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Lincomycin : A review and meta-analysis of its efficacy and tolerance in common infections encountered in clinical practice

Authors:
  • Dr Varsha's Health Solutions

Abstract

Lincomycin, the first antibiotic of the Lincosamide class, has been studied and used in several common outpatient and hospital-based infections, in both its oral and injectable forms. The main ones among these are Ear Nose Throat (ENT) and Respiratory Tract Infections (RTI), skin and Soft Tissue Infections (SSTI) including surgical wound infections, bone and joint Infections (osteomyelitis and septic arthritis), and oro-dental infections. Its spectrum of action covers Gram-positive bacteria mainly Staphylococcus, Streptococcus (pyogenes, viridans, pneumoniae), C diphtheriae, and Anaerobic bacteria including Clostridium Propionibacterium. Though there are several clinical and microbiological studies which have evaluated the efficacy and tolerance of Lincomycin in various common infections seen in clinical practice, the evidence present has not been widely reviewed, or propagated in the last few decades. Studies and data associated with the bacteriological sensitivity, clinical usage and benefit, adverse effects and place in infectious disease therapy has been reviewed and analyzed in detail here. Lincomycin can be a useful part of the currently available antibiotic armamentarium. More real-world and clinical studies, as well as study of microbiological sensitivity patterns should be further initiated for improving insights on the place of antibiotic.
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Journal of the Indian Medical Association
Drug Corner
Lincomycin : A review and meta-analysis of its efficacy and tolerance
in common infections encountered in clinical practice
Anish Desai1, Varsha Narayanan2, Sunaina S Anand3
Lincomycin, the first antibiotic of the Lincosamide class, has been studied and used in several common outpatient
and hospital-based infections, in both its oral and injectable forms. The main ones among these are Ear Nose
Throat (ENT) and Respiratory Tract Infections (RTI), skin and Soft Tissue Infections (SSTI) including surgical wound
infections, bone and joint Infections (osteomyelitis and septic arthritis), and oro-dental infections. Its spectrum of
action covers Gram-positive bacteria mainly Staphylococcus, Streptococcus (pyogenes, viridans, pneumoniae), C
diphtheriae, and Anaerobic bacteria including Clostridium Propionibacterium. Though there are several clinical and
microbiological studies which have evaluated the efficacy and tolerance of Lincomycin in various common infections
seen in clinical practice, the evidence present has not been widely reviewed, or propagated in the last few decades.
Studies and data associated with the bacteriological sensitivity, clinical usage and benefit, adverse effects and place
in infectious disease therapy has been reviewed and analyzed in detail here. Lincomycin can be a useful part of the
currently available antibiotic armamentarium. More real-world and clinical studies, as well as study of microbiological
sensitivity patterns should be further initiated for improving insights on the place of antibiotic.
[J Indian Med Assoc 2021; 119(8): 69-75]
Key words : Lincomycin, antibiotic, infections, Gram-positive, Anaerobes.
Lincomycin is the first antibiotic from the
Lincosamide class, isolated from the actinomycete
Streptomyces lincolnensis in 1964. It acts by inhibiting
protein synthesis in susceptible bacteria by binding
to the 50 S subunits of bacterial ribosomes and
preventing formation of the peptide bond during
transcription1-3. Though considered bacteriostatic, it
is bactericidal against susceptible bacteria and also
when used in high concentrations. Its spectrum of
action covers Gram-positive bacteria mainly
Staphylococcus, Streptococcus (pyogenes, viridans,
pneumoniae), C diphtheriae, and Anaerobic bacteria
including Clostridium (tetani and perfringens) and
Propionibacterium.
Lincomycin has been used in bacterial infections
of the respiratory system, skin and soft tissue including
wounds, bone and joint, and oro-dental infections and
is especially a useful option against Penicillinase
producing and Erythromycin resistant strains.
Lincomycin has limited activity against Enterococcus
faecalis and no activity against Gram-negative bacteria
like Enterobacteriaceae group, Neisseria and
1MD, FCP, PGDHEP, Director, Medical Affairs, Intellimed
Healthcare Solutions, Mumbai400070
2MBBS, MS (Oph), Fellowship (Family Medicine), Health and
Pharmaceutical Consultant, Dr Varsha's Health Solutions, Mumbai
400053
3Pharm D, Medical Affairs Executive, Intellimed Healthcare
Solutions, Mumbai 400070
Received on : 27/07/2021
Accepted on : 27/07/2021
Hemophilus. Lincomycin is to be used in cases proven
or strongly suspected to be caused by susceptible
bacteria based on information from culture-sensitivity
or local epidemiology and susceptibility patterns1-3.
Oral bioavailability of Lincomycin is 25-50% in
fasting state, and is significantly reduced by meals.
Peak plasma concentrations of 2-5ug/ml is achieved
in 2-4 hours and maintained for 6-8 hours.
Intramuscular administration of a single dose of 600
mg of Lincomycin produces average peak plasma levels
within an hour (usually 15-20 minutes) in the range of
11-12g/mL with therapeutic levels maintained for 17
to 20 hours for most susceptible Gram-positive
organisms. If given as an IV infusion, Lincomycin
attains up to 15-16ug/ml plasma concentrations
maintained over 14 hours.
Peak bone concentrations are usually attained in
about 2-3 hours at a level of 2-2.5ug/ml. Excretion is
mostly through bile, with 10-15% excretion through
urine2,4,5.
