Clindamycin, also known as clomithromycin, is a derivative of lincomycin and has good antibacterial effects on various anaerobic bacteria. It is suitable for the treatment of respiratory infection, urinary system infection, female pelvic and genitals infection, skin and soft tissue infection, bone and joint infection, intraperitoneal infection, and so on. Clindamycin is not suitable for central nervous system infection, because its ability to penetrate blood brain barrier is very poor.
Clindamycin injection includes clindamycin hydrochloride injection and clindamycin phosphate injection. Due to the "bias" injection of some patients, and before clindamycin injection does not need to do an allergy test, so clindamycin abuse at the base is very serious, resulting in many adverse drug reactions and adverse drug events.
Vigilance of the severe adverse reaction of clindamycin injection
In the national drug adverse reaction monitoring center case report database, the adverse reaction / event problem of clindamycin injection is more serious, mainly with systemic damage, respiratory system damage and urinary system damage, among which the problems of acute renal function damage and hematuria are relatively prominent.
1. Anaphylactic shock
Typical cases: a patient, a male, 18 years old. Because of acute upper respiratory tract infection, Clindamycin Hydrochloride Injection 0.9g intravenous drip, 5 minutes after the patient complained of dizziness, sweating, pale face, blood pressure 60/40mmHg, and then unaware. Immediately stop infusion, oxygen inhalation, adrenalin 1 mg, dexamethasone 10 mg treatment. 5 minutes later, the patient was conscious and the symptoms improved.
2. Acute renal impairment, hematuria
Typical cases: patients, women, 44 years old. Due to sore throat and fever, Clindamycin Phosphate Injection 1.8g was given intravenous infusion of 150 ml in saline 150 ml. After infusion, the patient appeared hematuria, hematuria, no blood clot in urine, low back acid, less urine, 459.5umol/L on the following day, diagnosis of acute renal failure.
3. Severe cardiovascular and respiratory depression
Clindamycin undiluted direct injection or a large number of rapid drops can cause serious cardiovascular and respiratory adverse reactions, so clindamycin injection should be diluted to 6mg/ml, and the injection rate is less than 30mg/min. That is, 0.6g clindamycin phosphate can be diluted to 100ml liquid at least. The infusion time should be more than 20 minutes, and no more than 0.6g per time.
Serious adverse events caused by irrational use of drugs
The analysis of the severe adverse reaction / event report of clindamycin injection in the National Center database shows that the product has clinical irrational use, and the problem of irrational use of drugs has been the main cause of serious adverse events. The main manifestations of irrational drug use are as follows:
1. Use of hyper adaptation
In the clindamycin injection specification, it is clear that it is suitable for infectious diseases caused by gram-positive and anaerobic bacteria, but the state center database has the presence of clindamycin injection for the use of the virus infection.
Typical cases: patients, women, 34 years old. The clindamycin phosphate (clindamycin phosphate) was given 250ml intravenous drip for the labial herpes. At nearly half of the infusion, the patients had palpitations, chills, chills, and blood pressure of 60/30mmHg, and were given dopamine and elevation of the blood pressure.
2. Excessive dosage and improper usage
The instructions in clindamycin injection clearly indicate that this product can be administered intravenously or intramuscularly. Adult, dose as follows: moderate infection: 0.6 ~ 1.2g/ day, can be divided into 2-4 doses; severe infection: 1.2 ~ 2.4g/ day, can be divided into 2-4 doses, or follow the doctor's advice.
The National Center database shows that the use of super dose is serious. It is not reasonable to reduce the number of doses and increase the dose each time, which is more likely to lead to adverse reactions and can not maintain effective blood concentration.
Typical cases: patients, women, 35 years old. Due to uterine myoma and chronic cervicitis, abdominal hysterectomy was performed with normal routine examination of preoperative urination, normal liver function and renal function examination: creatinine 51.4umol/L and urea 3.98mmol/L. 1 days before the operation, the patients were given Clindamycin Hydrochloride for Injection 2.4G once a day. The urine volume decreased at first days after the operation. Second days after operation, B ultrasound examination showed double kidney parenchyma echo, bilateral ureter dilatation and renal function examination: creatinine 363.1 mu mol/L.
3. The problem of drug use in children
Children in January or above, 15 to 25mg/kg daily, divided into 3~4 times intramuscular or intravenous drip; severe infection 25 to 40mg/kg, 3~4 times intramuscular injection or intravenous drip.
Although the instructions were used to mark the amount of weight per kilogram of children in the "usage" section, there were still different levels of super dose drug use in children.
Typical case: child, male, 2 years old 8 months, 15kg. Mino was first given cephalosporin (negative for cephalosporin Mino skin test) because of tonsillitis. 1.0g was injected intravenously with normal saline 100ml. Two days after the drug use, add clindamycin 0.4g into 5% Glucose Injection 100ml intravenous drip, medication for 1 minutes or so, children's throat edema, pale face, lip cyanosis, nausea, vomiting, whole body wet cold, immediately stop medicine. After intravenous injection of dexamethasone 5mg, hypodermic injection of epinephrine 0.25mg, and mask oxygen inhalation, the vital signs of children were basically stable.
Other common adverse reactions of clindamycin
1, digestive tract reaction
When clindamycin is applied, we should closely observe the digestive tract adverse reactions after clindamycin withdrawal. Clindamycin is metabolized in the liver.