Lincomycin: Uses, Dosage, Side Effects and Interactions

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Description of Lincomycin

Lincomycin is a lincosamide antibiotic derived from bacteria Streptomyces lincolnensis with primarily bacteriostatic activity against gram positive aerobes (Staphylococcus, Streptococcus, Pneumococcus, Bacillus anthracis, Corynebacterium diphtheria) and a wide range of anaerobic bacteria (Eubacterium, Propionibacterium, Peptococcus, Peptostreptococcus spp., and many strains of Clostridium perfringens and Cl. tetani).

Pharmacokinetics of Lincomycin

  • Food markedly reduces the rate and extent of absorption of lincomycin.
  • Lincomycin is widely distributed in the tissues including bone and body fluids but diffusion into the CSF is poor, it diffuses across the placenta.
  • Lincomycin is partially inactivated in the liver and is excreted as unchanged drug or metabolites in the urine and feces.

Indications and Uses of Lincomycin

Lincomycin is used in the treatment of serious infections of:

  • Ear-Nose-Throat
  • Mouth
  • Skin
  • Genital tract
  • Bone
  • Joint
  • Postoperative abdominal area
  • Bronchopulmonary infections
  • Septicaemia.

Dosage and Administration of Lincomycin

Oral Route Dosage

  • Take oral lincomycin on an empty stomach (1 hour before or 2 hours after meal) as food decreases its absorption.
  • As prescribed by the physician.

Adults: 1 Capsule of 500 mg 3 times daily. In severe cases; 2 Capsules, 3 times daily

Children: 30mg/kg/day in 3-4 divided doses. In severe cases; 60mg/kg/day in 3-4 divided doses.

Parenteral Route Dosage

Adult Dosage

IV doses

  • Infuse over ≥60mins.
  • Serious infections: 600 mg IM every 24hrs or 600mg–1g IV every 8–12hrs.
  • More severe infections: 600mg IM every 12hrs (or more often), or doses up to max 8g/day IV have been used for life-threatening infections.
  • Subconjunctival injection: 75mg subconjunctivally will result in ocular fluid levels of antibiotic with MICs sufficient for most susceptible pathogens.
  • In severe renal impairment: give 25–30% of recommended dose.

Children Dosage:

  • <1month: Safety not established.
  • IV doses: infuse over ≥60mins.
  • ≥1month: Serious infections: 10mg/kg IM every 24hrs.
  • More severe infections: 10mg/kg IM every 12hrs or more often.
  • Depending on severity of infection, it may also be give 10–20mg/kg/day IV in divided doses

Patients with renal impairment may require a reduction to one-third to one-half of the usual dose.

Contraindications or When  not to use Lincomycin

  1. Lincomycin should not be used by those who are hypersensitivity to it or to other Lincosamides.
  2. It should not be used to treat Meningitis (as it doesn’t reach the cerebrospinal fluid in significant concentrations)

Mechanism of Action of Lincomycin

How does Lincomycin work?

Lincomycin inhibits protein synthesis in susceptible bacteria by binding to the 50 S subunits of bacterial ribosomes. This prevents peptide bond formation upon transcription. Lincomycin is bacteriostatic, but may be bactericidal in high concentrations or when used against highly susceptible organisms.

Precautions

  • Patients with GI diseases, especially those with history of colitis
  • Elderly and women may be prone to developing severe diarrhea or pseudomembranous colitis.
  • Patients with allergy.
  • Periodic tests of liver and blood counts have been recommended in patients receiving prolonged therapy and in infants.
  • Caution should be exercised in patients receiving neuromuscular blocking agents.

Lincomycin Use in Pregnancy and Lactation

  • No adequate studies done on lincomycin to determine safe and effective use in pregnant women
  • Caution should be exercised when it is given to pregnant women.
  • Lincomycin may be excreted in small amounts in breast milk. Nursing mothers should not use or stop nursing when using the medication.

Lincomycin Interactions with Drugs

  1. Kaolin containing antidiarrheal preparations tend to decrease intestinal absorption of Lincomycin. To avoid this, take Lincomycin 2 hours apart from kaolin administration,
  2. Sodium cyclamate may decrease Lincomycin absorption.
  3. Oral contraceptive effect may be inhibited or decreased by lincomycin
  4. Lincomycin should be used with caution with neuromuscular blocking medications as it may increase their effects of neuromuscular blockage and lead to respiratory depression.

Side Effects of Lincomycin

Common

  1. nausea
  2. Vomiting
  3. Darrhea.

Occasional

  1. Urticaria
  2. Skin rashes
  3. Microflora disturbance

Rare

  1.  Anaphylaxis
  2.  Neutropenia (reversible)
  3. Elevated liver enzymes (reversible).
  4. pseudomembranous colitis
  5. Esophagitis,

The above listed side effects of Lincomycin is not exhaustive. Please inform your doctor about side-effects when using the medicine.

Lincomycin Overdosage and Its Treatment

  • After an acute oral overdose, patients may experience nausea, vomiting and diarrhea.
  • Life threatening allergic reactions may occur.
  • There is no specific antidote.
  • Management generally involves symptomatic and supportive measures and may include enhanced elimination by suitable means.
  • Maintain an open airway, and assist ventilation if necessary.
  • Replace fluid loss if required.
  • Serum level of Lincomycin is not appreciably affected by hemodialysis and peritoneal dialysis.
  • Should overdose occur, turn to the nearest healthcare facility for medical attention of the healthcare professionals.

Shelf-Life of Lincomycin:

24 months from the manufacturing date.

Never use after the expiry date clearly indicated on the outer packaging.

Storage of Lincomycin

Store in a cool, dry place below 30°C. Protect from light.

Chemical Structure of Lincomycin

Lincomycin chemical structure
Source: PubChem

 

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