominal pain, diarrhea; severe cases of abdominal angina, abdominal pain, severe diarrhea (water or pus like), fever, abnormal thirst and fatigue (pseudomembranous colitis). Diarrhea, colitis and pseudomembranous colitis can occur in the initial stage of medication, also can produce several weeks after drug withdrawal. 2. The blood system: sometimes can reduce the white blood cell, the neutrophilic granulocyte, the eosinophilia and the thrombocytopenia, and so on. Rare aplastic anemia. 3, allergic reactions: visible rash, itching, etc., occasionally urticaria, vascular edema and serum sickness reaction; rarely exfoliative dermatitis, bullous dermatitis, erythema multiforme and Steven-Johnson syndrome. 4, liver and kidney function abnormalities, such as elevated serum aminotransferase, jaundice and so on. 5. Intravenous drip may cause phlebitis. Intramuscular injection may cause pain, induration and aseptic abscess. 6, other: tinnitus, dizziness, Candida infection, etc.. taboo Forbidden to this product and lincomycin. Matters needing attention 1, the following conditions should be used with caution: (1) or a history of gastrointestinal disease, especially patients with ulcerative colitis, Crohn disease or antibiotic associated enteritis (this may cause pseudomembranous colitis); (2) liver dysfunction; (3) severe renal function deterioration; (4) with asthma or other history of allergies. 2, allergic to this product may be allergic to other clindamycin. 3. Disturbance of laboratory indexes: serum alanine aminotransferase and aspartate aminotransferase increased after taking the medicine. 4, need to pay close attention to defecation during treatment, such as increased frequency of defecation, should pay attention to pseudomembranous enterocolitis, the need for timely and appropriate treatment to stop drug. Mild patients may recover after discontinuation of the drug; moderate to severe patients need additional water, electrolytes, and protein. If the above treatment is invalid, then metronidazole should be taken orally 250 to 500mg, 3 times a day. In case of recurrence, the metronidazole can be taken orally again. When it is still invalid, it can be taken orally with vancomycin (or vancomycin), once 125 to 500mg, 1 times every 6 hours, with a course of treatment of 5~10 days. 5, in order to prevent the occurrence of acute rheumatic fever, use this product to treat hemolytic streptococcal infection, the course of treatment is at least 10 days. 6, this product occasionally lead to excessive multiplication of insensitive microorganisms or cause double infection, once double infection, should immediately stop the drug and take appropriate measures. 7, the course of treatment for elderly people, regular examination of liver, kidney function and blood routine. 8 、 severe renal failure and / or severe hepatic dysfunction, accompanied by severe metabolic disorder, the use of high doses of blood concentration monitoring. 9, this product can not pass through the blood cerebrospinal fluid barrier, so it can not be used for meningitis. 10, the sensitivity of different bacteria to this product can vary considerably, so drug sensitivity test is of great significance. Drug interaction 1., this product can increase the neuromuscular blockade of inhaled anesthetics, resulting in skeletal muscle weakness and respiratory depression or paralysis (apnea), and should be noted during surgery or after surgery. Treatment with anti cholinesterase drugs or calcium salts is expected to be effective. 2. this product with anti peristaltic antidiarrheals, containing kaolin angidiarrheal combination, In the course of treatment even in the weeks after treatment with watery diarrhea caused by severe pseudomembranous colitis may. Because the colon endotoxin can be delayed discharged, which leads to diarrhea prolongation and aggravation, the product should not be combined with the anti peristalsis antidiarrheal drug. With kaolin angidiarrheal combination, the absorption of this product will be significantly reduced, so the two should not be taken at the same time, to a certain time interval (at least 2 hours). 3., this product has neuromuscular blocking effect, can enhance the role of neuromuscular blocking drugs, both should avoid sharing. This product and the use of anti myasthenia drugs will lead to the latter weakened the effect of skeletal muscle, for the control of myasthenia gravis symptoms, when in use, the dose of anti myasthenia drugs should be adjusted. 4. chloramphenicol or erythromycin in the target site can be replaced by this product, or a combination of this and the inhibition of the 50S subunit of the bacterial ribosome, test in vitro showed that the product with erythromycin had antagonistic effects, so this product should not be combined with chloramphenicol and erythromycin. 5. with an opioid analgesic combination, the product of the central respiratory depression of respiration and opioid inhibition may be due to additive and lead to prolonged respiratory depression or cause respiratory paralysis (apnea) may, so we must closely observe or care for patients. 