Microbiological spectrum and effectiveness :
One of the recognized ways of reducing resistance
is not using a broad-spectrum antibiotic, when a narrow
spectrum antibiotic effective against the causative
organism is present. Lincomycin is one of the most
sensitive and effective options for Group A Streptococci
infections (MICs 0.12-1ug/ml) which show high
resistance to Penicillin6. Lincomycin is effective
against Staphylococcus aureus (and S albus) at
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minimum inhibitory concentrations (MICs) of 0.7-1.55
ug/ml and compares favorably to other antibiotics at
an MIC of 2ug/ml7. Studies have shown concentrations
of 2.5-5.0 ug/ml and 0.67-3.9 ug/ml after the 1000mg
and 500mg Lincomycin oral dosages, and 3.5-10 ug/
ml after 600mg intramuscular dose (IM), with a >95%
sensitivity to Staphylococcus aureus (30ug discs) as
compared to <20% for Penicillin8.
In a study, Lincomycin showed 98.7% sensitivity
to hospital based Staphylococcal strains (with the
resistant strains being phage typed as Atypical Group
III). Lincomycin also showed 100% sensitivity to
hospital isolated strains of Streptococcus pyogenes,
Streptococcus viridans, Pneumococcus, other
hemolytic Streptococci and Clostridium perfringens,
with 98% sensitivity to Enterococcus strains9. A study
from Uganda showed that 90%, 49%, 10% and 18%
Staphylococcal resistance was seen to Penicillin,
Streptomycin, Oxytetracycline and Cloxacillin
respectively with none seen for Lincomycin10 Penicillin
G and Erythromycin resistant S aureus is frequently
not resistant to Lincomycin5. Against Clostridium
species and C diphtheriae, Lincomycin has shown
MICs in the range of 0.3-1 ug/ml3. Apart from being
effective against Penicillinase resistant Staphylococci,
Lincomycin is also effective against Hemophilus
vaginalis11.
Lincomycin shows good penetration into pleural and
cerebrospinal fluid12,13. Lincomycin has very good bone
penetration with 75% of serum concentration in spongy
bone and 15% in compact bone14.
The plasma, bone, hip capsule, synovial and drain
fluid concentrations of Lincomycin were maintained
above MIC of Penicillinase producing Staphylococcus15.
Lincomycin is comparable to Clindamycin in attaining
MIC in synovial fluid within an hour in patients of
Rheumatoid Arthritis16. Lincomycin has shown good
clinical response in treating acute and chronic
osteomyelitis, and septic arthritis and would appear
to be one of the drugs of choice for acute or chronic
Staphylococcal bone or joint disease, as well as an
effective option in post hip replacement surgery17. It
can be given for prolonged periods due to its low toxicity
and high bone penetration (achieving consistent MICs
of 0.25-2 ug/ml).18
Lincomycin and Clindamycin :
Clindamycin was developed from Lincomycin 2
years later in 1966 by inversion of chirality and
replacing 7 hydroxy group with a chlorine atom19.
Clindamycin was ascertained to have better oral
absorption (which can lower gastrointestinal side
effects like diarrhea) and higher in vitro sensitivity to
susceptible organisms20. However, both antibiotics are
equally potent in blocking their ribosomal target site,
and show similar MICs and clinical effectiveness against
susceptible organisms21-23.
Lincomycin was nonetheless widely substituted in
clinical use for Gram-positive and Anaerobic infections,
by Clindamycin, till the association of Clindamycin with
Pseudomembranous colitis due to C difficile in 1973.
Thereafter the usage of Clindamycin declined but
emerged again once the etiology and management of
Pseudomembranous colitis had been understood and
advocated24.
Lincomycin showed less disturbance of faecal flora
and Enterobacteriaceae counts as compared to
Clindamycin. (48-50% versus 60-75%)25. Though both
drugs may be associated with neuromuscular blocking
actions in high doses, Lincomycin does not increase
acetylcholine release, does not have an anesthetic
action and has a 5 times less neuromuscular blocking
effect due to an effect on the muscle, than
Clindamycin26.
Due to the quick switch to Clindamycin within 2
years of the availability of Lincomycin, the robust
clinical data of Lincomycin in various common clinical
outpatient and hospital infections has not been widely
reviewed, analyzed or propagated in the last few
decades. Since Lincomycin represents an important
member of the Lincosamide group with potential to
effectively treat Gram-positive and Anaerobic infections,
it is important to review its clinical efficacy and
tolerance, for its befitting place in the currently available
antibiotic armamentarium.
Lincomycin Clinical Efficacy and Usage :
Lincomycin has been studied in several common
outpatient and hospital-based infections. The main
ones among these are Ear Nose Throat (ENT) and
Respiratory Tract Infections (RTI), Skin And Soft Tissue
Infections (SSTI) including surgical wound infections,
bone and joint Infections (osteomyelitis and septic
arthritis), and oro-dental infections. Databases were
searched for clinical studies of Lincomycin and 56
studies were reviewed and analyzed. Individual case
studies, studies with ill- defined outcome parameters
and improper methodology were not taken into
consideration, and in all 21 studies were included for
meta-analysis (Fig 1).
