Pharmacokinetic variability of clindamycin and influence of rifampicin on clindamycin concentration in patients with bone and joint infections

Curis, Emmanuel; Pestre, Vincent; Jullien, Vincent; Eyrolle, L.; Archambeau, Denis; Morand, P; Gatin, L.; Karoubi, M.; Pinar, Nicolas; Dumaine, Valérie; Van, Jean-Claude Nguyen; Babinet, Antoine; Anract, Philippe; Salmon, Dominique

doi:10.1007/s15010-015-0773-y

Cited by 33 publications

(25 citation statements)

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“…2. for pharmacokinetic explanations, it is demonstrated that cotreatment with RF reduces CL plasma concentrations, with a probable drug underexposure at the infection site (Curis et al, 2015;Join-Lambert et al, 2014). This phenomenon is to be correlated with the RF ability to induce the cytochrome CYP3A4…”

Section: Discussionmentioning

confidence: 97%

“…To counter the threat of resistance, RF should be preserved, as its use, in combination therapy for nonmycobacterial infections, is ever more frequent. In addition to the well‐known use in prosthetic valve endocarditis (PVE) therapy (Habib et al, ) (given its ability to penetrate through biofilm), other possible uses are either currently accepted or under investigation: RF use in MRSA infections (Purrello et al, ), antibiotic regimens with RF for targeted treatment of infections caused by extensively drug‐resistant carbapenem‐resistant Pseudomonas aeruginosa (XDR CRPa)/ Acinetobacter baumannii (XDR CRAb) (Papst et al, ), minocycline/rifampicin‐impregnated central venous catheters for preventing central line‐associated bloodstream infections (CLABSIs) in the intensive care unit (ICU) setting (Bonne et al, ), and telavancin combined with rifampicin against MRSA in an in vitro biofilm model (Jahanbakhsh, Singh, Yim, Rose, & Rybak, ) are just a few examples. for pharmacokinetic explanations, it is demonstrated that co‐treatment with RF reduces CL plasma concentrations, with a probable drug underexposure at the infection site (Curis et al, ; Join‐Lambert et al, ). This phenomenon is to be correlated with the RF ability to induce the cytochrome CYP3A4 (responsible for CL metabolism) (Sousa, Pozniak, & Boffito, ). for RF possible effect on the intestinal microbiota, nowadays, when considering a long‐lasting antibiotic therapy, the present authors cannot help but consider its effect on the intestinal microbiota.…”

Section: Discussionmentioning

confidence: 99%

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Clindamycin as unique antibiotic choice in Hidradenitis Suppurativa

Rosi

Pescitelli

Ricceri

et al. 2018

Dermatologic Therapy

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The rifampicin (RF)–clindamycin (CL) combination is recommended as first line therapy in moderate to severe Hidradenitis Suppurativa (HS) by European S1 guidelines. Although prolonged use of RF should be discouraged, there are currently few alternatives to this combination therapy. The aim of the present study was to assess retrospectively the efficacy of oral CL monotherapy in patients diagnosed with HS. In the period January 2017–May 2018, 31 HS patients who received a 300 mg b.i.d. oral dose of CL were studied retrospectively. Efficacy of the treatment was evaluated by comparing the main HS severity scores (Sartorius score modified by Revuz, Hidradenitis Suppurativa Physician Global Assessment [HS‐PGA] and International Hidradenitis Suppurativa Severity Score System [IHS4]) before (W0) and after (W12) CL oral therapy. CL efficacy was demonstrated by the extreme and significant reduction of all three disease severity parameters during the 12‐week period (p ≤ .01). There was also a statistically significant change in the mean visual analogue scale for pain. The present study demonstrates the efficacy of oral CL monotherapy as RF‐sparing regimen alternative to RF–CL combination in a selected group of patients.

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Section: Discussionmentioning

confidence: 97%

Section: Discussionmentioning

confidence: 99%

Clindamycin as unique antibiotic choice in Hidradenitis Suppurativa

Rosi

Pescitelli

Ricceri

et al. 2018

Dermatologic Therapy

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“…While performing this study, two articles on the pharmacokinetics of the clindamycin-rifampin combination regimen were published [34, 35]. Bernard et al and Cruris et al reported a dramatic reduction of clindamycin serum concentration in patients receiving clindamycin with rifampin compared to patients receiving clindamycin without rifampin.…”

