Lincomycin Hydrochloride

Antibacterial; structurally related to clindamycin.a

Administration

Administer by IM injection or slow IV infusion.100 Also has been administered by subconjunctival injection.100 Has been administered orally, but an oral preparation is not commercially available in the US.a

Do not administer by rapid IV injection.100

IV Infusion

Prior to IV infusion, lincomycin injection must be diluted with a compatible IV solution.100

For solution and drug compatibility information, see Compatibility under Stability.

Dilute each gram of lincomycin in ≥100 mL of compatible IV solution.100

IV infusions should be given over ≥1 hour.100

The manufacturer recommends that 600-mg or 1-g doses be given over 1 hour, 2-g doses be given over 2 hours, 3-g doses be given over 3 hours, and 4-g doses be given over 4 hours.100

Dosage

Available as lincomycin hydrochloride;100 dosage expressed in terms of lincomycin.100

Dosage depends on severity of infection.100

Pediatric Patients

Infants and children >1 month of age: 10 mg/kg once every 24 hours for serious infections or 10 mg/kg every 12 hours (or more frequently) for more severe infections.100

Infants and children >1 month of age: 10–20 mg/kg daily (depending on severity of infection) administered in 2 or 3 equally divided doses.100

Adults

600 mg once every 24 hours for serious infections or 600 mg every 12 hours (or more frequently) for more severe infections.100

600 mg to 1 g every 8–12 hours for serious infections;100 more severe infections may require increased dosage.100 Up to 8 g daily has been used in life-threatening infections.100

75-mg dose results in ocular fluid concentrations that last ≥5 hours and are sufficient for most susceptible bacteria.100

Prescribing Limits

Adults

Maximum 8 g daily.100

Special Populations

Hepatic Impairment

No specific dosage recommendations at this time.100 Use with caution; monitor serum lincomycin concentrations during high-dose therapy.100

Renal Impairment

Severe renal impairment: 25–30% of usual dose.100 Use with caution; monitor serum lincomycin concentrations during high-dose therapy.100

Geriatric Patients

No specific dosage recommendations at this time.100

Contraindications

• Hypersensitivity to clindamycin or lincomycin.100

Warnings/Precautions

Warnings

Possible emergence and overgrowth of nonsusceptible organisms, particularly yeasts.100 Institute appropriate therapy if superinfection occurs.100

Treatment with anti-infectives alters normal colon flora and may permit overgrowth of Clostridium difficile.100 101 102 103 104 105 C. difficile-associated diarrhea and colitis (CDAD; also known as antibiotic-associated diarrhea and colitis or pseudomembranous colitis) has been reported with nearly all anti-infectives, including lincomycin, and may range in severity from mild diarrhea to fatal colitis.100 101 102 103 104 105 Hypertoxin-producing strains of C. difficile are associated with increased morbidity and mortality since they may be refractory to anti-infectives and colectomy may be required.100

Consider CDAD if diarrhea develops during or after therapy and manage accordingly.100 101 102 103 104 105 Careful medical history is necessary since CDAD has been reported to occur as late as 2 months or longer after anti-infective therapy is discontinued.100

If CDAD is suspected or confirmed, lincomycin may need to be discontinued.100 101 102 103 104 105 Some mild cases of CDAD may respond to discontinuance alone.101 102 103 104 105 Manage moderate to severe cases with fluid, electrolyte, and protein supplementation, appropriate anti-infective therapy active against C. difficile (e.g., oral metronidazole or vancomycin), and surgical evaluation when clinically indicated.100 101 102 103 104 105

Do not use for treatment of meningitis; lincomycin diffusion into CSF is inadequate for these infections.100

Sensitivity Reactions

Angioneurotic edema, serum sickness, and anaphylaxis or anaphylactoid reactions have been reported.100 Erythema multiforme, sometimes resembling Stevens-Johnson syndrome, reported rarely.100

Rash,100 urticaria,100 pruritus,a and, rarely, exfoliative and vesiculobullous dermatitis,100 have occurred.