In all these studies, Lincomycin has been dosed
in accordance to its recommendation2-4. The oral dose
(available as 250/500 mg capsules) was given as 1-2
g/day in divided doses 2 hours before or after meals,
for out-patient treatment or step-down therapy. For
infections requiring hospitalization or related to surgery,
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the injectable form was used, as 600mg Intramuscularly
(IM) or by Intravenous (IV) infusion given 12-24 hourly
depending on severity of infection. Doses through IV
infusions maybe stepped up to 8 g/day for life
threatening infections. Dosage in children is 30- 60mg/
kg/day and 10-20mg/kg/day for oral and injectable
forms. Serum drug levels should be monitored
(especially if high doses are being used) in liver
dysfunction, and dose reduced by 25% or frequency
decreased in patients with renal dysfunction. Duration
of treatment is usually 3-7 days extending to 10 days
for group A, beta-hemolytic Streptococci (GABS)
infections in children. Long term treatment over a few
months maybe required for bone and joint infections.
Respiratory Tract Infections :
ENT and URTI :
Lincomycin has shown efficacy in the management
of ENT infections including acute upper respiratory
tract infections (URTI- tonsillitis, pharyngitis, sinusitis),
acute otitis media (AOM) along with pneumonia (lobar
and bronchopneumonia). It has also shown efficacy in
treating group A Streptococcal infection in children.
In a recent Indian study of 40 adult patients with
tonsillitis or sinusitis, oral Lincomycin 500mg and
Cefpodoxime 200mg dosed twice daily for 5 days, were
studied. At the end of the study, 67.9% and 52.3%
achieved complete symptomatic relief with Lincomycin
and Cefpodoxime respectively27. Complete relief from
Fig 1 Clinical Response Rates for Lincomycin in Infections
caused by Susceptible bacteria (Meta- analysis)
Abbreviations : URTI- Upper Respiratory Tract Infections; ENT- Ear
Nose Throat; GABS- Group A Beta-hemolytic Streptococci, SSTI-
Skin and Soft Tissue Infection
*SSTIs include bacterial/pustular dermatosis, pyodermas, folliculitis,
furuncles and impetigo
#URTI/ENT27-31, Pneumonia33-36, GABS37-40, SSTI41,43,44, SSTI
(wounds)41,44, 45, Bone and Joint46-48, Oro-dental50
fever and pharyngeal congestion was achieved in
93.7% and 87.5%, and 100% and 66.7% in the
Lincomycin and Cefpodoxime groups respectively. In
another study of 22 out- patients with predominantly
Gram-positive ENT infections, there was a 100% good
response28.
In another study on ENT infections in 88 patients,
53/58 (91.3%) and 21/30 (70%) of acute and chronic
infections showed symptomatic relief in a week. (25/
25 acute sinusitis, 12/14 chronic sinusitis, 9/12 AOM,
6/12 chronic otitis media, 10/10 in tonsillopharyngitis)29.
Resistant Gram- negative strains were seen in 50% of
treatment failures, while longer treatment was
recommended in chronic cases. Transient diarrhea was
seen in 5 patients with no treatment cessation needed.
In another similar study of 75 patients with acute
URTI and AOM, clinical cure in 68/75 (90.6%) was
achieved30.
In a study of 60 patients (including Diphtheria 24,
Scarlet fever 16, Pneumococcal pneumonia 13 and
bacterial pharyngitis 7), 96.7% showed a good to
excellent outcome, with no significant side effects.31
In a study on Asthma patients with Upper Respiratory
Tract Infections (URTI), excellent or good outcome was
seen in 36/51 (70.6%) who mainly had Gram-positive
infections with Staphylococci, Streptococci or
Pneumococci32.
Pneumonia :
In 2 different studies of 43 and 42 evaluable patients
with Pneumococcal pneumonia, 42/43 (97.6%) and
39/42 (92.8%) patients treated with Lincomycin showed
good to excellent response33,34. 1 mortality occurred
due to Klabsiella superinfection in the first study, and
no toxicity or impaired tolerance to Lincomycin was
seen in both these studies. In a multi-organism
pneumonia study with 30 patients (28 hospitalized, 2
OPD; 1 lung abscess, 18 lobar and 11 broncho-
pneumonia), 90% were cured, 6.6% showed
improvement, 29 showed radiological improvement or
cure, and the lung abscess resolved completely with
Lincomycin35.
In a study from Mumbai with patients of multi-
organism lobar pneumonia given Lincomycin, clinical
response was good in 22/25 (88%) patients, with
normal temperature attained in 2-3 days and
disappearance of cough and chest pain in 5-7 days36.
Radiological improvement occurred in about 10 days.
The organisms cultured included haemolytic
Streptococci in 9, Streptococcus pneumoniae in 5,
Staphylococcus albus in 5, Klebsiella pneumoniae in
4, Proteus vulgaris in 2 and Escherichia coli in 2
patients with more than one pathogen isolated in 6
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patients. Transient diarrhea not needing stoppage of
treatment was seen in only 1 patient.
Pediatric GABS infections :
There are 4 large clinical studies in children with
Group A Streptococci pharyngitis and tonsillitis. In a
study of 870 children, negative cultures were seen in
one week 93% versus 89% for Lincomycin and
Penicillin respectively37. Transient and inconsequential
diarrhea was seen in 9%. In the second study of 525
patients, cure rate of 92.1% was seen with Lincomycin
versus 86.1% for Penicillin38. Significant improvement
in 12-24 hours along with negative throat cultures on
the 3rd day was seen in all but 1 and 5 in Lincomycin
and Penicillin group respectively. Majority returned to
full activity by 3rd day. Clinical recurrence was 4.8%
versus 7.5% for Lincomycin versus Penicillin.
