Lincomycin

Pronunciation: LIN-koe-MYE-sin
Class: Antibiotic

Trade Names

Lincocin
- Injection 300 mg/mL

Pharmacology

Suppresses bacterial protein synthesis.

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Pharmacokinetics

Absorption

Following IM administration, average C max is 11.6 mcg/mL at 60 min and therapeutic levels are maintained for 17 to 20 h for most susceptible gram-positive organisms. Following a 2-hour IV infusion, average C max is approximately 16 mcg/mL and therapeutic levels are maintained for 14 h for most susceptible gram-positive organisms.

Elimination

Urinary excretion following IM and IV administration ranges from 1.8% to 24.8% and 4.9% to 30.3%, respectively. The t ½ is 5.4 h. Biliary excretion is an important route of elimination.

Special Populations

Renal Function Impairment

Serum t ½ may be prolonged in patients with severe renal function impairment.

Hepatic Function Impairment

Serum t ½ may be 2-fold longer in patients with abnormal hepatic function.

Indications and Usage

Treatment of serious infections caused by susceptible strains of streptococci, pneumococci, and staphylococci. Reserve use for patients in whom penicillin is inappropriate.

Contraindications

Hypersensitivity to lincomycin or clindamycin.

Dosage and Administration

Adults

IV For serious infections, administer 600 to 1,000 mg every 8 to 12 h. For more severe infections, the dose may be increased. In life-threatening infections, doses up to 8 g/day have been given (max, 8 g/day).

Children older than 1 mo of age

IV 10 to 20 mg/kg/day (5 to 10 mg/lb/day) depending on the severity of the infection; administer in divided doses.

Adults

IM For serious infections, administer 600 mg every 24 h. For more severe infections, 600 mg every 12 h or more often.

Children older than 1 mo of age

IM For serious infections, administer 10 mg/kg (5 mg/lb) every 24 h. For more severe infections, 10 mg/kg (5 mg/lb) every 12 h or more often.

Adults

Subconjunctival 75 mg (0.25 mL)

Severe Renal Function Impairment
Adults and Children older than 1 mo of age

IV / IM Appropriate dose is 25% to 30% of that recommended for patients with healthy renal function.

General Advice

  • IV concentration and rate: 600 to 1,000 mg: Use 100 mL of diluent and administer over a period of not less than 1 h. 2 g: Use 200 mL of diluent and administer over a period of not less than 2 h. 3 g: Use 300 mL of diluent and administer over a period of not less than 3 h. 4 g: Use 400 mL of diluent and administer over a period of not less than 4 h.

Storage/Stability

Store at 68° to 77°F.

Drug Interactions

Aluminum salts

GI absorption of lincomycin may be decreased and delayed.

Erythromycin

May cause antagonism.

Neuromuscular blocking agents

May enhance the effects of neuromuscular blocking agents.

Laboratory Test Interactions

None well documented.

Adverse Reactions

Cardiovascular

Cardiopulmonary arrest and hypotension following too rapid IV administration.

Dermatologic

Erythema multiforme; exfoliative and vesiculobullous dermatitis; rash; Stevens-Johnson syndrome; urticaria.

EENT

Tinnitus; vertigo.

GI

Colitis; diarrhea; glossitis; nausea; pruritus ani; pseudomembranous colitis; stomatitis; vomiting.

Genitourinary

Azotemia; oliguria; proteinuria; vaginitis.

Hematologic-Lymphatic

Agranulocytosis; aplastic anemia; leukopenia; neutropenia; pancytopenia; thrombocytopenic purpura.

Hepatic

Abnormal LFT (particularly serum transaminase); jaundice.

Hypersensitivity

Anaphylaxis; angioneurotic edema; serum sickness.

Precautions

Warnings

Lincomycin can cause Clostridium difficile –associated diarrhea (CDAD), which may range in severity from mild diarrhea to fatal colitis. Hypertoxin-producing strains of C. difficile can be refractory to antimicrobial therapy and may require colectomy. Consider CDAD in all patients presenting with diarrhea following lincomycin use; it may occur later than 2 mo after therapy. Promptly manage cases by administering appropriate fluids, electrolytes, protein supplementation, and antibiotic treatment.


Monitor

Monitor patients, especially elderly patients, for changes in bowel frequency. Perform periodic hepatic and renal function tests and blood cell counts.


Pregnancy

Category C .

Lactation

Excreted in breast milk.

Children

Safety and efficacy not established in children younger than 1 mo of age.

Elderly

May be more susceptible to changes in bowel frequency.

Renal Function

Serum t ½ may be prolonged in patients with severe renal function impairment. Use with caution.

Hepatic Function

Serum t ½ may be 2-fold longer in patient with abnormal hepatic function. Use with caution.

Special Risk Patients

Use with caution in patients with a history of asthma, significant allergies, or GI disease, particularly colitis

Superinfection

May result in bacterial, fungal, or yeast overgrowth of nonsusceptible organisms.

Anaphylactoid reactions

Serious anaphylactoid reactions requiring immediate emergency treatment may occur.

Benzyl alcohol

Sterile solution contains benzyl alcohol as a preservative, which has been associated with fatal gasping syndrome in premature infants.

Cardiopulmonary reactions

May occur when the drug is administered at greater than the recommended concentration and rate.

Meningitis

Drug levels in the CSF may be inadequate for the treatment of meningitis.

Overdosage

Symptoms

No data.

Patient Information

  • Instruct patients to contact health care provider as soon as possible if watery or bloody stools occur.
  • Instruct patients not to stop taking this medicine, even if they start to feel better.

Copyright © 2009 Wolters Kluwer Health.

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