Is there really any role for clindamycin left? Linezolid just seems to be better for the few niches clinda had left. Oral, anti-toxin, and is better in regards to dosing, CDI, and resistance rates. Is there anything you'd still prefer clinda for? #IDSky #MedSky #PharmSky - ThreadSky

juliambisome.bsky.social • 116 days ago

Is there really any role for clindamycin left? Linezolid just seems to be better for the few niches clinda had left. Oral, anti-toxin, and is better in regards to dosing, CDI, and resistance rates. Is there anything you'd still prefer clinda for? #IDSky #MedSky #PharmSky

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jonathanrydermd.bsky.social•116 days ago

I’ve long wanted to write a review about how it has no role in clinical practice anymore.

That said, treating susceptible MRSA infections in pregnancy, areas of world with low clinda resistance, and being studied as adjunctive antitoxin in SAB in SNAP trial?

juliambisome.bsky.social•116 days ago

Think I prefer linezolid in TSS and necrotizing infections currently, but excited to get some data with SNAP!

jonathanrydermd.bsky.social•116 days ago

Same

askinnermd.bsky.social•116 days ago

I think the more interesting question is would a company move forward with clindamycin if it came to market today? If not, why are we still using it

juliambisome.bsky.social•116 days ago

Certainly won't see me advocating for it anywhere! Easily my most hated antimicrobial, give me vanc any day over clinda

drmichaelmarks.bsky.social•116 days ago

Less interactions than linezolid. Less cost than linezolid. Able to give longer courses. Resistance rates highly variable worldwide. For most of the anti toxin effect resistance may not even matter. More observational data (caveat emptor) of benefit as an anti-toxin drug.

jessecouk.bsky.social•116 days ago

PCP salvage therapy for some reason 🤷🏼‍♂️

juliambisome.bsky.social•116 days ago

Got me there, although not entirely convinced the clindamycin really does anything there 🤔"Clindamycin at 5 micrograms/ml was ineffective alone. Combinations of clindamycin and primaquine in culture at various concentrations were effective, but there was no evidence of true synergy."

jessecouk.bsky.social•112 days ago

🤷🏼‍♂️

juliambisome.bsky.social•112 days ago

Just saw this too. Maybe it does do something! Although still a skeptic🤔

juliambisome.bsky.social•116 days ago

Noskin GA, Murphy RL, Black JR, Phair JP. Salvage therapy with clindamycin/primaquine for Pneumocystis carinii pneumonia. Clin Infect Dis. 1992 Jan;14(1):183-8. doi: 10.1093/clinids/14.1.183. PMID: 1571426.

brainofbpharm.bsky.social•116 days ago

Not as much salvage, but PJP (PCP? 😛) and a true sulfa allergy is my one allowable use for clinda still!

juliambisome.bsky.social•116 days ago

Fortunately don't see a lot of PJP/PCP where I'm at so haven't had to come to this, and the few true sulfa allergies we've been able to desensitize!

kindaconfused.bsky.social•116 days ago

I’m not a doctor, just a mom. My daughter has a brain tumor and takes a RAF inhibitor. Uses Clindamycin to prevent skin infections, which could land her in the hospital. Your post caught my eye, and now I’m curious about Linezolid. Isn’t it meant for drug resistant bacteria?

juliambisome.bsky.social•116 days ago

Yes linezolid is often used for resistant bacteria! Clindamycin and linezolid both work for MRSA and are used in similar spots, hence the comparison. In your daughter's case it sounds like she takes clinda chronically, and linezolid can cause toxicity with long courses so may not be an option there

kindaconfused.bsky.social•114 days ago

Thank you for the clarification! I’m always trying to learn as much as possible.

juliambisome.bsky.social•116 days ago

I also only work with adults though too, pediatrics is a totally different world!

pharmgirlmagic.bsky.social•112 days ago

I see a lot of prescriptions from a dentist for this drug. I do feel there are better options out there but I’m also worried about coverage for different mouth bacteria and endocarditis.

juliambisome.bsky.social•112 days ago

It's too bad there's no studies looking at linezolid for this indication 😕 despite the common teaching being that linezolid only covers gram positives, it actually also has activity against both G+ and G- anaerobes, so would probably work pretty well in the mouth!

pedropoliti.bsky.social•116 days ago

Cost.

diorizzy.bsky.social•116 days ago

I avoid it completely unless I don’t have any other options, which is rare.

dralirobb.bsky.social•116 days ago

We love a bit of clinda here 🇬🇧 - probably mainly ££ but also the bone marrow

microlabdoc.bsky.social•116 days ago

Very much cost and also availability as liquid PO form in community for paediatrics

juliambisome.bsky.social•116 days ago

Pedi and pregnancy are maybe the only ares I could still see it being useful! Even then though, with all the new MRSA agents I feel that area will disappear as well with more data

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