In another study with 303 children, comparing
Lincomycin with Ampicillin and Penicillin, the cure
rates were 82% versus 71.3% versus 70.6%
(Lincomycin versus Ampicillin versus Penicillin) with
Lincomycin showing lowest relapse rate and 0% carrier
rate at 4 weeks (versus 7% and 12.7%)39. Improvement
within 24 hours and fever below 100 deg F by day 2
was seen in 95% of the patients. A study comparing
with Clarithromycin showed clinical cure at 12-14 days
in 88, 80, 82%, microbiological eradication in 98, 91,
96% and 3-month recurrence in 0, 3, 0% with
Lincomycin, Penicillin and Clarithromycin
respectively40.
Skin and Soft Tissue Infections :
Skin infections are commonly caused by Gram-
positive and anaerobic bacteria like Staphylococcus,
Streptococcus and Propionibacterium, therefore
Lincomycin can have a valuable place in SSTI
management.
In a recent Indian study, 30 patients with SSTIs
were evaluated for response to Lincomycin 500mg oral
capsules given twice/thrice daily. Complete relief of
clinical signs and symptoms by day 14 was overall
around 80% as follows: cellulitis 60%, folliculitis 85.7%,
furuncles 66.7%, carbuncles 50%, oozing wounds
90.9%, and open wounds/surgical site infections
100%41. A patient each reported urticaria and diarrhea
as adverse effect which subsided spontaneously.
Another smaller study with 14 patients showed
improvements within 24 hours and average healing time
in eczematous dermatitis and folliculitis of 3-5 days,
furuncles and carbuncles 7-13 days, cellulitis,
lymphangitis, and lymphadenitis 3-7 days with
Lincomycin42. One patient of cystic acne achieved first
time clearance in 15 years which was maintained for 9
months on Lincomycin 500mg OD.
A large study in bacterial dermatosis with 315
patients was done with excellent or satisfactory
response in 271/315 (86%)43. The study included
Impetigo, furunculosis, pustular dermatitis, pustular
psoriasis, cystic acne and pyodermas. High rates of
clearance of cystic acne were seen 140/171 (82%)
with a 100% response in Impetigo and furunculosis,
and >95% response in pustular dermatosis. Transient
diarrhea not needing discontinuation, was seen when
high dose, or prolonged therapy was used. Another
study of 30 patients with Staphylococcal (2/3rds) and
Streptococcal soft tissue infections (19 abscesses, 5
cellulitis, 5 infected wounds, and 1 phebitis) showed a
satisfactory clinical response in all cases44. A small
study of surgical site/wound infections showed marked
improvement with excellent response in 25/27 (92.6%)
patients45. Majority of isolates were of Staphylococcal
and the 3 cases being Streptococcal on microbiological
testing. A study of 150 patients with Staphylococcal
acute abscesses, similar rates of healing were seen
with Lincomycin and Clindamycin when given for 4 days
post incision and drainage23.
Bone and Joint Infections :
Lincomycin achieves good levels in Bone and Joint,
and can be an effective option in cases of Osteomyelitis
due to the ability to give it for prolonged periods with
low toxicity, high efficacy and low recurrent rates18. In
a study of 25 Osteomyelitis cases treated with
Lincomycin, no recurrence was seen in 24/25 (96%)
for 2 years (recurred case was given inadequate
dosage)46. In 50 cases of Chronic Osteomyelitis,
Lincomycin along with removal of dead and ischemic
cells improved healing rates.47 Of the 50 patients, 47
healed (94%) and 41 remained healed for an
observation period lasting from nine months to three
years, and ten months. In a study conducted over a 5-
year period, 121 patients with Acute Hematogenous
Osteomyelitis or Chronic Osteomyelitis were
evaluated.48 Lincomycin produced cure in 113/121
(93.4%).
In a study of 62 patients with Post-operative
Osteomyelitis (89% lower limb fractures with 54%
closed fractures), Staphylococcal strains were isolated
in 80% cases with 68% being Penicillin resistant.
Results with Lincomycin were good in 74%, and fair in
8%, with Lincomycin resistance seen in 3 patients,
and an amputation rate of 13%
49
.
Oro-dental infections :
Lincomycin has been seen to be effective in oro-
dental and circumoral infections caused by
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Staphylococcus and Anaerobes50. A recent Indian
clinical study evaluated 42 patients with oro- dental
infections by administering oral Lincomycin 500 mg
for 5 days. At end of treatment 100% of gingivitis
patients and 96.8% of periodontitis patients achieved
complete relief from signs and symptoms of pain/
tenderness, bleeding, halitosis, sensitivity to heat/cold,
tooth mobility, redness, presence of exudates or
evidence of bone destruction. Relief by day 2 was seen
in 85.7% and 88.4% patients in the 2 groups. No
adverse events were seen in the study.
Common infections in Clinical Practice :
Clinical studies with Lincomycin have been
performed to see its efficacy, tolerance and use in
general and common out-patient and in-patient clinical
practice.
In a study of 18 patients (50% osteomyelitis,
enteritis, arthritis and SSTI), where the cultured
organism was predominantly Staphylococcus aureus,
culture negativity was achieved in an average of 10
days with Lincomycin in most patients7. In another
study of 70 hospitalized patients with Staphylococcal
and Streptococcal infections treated with Lincomycin,
total recovery rate of 78.5% (55/70) with complete
recovery in 16/22 patients with Staphylococcal
infections, 9/14 with pneumonia, 15/17 with acute
exacerbations of bronchitis and 2 patients with other
bacterial infections was seen52. The study concluded
that the place of Lincomycin in therapeutics seems to
be principally in the treatment of chronic osteomyelitis,
in patients allergic to the Penicillins, and in the
treatment of staphylococcal respiratory and other
infections for which Penicillin is usually employed. Only
4 patients had mild-transient diarrhea not requiring
therapy cessation.
