Antibiotics - Lincosamides: Nursing Pharmacology

Overview

Lincosamides are a class of antibiotics primarily used to treat severe infections caused by gram-positive and anaerobic bacteria. Clindamycin and lincomycin are the main drugs in this class, with clindamycin being the more commonly used due to its broader applications.

Key Drugs

• Clindamycin (Cleocin)
• Lincomycin (Lincocin)

Mechanism of Action

• Bacteriostatic at standard doses: Binds to the bacterial 50S ribosomal subunit, inhibiting protein synthesis and limiting bacterial growth.
• Bactericidal at high concentrations.

Indications

• Skin and soft tissue infections by gram-positive bacteria (e.g., staphylococci, streptococci)
• Active against community-acquired MRSA
• Anaerobic bacterial infections
• Prophylaxis of endocarditis in clients with valvular heart disease
• Treatment of Pneumocystis jirovecii pneumonia in HIV-positive clients
• Topical treatment for acne, rosacea; intravaginal use for bacterial vaginosis

Routes of Administration

• Oral (PO)
• Intramuscular (IM)
• Intravenous (IV)
• Topical (TOP)
• Intravaginal

Side Effects

• Gastrointestinal: Nausea, vomiting, diarrhea, abdominal cramps
• Severe: Clostridioides difficile infection (CDI), pseudomembranous colitis
• Hypersensitivity reactions: Stevens-Johnson syndrome, exfoliative dermatitis
• Injection site reactions
• Intravaginal: Redness, burning, itching, possible vaginal candidiasis

Contraindications & Cautions

• Pregnancy and breastfeeding
• Gastrointestinal or hepatic disease
• Stop if pseudomembranous colitis develops

Nursing Considerations

Assessment and Monitoring

• Baseline assessment of the affected area: Abscess size, drainage, redness, swelling, odor, pain
• Laboratory tests: CBC, hepatic and renal function, culture, and sensitivity
• Monitor IV, signs of infiltration, hypersensitivity, CDI
• Evaluate therapeutic response: Reduction in infection signs, decreased drainage and pain

Client Education

• Purpose: To treat infection
• Administration: Take four times a day with at least eight ounces of water, with or without food to reduce esophageal irritation
• Side Effects: Discuss potential nausea, vomiting, and bitter taste; take with food to mitigate
• Immediate notification for severe symptoms: Fever, abdominal pain, severe or bloody diarrhea

Contributors & Reviewers

• Authors: Anna Hernandez, MD; Kelsey LaFayette, BAN, RN
• Illustrator: Robyn Hughes, MScBMC
• Content Reviewers: Antonella Melani, MD; Lisa Miklush, PhD, RNC, CNS; Ashley Mauldin MSN, APRN, FNP-BC; Gabrielle Proper, RN, BScN, MN
• Contributors: Evan Debevec-McKenney; Jessica Reynolds, MS

Sources

• "Focus on Nursing Pharmacology" LWW (2019)
• "Pharmacology" Elsevier Health Sciences (2014)
• "Mosby's 2021 Nursing Drug Reference" Mosby (2020)
• "Saunders Comprehensive Review for the NCLEX-RN Examination" Saunders (2016)

This information is crucial for nursing students and professionals who need to understand the details and implications of prescribing and administering lincosamide antibiotics, particularly clindamycin, in clinical settings.