Use with caution in patients with history of asthma or significant allergies.100

If anaphylactoid reactions or other hypersensitivity reactions occur, discontinue lincomycin and institute appropriate therapy as indicated (e.g., epinephrine, corticosteroids, maintenance of an adequate airway and oxygen).100

General Precautions

To reduce development of drug-resistant bacteria and maintain effectiveness of lincomycin and other antibacterials, use only for treatment or prevention of infections proven or strongly suspected to be caused by susceptible bacteria.100

When selecting or modifying anti-infective therapy, use results of culture and in vitro susceptibility testing.100 In the absence of such data, consider local epidemiology and susceptibility patterns when selecting anti-infectives for empiric therapy.100

Certain infections may require incision and drainage or other indicated surgical procedures in addition to anti-infective therapy.100

Use with caution in patients with a history of GI disease, particularly colitis.100 (See Superinfection/Clostridium difficile-associated Colitis [CDAD] under Cautions.)

Rapid IV administration has caused hypotension,100 syncope,a and rarely cardiopulmonary arrest.100

Severe cardiopulmonary reactions have occurred when lincomycin was administered in concentrations and at rates of administration higher than recommended.100

Leukopenia, 100 neutropenia,100 eosinophilia,a agranulocytosis,100 and thrombocytopenic purpura100 reported. Rare reports of plastic anemia and pancytopenia.100

Monitor blood counts periodically during prolonged therapy.100

Transient increases in serum bilirubin, alkaline phosphatase, and AST concentrations and jaundice reported;100 relationship to lincomycin not known.100

Monitor liver function tests periodically during prolonged therapy.100

Azotemia, oliguria, and proteinuria reported rarely;100 relationship to lincomycin not known.100

Monitor renal function tests periodically during prolonged therapy.100

Specific Populations

Category C.100

Distributed into milk;100 discontinue nursing or the drug.100

Safety and efficacy not established in infants <1 month of age.100

Large amounts of benzyl alcohol (i.e., 100–400 mg/kg daily) have been associated with toxicity (fatal “gasping syndrome”) in neonates;100 106 107 108 109 110 each mL of lincomycin injection contains 9.45 mg of benzyl alcohol.100

Some geriatric patients with associated severe illness may tolerate diarrhea less well than younger individuals;100 carefully monitor for change in bowel frequency.100

Use with caution; monitor serum lincomycin concentrations during high-dose therapy.100

Use with caution in those with severe renal impairment; monitor serum lincomycin concentrations during high-dose therapy.100

Common Adverse Effects

GI effects (nausea,100 vomiting,100 diarrhea,100 colitis,100 abdominal pain,a tenesmus,a glossitis,100 stomatitis,100 pruritus ani100 ), rash,100 urticaria,100 pruritus,a vaginitis,100 headache,a myalgia,a tinnitus,100 dizziness,a vertigo.100

• Advise patients that antibacterials (including lincomycin) should only be used to treat bacterial infections and not used to treat viral infections (e.g., the common cold).100

• Importance of completing full course of therapy, even if feeling better after a few days.100

• Advise patients that skipping doses or not completing the full course of therapy may decrease effectiveness and increase the likelihood that bacteria will develop resistance and will not be treatable with lincomycin or other antibacterials in the future.100

• Advise patients that diarrhea is a common problem caused by anti-infectives and usually ends when the drug is discontinued.100 Importance of contacting a clinician if watery and bloody stools (with or without stomach cramps and fever) occur during or as late as 2 months or longer after the last dose.100

• Importance of informing clinicians of existing or contemplated therapy, including prescription and OTC drugs, and any concomitant illnesses.100

• Importance of women informing clinician if they are or plan to become pregnant or plan to breast-feed.100

• Importance of advising patients of other important precautionary information.100 (See Cautions.)

Excipients in commercially available drug preparations may have clinically important effects in some individuals; consult specific product labeling for details.

Please refer to the ASHP Drug Shortages Resource Center for information on shortages of one or more of these preparations.