In a group of infections comprising of osteomyelitis,
septic arthritis, bronchopneumonia and SSTI, in 22
patients, 19/24 (79.2%) showed clinical cure and 14/
24 showed bacteriological cure53. Only one patient had
mild-transient diarrhea not requiring therapy cessation.
Another study with 65 patients of osteomyelitis, septic
arthritis, pneumococcal meningitis, endocarditis, and
septicemia, cure rates were as follows: Bone Joint
Infections 31/52 cured, 12 satisfactorily responded, 8
failures (all chronic infections), 1 relapsed;
Pneumococcal meningitis 3/3 responded; Septicemia
including endocarditis 8/10 responded well.54 Overall
response rate was satisfactory/good 54/65 (83%) with
8 cases of mild-transient diarrhea not requiring therapy
cessation.
In a general practice study, good clinical response
with Lincomycin was seen in 83/96 (86.5%) patients
(Pneumonia 36/42, Pharyngotonsillitis 12/13,
Osteomyelitis 17/17 and Wound-Soft tissue infections
12/13).55 Adverse effects included 6 cases of diarrhea
and 1 mildly pruritic drug eruption, all showing
spontaneous resolution. Similar good to excellent
response with Lincomycin was seen in 43/56 or 76.8%
patients (pharyngotonsillitis 12/13, sinusitis 7/10,
carbuncle/furuncle 12/14, otitis media 5/5, pustular
acne 3/4, miscellaneous infections 5/6) in another
study56. Though troublesome diarrhea was seen in 5
patients, it did not interrupt treatment. A third study
also showed overall 47/55 (85.4%) showed good
therapeutic result in 47/55 patients (16/18 pneumonia,
9/10 tonsillopharyngitis, 1/1 lung abscess,
osteomyelitis 9/9)57. A study done in 37 patients with
pharyngotonsillitis, bronchitis, sinusitis, osteomyelitis,
SSTI and wound Infections showed good response in
36 (97.3%) patients with rapid response <24 hours
seen in some cases58.
A pediatric clinical practice study performed,
showed cure achieved in all 295 children with mean
duration of therapy of 15 days with injectable
Lincomycin59. The infections included mainly skin and
soft tissue, and bone and joint infections. No significant
adverse effects were seen.
DISCUSSION
Lincomycin has been seen to be of benefit in several
clinical studies where infections were due to
susceptible bacteria like Gram-positive and Anaerobic
organisms. It has been found efficacious in acute upper
respiratory tract infections and ENT infections
including tonsillitis, pharyngitis, sinusitis and AOM,
as well as Pneumococcal pneumonia and pediatric
Streptococcal infections27-40. Lincomycin can be an
effective option in RTIs when the susceptibility local
trends and epidemiology are known, and when culture
data is available. Among SSTI, wound infections,
including surgical ones, display a high response to
Lincomycin41-45. The response has been effective in
bacterial dermatosis like folliculitis, furunculosis,
impetigo and pyodermas, however deeper infections
like cellulitis, and carbuncles may need more prolonged
or injectable treatment. Lincomycin along with incision-
drainage gives effective results in abscesses23.
Lincomycin, given as prolonged maintenance oral
therapy can be an asset for nodulo-cystic acne
43
. For
mild-moderate acne, now Lincomycin in also available
in a 2% topical form60.
In acute bone and joint infections, like osteomyelitis
and septic arthritis, Lincomycin has shown good
results when given in appropriate prolonged regimens
to maintain minimal relapse rates18,46-49. One dental
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Journal of the Indian Medical Association
study has shown high response rates in gingivitis and
periodontitis which are predominantly Staphylococcal
and Anaerobic infections. The study also showed
effectiveness of Lincomycin in managing procedure
related infections50. Lincomycin has shown to have a
valuable place in several common out-patient and in-
patient infections encountered in general clinical
practice. However often such infections may display
mixed microbiology including Gram-positive, negative
and Anaerobic bacteria. Combining Lincomycin with
Aminoglycoside antibiotics can be an effective strategy
in managing such infections in hospitalized patients61.
Lincomycin has shown acceptable tolerance in the
reviewed study. While diarrhea is the predominant side
effect seen in up to 10% cases, it was transient, seen
more with higher doses, and also did not necessitate
cessation of therapy. Though cases with Lincosamides
of Pseudomembranous colitis have been reported in
literature, none were seen in the studies of Lincomycin
reviewed62. No other significant adverse effects have
been seen with Lincomycin.
CONCLUSION
Lincomycin when appropriately used can be a
valuable part of the current antibiotic armamentarium.
Based on the data of efficacy and tolerance reviewed,
more recent clinical and real-world studies are
warranted for Lincomycin (oral/injectable) used both
as monotherapy in known susceptible infections, and
as combination empirical therapy in common
infections. Recently Lincomycin has shown efficacy
and become available as a 2% topical formulation for
acne and bacterial skin infections62. Also, there should
be more research in to inducible and cross resistance
patterns of Lincomycin along with other antibiotics.
Conflict of Interest : The authors are medical
consultants to Wallace Pharmaceuticals, India.
REFERENCES
1
Vardanyan RS, Hruby VJ Lincomycin. Antibiotics. Chp 32:
Synthesis of Essential Drugs (Science Direct) 2006; 425-
98.
2
Lincomycin FDA Gov data and prescribing-label information
accessed Aug 2020.
3
Lincomycin MIMS India accessed Aug 2020.