6., this product should not be added to the complex infusion, so as to avoid incompatibility. Drug overdose: not yet clear. Storage: sealed and kept in a cool place. pharmacology and toxicology This product is lincomycins antibiotics for lincomycin derivatives, antibacterial spectrum and lincomycin, clindamycin antimicrobial activity was 4 ~ 8 times. Gram-positive bacteria, such as Staphylococcus (including penicillin resistant strains), Streptococcus, diphtheria, Bacillus anthracis, and so on, have higher antibacterial activity. It also has good antimicrobial activity against gram negative anaerobic bacteria. Bacteroides is highly sensitive to this product, including fragile Bacteroides, Clostridium, digestive bacteria, digestive bacteria, Streptococcus pneumoniae, and so on. Gram negative aerobic bacteria, including Haemophilus influenzae, Neisseria, and mycoplasma, are resistant to this drug. This product has no cross resistance with penicillin, chloramphenicol, cephalosporins and tetracyclines. It is partially cross resistant with macrolides and has cross resistance with lincomycin. The mechanism of action of this product is to bind to the bacterial ribosomal 50S subunit and block the elongation of the peptide chain, thereby inhibiting protein synthesis in bacterial cells. This strain is a bacteriostatic agent, but it also has bactericidal effect on some bacteria at high concentration. pharmacological action This product belongs to lincomycin. For lincomycin derivatives, antibacterial spectrum and lincomycin, clindamycin antimicrobial activity was 4 ~ 8 times. Gram-positive bacteria, such as Staphylococcus (including penicillin resistant strains), Streptococcus, diphtheria, Bacillus anthracis, and so on, have higher antibacterial activity. It also has good antimicrobial activity against gram negative anaerobic bacteria. Bacteroides is highly sensitive to this product, including fragile Bacteroides, Clostridium, digestive bacteria, digestive bacteria, Streptococcus pneumoniae, and so on. Gram negative aerobic bacteria, including Haemophilus influenzae, Neisseria, and mycoplasma, are resistant to this drug. This product has no cross resistance with penicillin, chloramphenicol, cephalosporins and tetracyclines. It is partially cross resistant with macrolides and has cross resistance with lincomycin. The mechanism of action of this product is to bind to the bacterial ribosomal 50S subunit and block the elongation of the peptide chain, thereby inhibiting protein synthesis in bacterial cells. This strain is a bacteriostatic agent, but it also has bactericidal effect on some bacteria at high concentration. Pharmacokinetics After intramuscular injection, the peak time of serum concentration (Tmax) was about 3 hours for adults and about 1 hours for children. Intravenous injection of this product 300mg, 10 minutes, serum concentration of 7 mg/L. The apparent volume of distribution (Vd) is about 94L. The protein binding rate of this product is high, 92%-94%. This product is wide distribution, can enter the respiratory system, saliva, sputum, pleural effusion, bile, liver, prostate, bladder, appendix, semen, soft tissue, bone and joints, but also through the placenta, but not easy to enter the cerebrospinal fluid. High levels can be found in bone tissue, bile, and urine. This product is metabolized in the liver, Some metabolites can retain antimicrobial activity. Metabolites excreted by bile and urine. About 10% of the dosage is excreted by the active ingredient, and the rest is excreted without active metabolites. The blood elimination half-life (t1/2) is about 3 hours, and the hepatic and renal dysfunction in t1/2 can be slightly prolonged. Hemodialysis and peritoneal dialysis can not remove this product. usage and dosage Intramuscular injection or intravenous drip. Adult 0.6 to 1.2g per day, 2~4 applications; serious infection: 1.2 to 2.4G a day, divided into 2~4 intravenous drip. 4 weeks and more than 4 weeks, children 15 to 25mg/kg a day, divided into 3~4 applications; serious infection: 25 to 40mg/ kg, 3~4 applications. The volume of intramuscular injection of this product can not exceed 1 600mg, more than this capacity should be changed to intravenous administration. The speed of intravenous administration should not be too fast. 600mg should be added to the infusion of no less than 100ml, with at least 20 minutes' infusion. Within 1 hours, the dose should not exceed 1200mg. Adverse reaction 1. gastrointestinal reactions: common nausea and vomiting, abdominal pain, diarrhea; severe cases of abdominal angina, abdominal pain, severe diarrhea (water or pus like), fever, abnormal thirst and fatigue (pseudomembranous colitis). Diarrhea, colitis and pseudomembranous colitis can occur in the initial stage of medication, also can produce several weeks after drug withdrawal. 2. blood system: occasionally can reduce the leucocyte, the neutrophil, the eosinophilia and the thrombocytopenia, and so on. Rare aplastic anemia. 3. allergic reactions: rash, itching and so on. Occasionally, urticaria, vascular edema and serum sickness reaction are rare. Exfoliative dermatitis, bullous dermatitis, erythema multiforme and Steven-Johnson syndrome are rare. 4. liver and kidney dysfunction, such as elevated serum aminotransferase, jaundice and so on. 5. intravenous drip may cause phlebitis; intramuscular injection may cause pain, induration and aseptic abscess locally. 6. other: tinnitus, dizziness, Candida infection, etc..