Thursday, October 21, 2021

Dosage, Side Effects and More

  • Clindamycin is prescribed as an oral or topical antibiotic for bacterial infections
  • Topical clindamycin effectively treats mild–severe acne 
  • Improvements can be seen within 2–6 weeks of starting treatment
  • Clindamycin is typically combined with other acne medications 

Acne vulgaris is a very common skin condition that develops when pores become clogged with oil, dead skin cells and debris. Bacteria plays a central role in acne development, making antibiotic therapy a staple in acne treatment. Clindamycin for acne is an antibiotic that is typically prescribed in combination with another medication for greater efficacy.   

If left untreated, mild symptoms can worsen and progress to more severe acne formation. Whether mild, moderate or severe, acne can cause long-lasting or permanent scarring. 

What Is Clindamycin?

Clindamycin is an antibiotic that was developed in the 1960s by chemically modifying lincomycin, a natural antibiotic. It works by interfering with bacterial protein production, halting the growth and replication of bacteria.

Clindamycin can treat many skin and soft tissue infections, diabetic foot infections, bone and joint infections, lung infections, vaginal infections and some infections inside the abdomen and pelvis. It also has some effectiveness against certain nonbacterial pathogens such as malaria and toxoplasma.

How Clindamycin Works to Treat Acne

Clindamycin works against a type of skin bacteria called Cutibacterium acnes (formerly Propionibacterium acnes), which is closely linked to the development of acne.

In addition to its action against bacteria, clindamycin can suppress inflammation in the skin. Inflammation produces swelling and accumulation of material in skin pores, leading to the development of inflamed acne lesions.

Results

Clindamycin can produce significant reductions in the number and severity of both inflammatory and noninflammatory acne lesions. However, the best results are achieved when clindamycin is combined with another topical acne medication such as benzoyl peroxide, adapalene or tretinoin.

A large analysis conducted by Harvard investigators included 23 clinical studies, and compared clindamycin to benzoyl peroxide and clindamycin and benzoyl peroxide combination therapy. The following improvements in inflamed and noninflamed acne lesions were noted:

TreatmentMean reduction in inflamed lesions at 10–12 weeksMean reduction in noninflamed lesions at 10–12 weeks
Clindamycin alone45.9%32.6%
Benzoyl peroxide alone43.7%30.9%
Clindamycin and benzoyl peroxide55.6%40.3%

As combination therapy provides greater results, two medications are typically prescribed. Topical clindamycin with benzoyl peroxide is a first-line treatment for mild acne. The combination of clindamycin with a topical retinoid (such as adapalene or tretinoin) or with oral antibiotics is recommended for moderate-to-severe acne.

How long does it take to work?

The Harvard analysis showed that at 2–4 weeks, there was a 21.5% reduction in inflammatory acne lesions in people treated with clindamycin alone. Those who were treated with clindamycin and benzoyl peroxide saw a 40.7% reduction.

In general, many people will see improvements in their skin within 2–6 weeks, however for others it could take longer to see improvements. The severity of the acne as well as individual response plays a large role in determining outcome. Regardless of the results, you should not stop treatment on your own without first consulting your dermatologist. 

Topical Clindamycin for Acne

Topical clindamycin is available in the form of gels (Cleocin-T, Clindagel), lotions (Cleocin-T), foams (Evoclin), solutions (Cleocin-T), and pledgets or medicated wipes (Clindacin ETZ, Clindacin-P, Cleocin-T). Generic forms are also available.

Compared to oral clindamycin, topical clindamycin has the benefit of limiting the drug’s effects to the skin. This is safer as it avoids some of the risks associated with systemic clindamycin therapy like antibiotic-associated diarrhea.  

How to use it 

Before applying clindamycin, thoroughly wash the affected area with a mild cleanser and warm water, then rinse and gently pat dry with a towel. After applying clindamycin, wash your hands to thoroughly remove any residue.

If you are using clindamycin foam, spray the medication into the cap that covers the nozzle. Remove small amounts from the cap using your fingertips and gently apply to your skin. Keep massaging until the foam disappears.

The topical solution form of clindamycin is available in a bottle with an applicator tip. Gently press this tip to your skin in a dabbing motion and repeat to cover the treatment area.

For lotions and gels, use your fingertips to spread a thin layer of the medication over the targeted area.

If you are using medicated pads, gently wipe the skin with the pad then discard it. You can use more than one pad if the treatment area is large.

Dosage

Most forms of topical clindamycin are found in a 1% concentration. Combination forms with tretinoin (Veltin, Ziana) contain 1.2% clindamycin and 0.025% tretinoin.

The foam form is typically used once a day; gels, lotions, solutions and pledgets are usually applied twice a day.

Oral Clindamycin for Acne

In the past, oral clindamycin was prescribed for the treatment of acne vulgaris. Although effective, oral clindamycin is no longer recommended for acne due to the risk of causing dangerous side effects.