4
Lincomycin Medscape reference 342555#10 accessed Aug
2020.
5
Clapper WE, Meade GH, Stewart DB The Susceptibility Of
Certain Bacteria To Lincomycin As Related To Attainable Serum
Levels In Human Adults. Am J Med Sci 1964; 247: 274-77.
6
Holloway BW, Asche LV Mechanical and Clinical Implications
of Antibiotic Resistance in Bacteria. Drugs 1977; 14: 283-90.
7
Grondin C, St Martin M, Potvin A Lincomycin and
Staphylococcal Infections-A clinical study of 18 cases. Can
Med Ass J 1964; 92: 1062-65.
8
Macloed AJ, Ross HB, Osere RL, Digout G, van Rooyen GE
Lincomycin: A new antibiotic active against Staphylococcus
and other Gram positive cocci: Clinical and Laboratory
studies. Can Med Ass J 1964; 91: 1056-60.
9
Duncan IBR, Jeans B Lincomycin in Hospital Practice. Can
Med Assoc J 1965; 93(13): 685-91.
10
Buttner DW, Westhoff H Antibiotic sensitivity of
Staphylococcus Aureus in Uganda with special reference to
pyomyositis and osteomyelitis. East African Medical Journal
1973; 50: 2.
11
Mickal A, Dildy GA, Miller HJ Lincomycin in the treatment of
cervicitis and vaginitis in pregnancy. South Med J 1966; 59(5):
567-70.
12
Thomas PA, Jolly PC Lincomycin diffusion into pleural
drainage fluid of post- thoracotomy patients. Am Rev Respir
Dis 1967; 96(5): 1044-8. doi:10.1164/arrd.1967.96.5.1044
13
Vacek V, Hejzlar M, Skalova M Penetration of antibiotics
into the cerebrospinal fluid in inflammatory conditions. 2.
Lincomycin. Int J Clin Pharmacol Ther Toxicol 1968; 1(6):
501-3.
14
Lykkegaard NM, Hansen I, Nielsen BJ The Penetration Of
Lincomycin Into Normal Human Bone Determinations of
Penetration into Compact Bone. Spongy Bone and Bone
Marrow Acta Orthop Scand 1976; 47: 267-70.
15
Parsons RL, Beavis JP, Hossak GA, Paddock GM Plasma,
Bone, Hip Capsule, Synovial and Drain Fluid concentrations
of Lincomycin during Total Hip Replacement. Br J Pharmacol
1977: 433-7.
16
Deodhar SD, Russel F, Dick WC, Nuki G, Buchanan WW
Penetration of Lincomycin and Clindamycin into the synovial
cavity in Rheumatoid Arthritis. Current Medical Research
Opinion 1972; 1: 2.
17
McMillan NL, McRae RK, McDougall A Lincomycin in the
treatment of osteomyelitis. Practitioner 1967; 198(185): 390-
5.
18
Murdoch J, Geddes AM, Munroe JF Recent advances in
Chemotherapy. SA Medical Journal 1965: 54-7.
19
Birkenmeyer RD, Kagan F Lincomycin. XI. Synthesis and
structure of clindamycin. A potent antibacterial agent. J Med
Chem 1970; 13(4): 616-9.
20
Spízek J, Rezanka T Lincomycin, clindamycin and their
applications. Appl Microbiol Biotechnol 2004; 64(4): 455-64.
21
Douthwaite S Interaction of the antibiotics clindamycin and
Lincomycin with Escherichia coli 23S ribosomal RNA. Nucleic
Acids Res 1992; 20(18): 4717-20.
22
Lincomycin FDA Gov data and prescribing-label information
accessed Aug 2020.
23
Jones NAG, Wilson DH The treatment of acute abscesses
by incision, curettage, and primary suture under antibiotic. Br
J Surg 1976; 63: 499-501
24
Philips I Past and current use of clindamycin and
Lincomycin. Journal of Antimicrobial Chemotherapy 1981;
7(suppl A): 11-8.
25
Leigh DA, Simmons K Effect of clindamycin and Lincomycin
therapy on faecal flora. Journal of Clinical Pathology 1978;
31: 439-43.
26
Wright JM, Collier B Characterization of the neuromuscular
block produced by Clindamycin and Lincomycin. Can J
Physiol Pharmacol 1976; 54(6): 937-44.
27
Kothadia A A multicentric, open labeled, randomized,
postmarketing efficacy study comparing multidose Lincomycin
hydrochloride 500mg capsule with multidose Cefpodoxime
axetil 200mg tablet in tonsillitis, sinusitis. J Ind Med Ass 2012;
110: 580-5.
28
Injectable Lincomycin use in the more common ENT infections,
a case series. Maffezoni E, Maffezoni A. Gazzetta Medica
75
Vol 119, No 8, August 2021
Journal of the Indian Medical Association
Italiana 1980; 139: 1-4.
29
Trakas JC, Lind HE Lincomycin, a new antibiotic, in
otolaryngological infections. Eye Ear Nose Throat Mon 1965;
44(12): 46-50.
30
Trainor GM Lincomycin in acute upper respiratory tract
infections and otitis media. Clinical Medicine 1969; 2: 20-1.
31
Harnecker J, Contreras J, Gilabert B, Ubilla V Bacteriological
And Clinical Studies Of Lincomycin Hydrochloride. Antimicrob
Agents Chemother (Bethesda) 1963; 161: 204-9.
32
Green MA Lincomycin, A New Antibiotic, In Respiratory
Allergy Associated With Infection. J Asthma Res 1964; 2(1):
33-8.
