clindamycin
Sources réglementaires consultées
Indications approuvées
- Traitement de l’acné vulgaire léger à modéré.
Contre-indications
Absolues
- Hypersensibilité à la clindamycine, à la lincomycine ou aux excipients.
Mises en garde cliniques
- Mise en garde majeure · Arrêter immédiatement en cas de diarrhée ou de colite associée aux antibiotiques ; de très rares colites pseudomembraneuses ont été signalées même par voie topique. — CIMA/AEMPS, ficha técnica 60362
- L’usage prolongé peut sélectionner des résistances ou une prolifération d’organismes non sensibles ; prudence particulière en cas de maladie de Crohn, colite ulcéreuse ou atopie. — CIMA/AEMPS, ficha técnica 60362
Interactions médicamenteuses
- SévèreÉrythromycine
Mécanisme: Il existe un antagonisme in vitro et une résistance croisée potentielle.
Recommandation: Ne pas utiliser simultanément.
CIMA/AEMPS, ficha técnica 60362https://cima.aemps.es/cima/dochtml/ft/60362/FT_60362.html
- ModéréeChloramphénicol
Mécanisme: L’effet bactériostatique du chloramphénicol peut antagoniser l’effet bactéricide de la classe antibiotique associée.
Recommandation: Éviter l’utilisation concomitante sauf évaluation clinique spécifique.
CIMA/AEMPS, ficha técnica 60362https://cima.aemps.es/cima/dochtml/ft/60362/FT_60362.html
- ModéréeAcide salicylique, soufre, peroxyde de benzoyle ou autres irritants topiques
Mécanisme: Ils peuvent augmenter l’irritation locale.
Recommandation: Utiliser avec prudence et adapter selon la tolérance.
CIMA/AEMPS, ficha técnica 60362https://cima.aemps.es/cima/dochtml/ft/60362/FT_60362.html
- ModéréeBloquants neuromusculaires
Mécanisme: La clindamycine peut renforcer le bloc neuromusculaire.
Recommandation: Utiliser avec prudence et surveiller le blocage.
CIMA/AEMPS, ficha técnica 60362https://cima.aemps.es/cima/dochtml/ft/60362/FT_60362.html
Effets indésirables
Communs (≥1%)
Sensation de brûlure · Sécheresse cutanée · Dermatite de contact · Érythème · Desquamation cutanée
Rares mais graves
Colite pseudomembraneuse
Grossesse et allaitement
Pendant la grossesse, utiliser uniquement si l’état nécessite la clindamycine et qu’aucune alternative adaptée n’existe ; utiliser une contraception efficace pendant le traitement. Pendant l’allaitement, décider d’interrompre l’allaitement ou le traitement selon les bénéfices et les risques.
Bibliographie récente (PubMed)
Acne vulgaris commonly affects adults, adolescents, and preadolescents aged 9 years or older. The objective of this study was to provide evidence-based recommendations for the management of acne. A work group conducted a systematic review and applied the Grading of Recommendations, Assessment, Development, and Evaluation approach for assessing the certainty of evidence and formulating and grading recommendations. This guideline presents 18 evidence-based recommendations and 5 good practice statements. Strong recommendations are made for benzoyl peroxide, topical retinoids, topical antibiotics, and oral doxycycline. Oral isotretinoin is strongly recommended for acne that is severe, causing psychosocial burden or scarring, or failing standard oral or topical therapy. Conditional recommendations are made for topical clascoterone, salicylic acid, and azelaic acid, as well as for oral minocycline, sarecycline, combined oral contraceptive pills, and spironolactone. Combining topical therapies with multiple mechanisms of action, limiting systemic antibiotic use, combining systemic antibiotics with topical therapies, and adding intralesional corticosteroid injections for larger acne lesions are recommended as good practice statements. Analysis is based on the best available evidence at the time of the systematic review. These guidelines provide evidence-based recommendations for the management of acne vulgaris.