When taken by mouth, clindamycin can disturb the natural gut microbiome and cause an overgrowth of a type of bacteria called Clostridium difficile. This can result in pseudomembranous colitis, an inflammation of the colon that can lead to serious complications such as perforation of the colon and can even be lethal in some cases.

Up to 21% of patients who take clindamycin can experience diarrhea. 

Side Effects and Risk Factors

Topical clindamycin is quite safe, and its side effects are mild and self-resolving. Side effects can include skin dryness, redness, irritation, itching and exfoliation. Although very rare, diarrhea and colitis have been reported in a few cases following the use of topical clindamycin.

Data on the safety of topical clindamycin during pregnancy and breastfeeding is lacking. Although breastfeeding and pregnant women can use clindamycin, they should avoid prolonged use of the medication.

Dermatologists will typically prescribe clindamycin along with other acne medications to reduce the risk of developing bacterial resistance to the antibiotic. One common treatment strategy is using clindamycin alongside benzoyl peroxide for greater results. 

Alternatives

Topical antibiotic therapy is an important component in the treatment of acne. Benzoyl peroxide, erythromycin, dapsone and minocycline are topical medications that can kill acne-causing bacteria.

Benzoyl peroxide

Although not technically an antibiotic, benzoyl peroxide has antimicrobial activity. Benzoyl peroxide works quickly to kill acne-causing bacteria by releasing oxygen within the follicles.

Benzoyl peroxide can also reduce the production of irritating fatty acids and clear dead skin cells and debris that plug pores.

Dapsone

Topical dapsone is an antibiotic with moderate efficacy at treating acne lesions, particularly inflammatory ones. Dapsone has been found to be more effective in women than in men.

Erythromycin

Erythromycin is a macrolide antibiotic with activity against bacteria. Erythromycin and clindamycin have comparable effectiveness and safety, and are used similarly.

Takeaway

Clindamycin is an antibiotic that is effective in killing acne-causing bacteria. When used topically in combination with other acne medications such as benzoyl peroxide or tretinoin, it can treat mild, moderate or severe acne. The oral form of clindamycin is not recommended as a treatment for acne due to the associated severe side effects.

Topical clindamycin is available in a number of formulations. Your dermatologist will determine which would be best for you based on your skin type and acne severity. For best results, follow all instructions carefully, and speak to your dermatologist before stopping treatment.

Sources

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  • Pradhan S, Madke B, Kabra P, Singh AL. Anti-inflammatory and Immunomodulatory Effects of Antibiotics and Their Use in Dermatology. Indian J Dermatol. 2016;61(5):469-481. doi:10.4103/0019-5154.190105
  • Elizabeth M. Seidler, Alexa B. Kimball. Meta-analysis comparing efficacy of benzoyl peroxide, clindamycin, benzoyl peroxide with salicylic acid, and combination benzoyl peroxide/clindamycin in acne. Journal of the American Academy of Dermatology, Volume 63, Issue 1, 2010, Pages 52-62, ISSN 0190-9622. https://doi.org/10.1016/j.jaad.2009.07.052
  • John E Wolf, David Kaplan, Stephen J Kraus, Keith H Loven, Toivo Rist, Leonard J Swinyer, Michael D Baker, Yin S Liu, Janusz Czernielewski. Efficacy and tolerability of combined topical treatment of acne vulgaris with adapalene and clindamycin: a multicenter, randomized, investigator-blinded study 1 1Disclosures: John Wolf has served as a consultant and Speaker Bureau member for Galderma. Michael Baker is a former employee and current consultant to Galderma R&D Inc. Two of the authors are employees of Galderma. The other authors have no conflict of interest to disclose. Journal of the American Academy of Dermatology, Volume 49, Issue 3, Supplement, 2003, Pages S211-S217, ISSN 0190-9622. https://doi.org/10.1067/S0190-9622(03)01152-6
  • James J. Leyden, Lincoln Krochmal, Alex Yaroshinsky. Two randomized, double-blind, controlled trials of 2219 subjects to compare the combination clindamycin/tretinoin hydrogel with each agent alone and vehicle for the treatment of acne vulgaris. Journal of the American Academy of Dermatology, Volume 54, Issue 1, 2006, Pages 73-81, ISSN 0190-9622. https://doi.org/10.1016/j.jaad.2005.04.046
  • Elizabeth M. Seidler, Alexa B. Kimball. Meta-analysis comparing efficacy of benzoyl peroxide, clindamycin, benzoyl peroxide with salicylic acid, and combination benzoyl peroxide/clindamycin in acne. Journal of the American Academy of Dermatology, Volume 63, Issue 1, 2010, Pages 52-62, ISSN 0190-9622. https://doi.org/10.1016/j.jaad.2009.07.052
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  • Schäffler H, Breitrück A. Clostridium difficile – From Colonization to Infection. Front Microbiol. 2018;9:646. Published 2018 Apr 10. doi:10.3389/fmicb.2018.00646
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