33
Andersen R, Bauman M, Austrian R Lincomycin and
Penicilling in the Treatment of Mild and Moderately Severe
Pneumococcal Pneumonia: A Comparative Study. American
Review of Respiratory Diseases 1968; 97(5): 914-8.
34
Donohoe RF, Swift JP Lincomycin therapy of pneumonia:
clinical experience with 50 patients. South Med J 1967; 60(2):
203-8.
35
Severo V Lincomycin in acute infectious pneumopathy.
Rev Bras Clin Therap 1981; 10(9): 681-2.
36
Manghani KK Evaluation of Lincomycin in lobar pneumonia.
Indian Journal of Medical Sciences 1967; 21(9): 603-10.
37
Jackson H, Cooper J, Mellinger WJ, Olsen AR Group A
beta-hemolytic streptococcal pharyngitisresults of
treatment with Lincomycin. JAMA 1965; 194(11): 1189-92.
38
Randolph MF, DeHaan RM A comparison of Lincomycin
and Penicillin in the treatment of group A streptococcal
infections: speculation on the “L” form as a mechanism of
recurrence. Del Med J 1969; 41(2): 51-62.
39
Breese BB, Disney FA, Talpey WB Beta-Hemolytic
Streptococcal Illness: Comparison of Lincomycin, Ampicillin,
and Potassium Penicillin G in Treatment. Am J Dis Child
1966; 112(1): 21-7.
40
Angeli G, Fakuda A, Gallegos B, Ladue L, Miniti A, Suarez S,
et al Efficacy of lincomycin versus penicillin and
clarithromycin in patients with acute pharyngitis/ tonsillitis
caused by group a beta-hemolytic streptococci and a clinical
history of recurrence. Current Therapeutic Research 1997;
58(12): 917-29.
41
Sarkar S Clinical efficacy of Lincomycin hydrochloride in
the treatment of skin infections: Result of a pilot study in
Indian adult patients. Indian Medical Gazette March 2017;
83-7.
42
Kanee B Lincomycin in Dermatological Practice. Can Med
Ass J 1965; 93: 220-2.
43
Murray NM Lincomycin in management of bacterial
dermatosis. Clin Med 1966; 73: 79-80.
44
Noreiga ER, Casillas MAI, Ahumada SE Infections in soft
tissues, a new revision of their bacteriology and treatment.
Med Mex 5th ed 1979; 96(7): 163-8.
45
Koven IH The efficacy of Lincomycin in the management
of minor surgical infections. College of General Practice of
Canada Journal 1968; 3: 38-40.
46
McMillan NL, McRae RK, McDougall A Lincomycin in the
treatment of Osteomyelitis. The Practitioner 1967; 198: 390-
5.
47
Paus B Chronic Osteomyelitis, a report of 50 cases treated
with Lincomycin. Acta Orthop Scandinavia 1971; 42: 320-7.
48
Herrell WE Lincomycin in the treatment of Staphylococcal
Osteomyelitis. Clinical medicine 1968: 17-9.
49
Hagen R Osteomyelitis after operative fracture treatment.
Acta Orthop Scand 1978; 49: 542-8.
50
Davis WM Jr, Balcom JH III Lincomycin studies of drug
absorption and efficacy: An evaluation by double-blind
technique in treatment of odontogenic infections. Oral Surgery,
Oral Medicine, Oral Pathology 1969; 27(5): 688-96.
51
Katwe S Dental Infections related to Gingivitis, Periodontitis,
and Pre/Post surgical dental procedures in patients. J Ind
Dent Ass 2014; 8(7): 37-42.
52
Duncan IBR, Jeans B Lincomycin in Hospital Practice. Can
Med Assoc J 1965; 93(13): 685-91.
53
Geddes AM, Sleet RA, Murdoch JM Lincomycin
Hydrochloride: Clinical And Laboratory Studies. Br Med J
1964; 2(5410): 670-2.
54
Geddes AM, Munroe JF, Murdoch J, Begg KJ, Burns BA 4
years Hospital Experience with Lincomycin Hydrochloride.
International Congress of Chemotherapy Vienna 1967.
55
Halloway WJ, Scott EG Clinical Experience with
Lincomycin. Amer J Med Sci 1965; 249: 691-5.
56
Grainger GJ Lincomycin Hydrochloride in General Practice.
The Practitioner 1966; 197: 1177.
57
Halloway WJ, Kallbaugh RA, Scott EG Lincomycin: A clinical
study. Antimicrobial agents and Chemotherapy 1963; 200-
3.
58
Guslits SS Lincomycin in Commonly Encountered Infections.
Can Fam Phy 1968; 65: 67-9.
59
Berry DD, Ben H. Brouhard H, Box QT Adverse Reactions
to Parenteral Lincomycin. Pediatrics March 1981; 67(3): 389-
91.
60
Craig WA Optimizing Aminoglycosides. Crit Care Clin 2011;
27: 107-21.
61
Smart RF, Ramsden DA, Gear MW, Nicol A, Lennox WM
Severe pseudomembranous colitis after lincomycin and
clindamycin. Br J Surg 1976; 63(1): 25-9.
62
Sharma AD, Gupte PD, Sundaram M Topical lincomycin gel
in acne vulgaris: a multicentric placebo-controlled study. Indian
J Dermatol Venereol Leprol 2003; 69(4): 271-3.
ResearchGate has not been able to resolve any citations for this publication.