Bacterial vaginosis affects one third of reproductive-aged women, and recurrence is common. Evidence of sexual exchange of bacterial vaginosis-associated organisms between partners suggests that male-partner treatment may increase the likelihood of cure. This open-label, randomized, controlled trial involved couples in which a woman had bacterial vaginosis and was in a monogamous relationship with a male partner. In the partner-treatment group, the woman received first-line recommended antimicrobial agents and the male partner received oral and topical antimicrobial treatment (metronidazole 400-mg tablets and 2% clindamycin cream applied to penile skin, both twice daily for 7 days). In the control group, the woman received first-line treatment and the male partner received no treatment (standard care). The primary outcome was recurrence of bacterial vaginosis within 12 weeks. A total of 81 couples were assigned to the partner-treatment group, and 83 couples were assigned to the control group. The trial was stopped by the data and safety monitoring board after 150 couples had completed the 12-week follow-up period because treatment of the woman only was inferior to treatment of both the woman and her male partner. In the modified intention-to-treat population, recurrence occurred in 24 of 69 women (35%) in the partner-treatment group (recurrence rate, 1.6 per person-year; 95% confidence interval [CI], 1.1 to 2.4) and in 43 of 68 women (63%) in the control group (recurrence rate, 4.2 per person-year; 95% CI, 3.2 to 5.7), which corresponded to an absolute risk difference of -2.6 recurrences per person-year (95% CI, -4.0 to -1.2; P<0.001). Adverse events in treated men included nausea, headache, and metallic taste. The addition of combined oral and topical antimicrobial therapy for male partners to treatment of women for bacterial vaginosis resulted in a lower rate of recurrence of bacterial vaginosis within 12 weeks than standard care. (Funded by the National Health an
This second part of the S2k guidelines is an update of the 2015 S1 European guidelines. These guidelines aim to provide an accepted decision aid for the selection, implementation and assessment of appropriate and sufficient therapy for patients with hidradenitis suppurativa/acne inversa (HS). The chapters have been selected after a Delphi procedure among the experts/authors. Certain passages have been adopted without changes from the previous version. Potential treatment complications are not included, being beyond the scope of these guidelines. Since the S1 guidelines publication, validation of new therapeutic approaches has almost completely overhauled the knowledge in the field of HS treatment. Inflammatory nodules/abscesses/draining tunnels are the primary lesions, which enable the classification of the disease severity by new validated tools. In relation to the degree of detectable inflammation, HS is classified into the inflammatory and the predominantly non-inflammatory forms. While the intensity of the inflammatory form can be subdivided by the IHS4 classification in mild, moderate and severe HS and is treated by medication accordingly, the decision on surgical treatment of the predominantly non-inflammatory form is based on the Hurley stage of the affected localization. The effectiveness of oral tetracyclines as an alternative to the oral combination of clindamycin/rifampicin should be noted. The duration of systemic antibiotic therapy can be shortened by a 5-day intravenous clindamycin treatment. Adalimumab, secukinumab and bimekizumab subcutaneous administration has been approved by the EMA for the treatment of moderate-to-severe HS. Various surgical procedures are available for the predominantly non-inflammatory form of the disease. The combination of a medical therapy to reduce inflammation with a surgical procedure to remove irreversible tissue damage is currently considered a holistic therapeutic approach. Suitable therapeutic options while considerin
The vaginal microbiome is a well-defined compartment of the human microbiome. It has unique conditions, characterized by the dominance of one bacterial species, the Lactobacilli. This microbiota manifests itself by a low degree of diversity and by a strong dynamic of change in its composition under the influence of various exogenous and endogenous factors. The increase in diversity may paradoxically be associated with dysbiosis, such as bacterial vaginosis (BV). BV is the result of a disturbance in the vaginal ecosystem; i.e., a sudden replacement of Lactobacilli by anaerobic bacteria such as Gardnerella vaginalis, Atopobium vaginae, Ureaplasma urealyticum, Mycoplasma hominis, and others. It is the most common cause of vaginal discharge in women of childbearing age, approximately 30% of all causes. The etiology of this dysbiosis remains unknown, but its health consequences are significant, including obstetrical complications, increased risk of sexually transmitted infections and urogenital infections. Its diagnosis is based on Amsel's clinical criteria and/or a gram stain based on the Nugent score. While both of these methods have been widely applied worldwide for approximately three decades, Nugent score are still considered the "gold standard" of BV diagnostic tools. Given the limitations of these tools, methods based on molecular biology have been developed as alternative rational strategies for the diagnosis of BV. The treatment of BV aims at restoring the balance of the vaginal flora to stop the proliferation of harmful microorganisms. Prescription of antibiotics such as metronidazole, clindamycin, etc. is recommended. Faced with the considerable uncertainty about the cause of BV, the high rate of recurrence, the unacceptable treatment options, and clinical management which is often insensitive and inconsistent, research on this topic is intensifying. Knowledge of its composition and its associated variations represents the key element in improving the therapeu