Section: Discussionmentioning

confidence: 99%

Clindamycin-rifampin combination therapy for staphylococcal periprosthetic joint infections: a retrospective observational study

et al. 2017

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BackgroundStaphylococcal species account for more than 50% of periprosthetic joint infections (PJI) and antimicrobial therapy with rifampin-based combination regimens has been shown effective. The present study evaluates the safety and efficacy of clindamycin in combination with rifampin for the management of staphylococcal PJI.MethodsIn this retrospective cohort study, patients were included who received clindamycin-rifampin combination therapy to treat a periprosthetic hip or knee infection by Staphylococcus aureus or coagulase-negative staphylococci. Patients were treated according to a standardized treatment algorithm and followed for a median of 54 months.Of the 36 patients with periprosthetic staphylococcal infections, 31 had an infection of the hip, and five had an infection of the knee. Eighteen patients underwent debridement and retention of the implant (DAIR) for an early infection, the other 18 patients underwent revision of loose components in presumed aseptic loosening with unexpected positive cultures.ResultsIn this study, we report a success rate of 86%, with five recurrent/persistent PJI in 36 treated patients. Cure rate was 78% (14/18) in the DAIR patients and 94% (17/18) in the revision group. Five patients (14%) discontinued clindamycin-rifampin due to side effects. Of the 31 patients completing the clindamycin-rifampin regimen 29 patients (94%) were cured.ConclusionCombined therapy with clindamycin and rifampin is a safe, well tolerated and effective regimen for the treatment of staphylococcal periprosthetic infection.

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“…For rifampicin it takes only 9–12 days to reach maximum levels . This enzyme induction significantly reduces clindamycin levels in patients treated with the combination of clindamycin and rifampicin . Reversal of the rifampicin‐induced hypermetabolism takes about 2–4 weeks .…”

Section: Critical Appraisal Of the Evidencementioning

confidence: 99%

Long‐term clinical safety of clindamycin and rifampicin combination for the treatment of hidradenitis suppurativa. A Critically Appraised Topic

et al. 2018

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Clinical question/scenario Can therapy with clindamycin and rifampicin be safely continued long term beyond the recommended 10-week course? Background Clindamycin and rifampicin are used in combination to treat hidradenitis suppurativa (HS). There is no data on the efficacy and safety of clindamycin/rifampicin combination therapy for HS beyond 10 weeks. Methods We identified the following major concerns that still lack a proper evidenced-based analysis: for rifampicin, drug-induced liver injury, interstitial nephritis, drug interaction and hepatic p450 3A4 enzyme induction; for clindamycin, the concern was community-acquired Clostridium difficile infection (CA-CDI); and experience with long-term treatment. Data sources were used as appropriate to answer the question. Systematic searches were used to assess the risk of CA-CDI and experience with long-term treatment with clindamycin. Results/identified evidence The risk for rifampicin-induced liver injury is highest in the first 6 weeks of treatment, whereas interstitial nephritis is primarily observed during intermittent treatment. Enzyme induction due to rifampicin is usually complete after about 2 weeks of treatment and reduces clindamycin blood levels by about 90%. Three meta-analyses identified antibiotic use as a risk factor for CA-CDI. Two of them assigned the highest risk to clindamycin. None of them stratified by length of treatment. There is extensive experience with rifampicin, primarily for the treatment of tuberculosis. Long-term experience with clindamycin is limited. Discussion and recommendation for clinical care The analysed risks associated with a combination of clindamycin and rifampicin for hidradenitis suppurative cluster within the first 10 weeks. Treatment can be continued beyond 10 weeks, if clinically necessary. Clinical questionCan therapy with clindamycin and rifampicin be safely continued long term beyond a 10-week course? Clinical scenarioA 28-year-old man had severe occlusion triad [a combination of hidradenitis suppurativa (HS), dissecting cellulitis of the scalp and nodulocystic acne] for at least 7 years. The patient failed to respond to doxycycline, acitretin, methotrexate, steroid injections, finasteride and dapsone, and was unwilling to use prescribed adalumimab due to injection pain. He has had multiple surgeries, particularly of the face. He never achieved complete disease control but due to irregular follow-up had taken multiple courses of clindamycin and rifampicin intermittently over 5 years that were of different duration, but usually lasted up to about half a year. The patient wishes to continue clindamycin and rifampicin because he felt that they had produced the best results. Linked Comment: Hambly and Kirby. Br J Dermatol 2019; 180:702-703.

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Pharmacokinetic variability of clindamycin and influence of rifampicin on clindamycin concentration in patients with bone and joint infections

Abstract: This study shows the high inter-variability of plasma clindamycin concentration and confirms that co-treatment with rifampicin significantly decreases clindamycin trough concentrations.

Cited by 33 publications

References 38 publications

Clindamycin as unique antibiotic choice in Hidradenitis Suppurativa

Clindamycin as unique antibiotic choice in Hidradenitis Suppurativa

Clindamycin-rifampin combination therapy for staphylococcal periprosthetic joint infections: a retrospective observational study

Long‐term clinical safety of clindamycin and rifampicin combination for the treatment of hidradenitis suppurativa. A Critically Appraised Topic

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