Cinamycin600 mg/4 ml

Cinamycin 600 mg/4 ml is a lincosamide antibiotic indicated for the treatment of serious infections caused by susceptible anaerobic bacteria and susceptible strains of gram-positive bacteria, including Streptococci, Staphylococci and Pneumococci. It is particularly valuable where a patient is allergic to penicillin or where anaerobic organisms are involved.

Cinamycin 600 mg/4 ml is indicated in the treatment of the following infections when caused by susceptible organisms:

• Upper respiratory tract infections — such as tonsillitis, pharyngitis, sinusitis and otitis media.
• Lower respiratory tract infections — including bronchitis, pneumonia, empyema and lung abscess.
• Skin and soft tissue infections — such as cellulitis, boils, wound infections, erysipelas and abscesses.
• Bone and joint infections — including osteomyelitis and septic arthritis.
• Pelvic infections — such as endometritis, pelvic cellulitis and post-surgical vaginal cuff infection.
• Intra-abdominal infections — including peritonitis and intra-abdominal abscess.
• Septicaemia and endocarditis — in bloodstream and heart-valve infections caused by susceptible organisms.
• Dental infections — such as dental abscess and other odontogenic infections.

Cinamycin 600 mg/4 ml is also used as an alternative therapy, in combination with quinine or amodiaquine, for the treatment of multi-drug resistant Plasmodium falciparum (malaria) infection.

Macrolides

Clindamycin is a semisynthetic lincosamide antibiotic derived from lincomycin. It works by binding to the 50S subunit of the bacterial ribosome, inhibiting protein synthesis and thereby suppressing bacterial growth. Depending on the concentration achieved at the infection site and the susceptibility of the organism, clindamycin may be either bacteriostatic or bactericidal.

Clindamycin demonstrates activity against a broad range of clinically important organisms:

• Aerobic gram-positive cocci: Staphylococcus aureus, Staphylococcus epidermidis (both penicillinase-producing and non-penicillinase-producing strains), Streptococci and Pneumococci.
• Anaerobic gram-negative bacilli: Bacteroides species and Fusobacterium species.
• Anaerobic gram-positive non-spore-forming bacilli: Propionibacterium, Eubacterium and Actinomyces species.
• Anaerobic and microaerophilic gram-positive cocci: Peptococcus species, Peptostreptococcus species, microaerophilic streptococci and Clostridium perfringens.

Following oral administration, clindamycin is well absorbed and reaches therapeutic plasma concentrations rapidly. It is widely distributed into body fluids and tissues, including bone, which makes it especially useful in bone and joint infections. Clindamycin is metabolised in the liver and excreted mainly in the bile and faeces, with a smaller portion eliminated in the urine.

Cinamycin 600 mg/4 ml may interact with the following medicines, so the treating physician should be informed of all drugs the patient is taking:

• Neuromuscular blocking agents: Cinamycin 600 mg/4 ml enhances the action of other neuromuscular blocking agents. It should therefore be used with caution in patients receiving such agents, as this may lead to prolonged muscle relaxation.
• Erythromycin: Antagonism has been demonstrated between Cinamycin 600 mg/4 ml and erythromycin in vitro. Because of the possible clinical significance, these two drugs should not be administered concurrently.

Like all medicines, Cinamycin 600 mg/4 ml may cause side effects, although not everybody experiences them. The following adverse effects have been reported with the use of Cinamycin 600 mg/4 ml:

• Abdominal pain
• Oesophagitis and oesophageal ulcer
• Nausea and vomiting
• Diarrhoea
• Pruritus (itching)
• Skin rashes
• Urticaria (hives)

Persistent, watery or bloody diarrhoea during or after treatment should be reported to a physician promptly, as antibiotics such as Cinamycin 600 mg/4 ml can occasionally be associated with serious inflammation of the bowel.

Pregnancy Category B. Cinamycin 600 mg/4 ml crosses the placenta in humans; after multiple doses, amniotic fluid concentrations have been measured at approximately 30% of maternal blood concentrations. Cinamycin 600 mg/4 ml should be used during pregnancy only if clearly needed and under the supervision of a physician.

Cinamycin 600 mg/4 ml has been reported to appear in breast milk. It is therefore not recommended for nursing mothers unless clearly needed and the potential benefit justifies the potential risk to the infant.

Cinamycin 600 mg/4 ml should be prescribed with caution in individuals with a history of gastrointestinal disease, particularly colitis. As with any antibiotic, prolonged use may occasionally result in overgrowth of non-susceptible organisms. The full prescribed course should always be completed, even if symptoms improve early, to reduce the risk of relapse and antibiotic resistance.

Overdosage with orally administered Cinamycin 600 mg/4 ml has been rare. Adverse reactions similar to those seen with normal doses can be expected, though unexpected reactions may occur. Haemodialysis and peritoneal dialysis are not effective in removing Cinamycin 600 mg/4 ml from the serum. There is no specific antidote; overdosage should be managed with supportive care and simple gastric lavage where appropriate.

Keep the medicine below 30°C, away from light and moisture. Keep out of the reach of children. Do not use after the expiry date printed on the pack.

• Newborns and infants: When Cinamycin 600 mg/4 ml is administered to newborns and infants (birth to 16 years of age), appropriate monitoring of organ system functions is desirable.
• Geriatric use: Dose adjustment of Cinamycin 600 mg/4 ml is not necessary in elderly patients.

Powder for Oral Solution

Shake the bottle well to loosen the powder. Add 80 ml of boiled and cooled water to the dry mixture in the bottle. For ease of preparation, add the water in two portions, shaking well after each addition until all the powder is fully dissolved. Keep the bottle tightly closed. The reconstituted solution should be used within 2 weeks when kept at room temperature.

Dilution of Clindamycin Injection for Intravenous Use

Clindamycin phosphate must be diluted before intravenous administration. The concentration of clindamycin in the infusion diluent should not exceed 18 mg per ml, and infusion rates should not exceed 30 mg per minute. Administration of more than 1200 mg in a single one-hour infusion is not recommended. Single intramuscular injections greater than 600 mg are not recommended. Dilution is not required for intramuscular administration. Parenteral products should be inspected visually for particulate matter and discolouration prior to administration whenever the solution and container permit.

Dilution & Compatibility

Physical and biological compatibility studies monitored for 24 hours at room temperature have demonstrated no inactivation or incompatibility of clindamycin phosphate sterile solution in intravenous solutions containing sodium chloride, glucose, calcium or potassium, and in solutions containing vitamin B-complex at concentrations normally used clinically. No incompatibility has been demonstrated with the antibiotics cephalothin, kanamycin, gentamicin, penicillin or carbenicillin. Diluted solutions of clindamycin injection remain physico-chemically stable for 16 days at 25°C (room temperature) and for 32 days at 4°C (refrigeration).