Article
The penetration of lincomycin into normal bone was studied in 10 patients with fracture of the neck of the femur, a separate determination being made of the lincomycin concentration in serum, bone marrow, spongy bone and compact bone. The concentration of lincomycin in bone marrow was found to be at the same level as that in the serum. The concentration in spongy bone amounted in most cases to 50 to 75 per cent of the concentration in the serum, whereas the concentration in compact bone varied from 0 to 15 per cent of that in the serum.
Article
This open-label, prospective, randomized, comparative, single-masked study was performed at eight centers in the Philippines and Latin America (Chile, Colombia, Peru, Brazil, and Venezuela). The purpose of this study was to assess the efficacy and tolerability of three different antibiotic regimens for the treatment of acute pharyngitis/tonsillitis as a result of group A beta-hemolytic streptococci (GABHS), and to assess the rate of recurrences. Children (aged 3 to 15 years) and adults with a recent history of tonsillitis associated with a positive rapid diagnostic test for group A streptococcus, later confirmed by positive cultures for GABHS, were randomized to one of the following antibiotic regimens (according to patient age) for 10 days: (1) lincomycin hydrochloride capsules or suspension: adults—two 500-mg capsules two times a day (BID) for 10 days; children—60 mg/kg per day divided BID for 10 days (maximum dose, 1000 mg/d); (2) phenoxymethylpenicillin capsules or suspension: adults—one 500-mg capsule three times a day (TID) for 10 days; children—50 mg/kg per day divided TID for 10 days (maximum dose, 1500 mg/d); (3) clarithromycin capsules or suspension: adults—one 250-mg capsule BID for 10 days; children—7.5 mg/kg per day divided BID for 10 days (maximum dose, 500 mg/d). After the initiation of treatment (12 to 14 days) and 3 months after completion, patients were evaluated to assess clinical and microbiologic recurrences. Our results indicate that all drugs had statistically similar clinical and bacteriologic efficacy as well as tolerability for the treatment of acute GABHS pharyngitis/tonsillitis with a clinical history of recurrence.
Article
The site of neuromuscular blockade induced by clindamycin and lincomycin was studied on isolated nerve and nerve-muscle preparations. Clindamycin (3.6 X 10(-3) M) but not lincomycin (up to 1.5 X 10(-2) M) had a local anaesthetic effect on a frog desheathed nerve preparation. Clindamycin (8 X 10(-4) M) and lincomycin (4 X 10(-3) M) depressed the response of the rat diaphragm to nerve stimulation and to direct muscle stimulation in parallel. This indicated that the predominant neuromuscular blocking effect of these antibiotics was due to an effect on the muscle. Clindamycin was fivefold more potent than lincomycin in this effect, and the unionized form of both drugs was the active form. Lincomycin (4 X 10(-3) M) but not clindamycin (8 X 10(-4) M) also had some depressant effect on nerve-muscle transmission as indicated by the interaction of the effects of the antibiotics and d-tubocurarine. The significance of these findings is discussed in relation to the acute clinical toxicity of these antibiotics.
Article
Bacterial counts were carried out on the faeces of 160 patients receiving clindamycin or lincomycin treatment for bacterial infections. In all the patients the total bacteroides count was significantly reduced while strains of Enterobacteriaciae, yeasts, and streptococci were correspondingly increased. Severe diarrhoea developed in 25 (16%) patients, but this could not be related to a change in faecal flora. Diarrhoea was most common when clindamycin was given prophylactically, women were more affected than men, and the incidence was highest in those aged over 60 years. No cases of pseudomembranous colitis were seen. Although clindamycin is a valuable antibiotic for treating established severe anaerobic bacterial infections it should be used cautiously in elderly patients.
Article
One hundred and fifty consecutive acute abscesses have been treated by incision, curettage and primary suture under antibiotic cover. The antibiotic used in this series was lincomycin 600 mg i.m. with premedication and clindamycin 150 mg 6-hourly for 4 days postoperatively (children and infants received smaller doses). Similar results for the rate of healing were achieved in all groups of abscesses. A case is made for the use of the technique of incision, currettage and primary suture with antibiotic covere for acute abscesses as an alternative to conventional methods of treatment.
Article
1 Lincomycin (600 mg) was given 6 h preoperatively by intramuscular injection, as an intravenous infusion over 30 min and for 72 h postoperatively in twelve patients having total hip replacement. 2 The plasma, bone, hip capsule, synovial and drain fluid concentrations of lincomycin were almost always above the M.I.C. of lincomycin against penicillinase producing Staphylococcus aureus. 3 There was a good correlation between the estimated concentrations of lincomycin in bone by the grinding and agitation methods of analysis. 4 Two patients developed pseudomembranous colitis after parenteral lincomycin.
Article
Four cases of severe pseudomembranous colitis following the use of lincomycin and clindamycin are described; 2 required emergency total colectomy and 2 died. Cases of such gravity after the use of these drugs have not been previously reported. One hundred and fifty-six orthopaedic cases where clindamycin and lincomycin were used postoperatively are reviewed; 34 had diarrhoea (22 per cent), and 3 of the severe cases occurred in this group. The diagnosis of pseudomembranous colitis may be difficult as the latent period from initiation of drug therapy to commencement of diarrhoea may be as much as 18 days, and that from cessation of drug therapy may be as much as 11 days. The value of early sigmoidoscopy in cases of diarrhoea of obscure aetiology is emphasized, and the characteristic sigmoidoscopic and histological appearances of pseudomembranous colitis are described. As these drugs may produce a lethal condition it is suggested that they should be used with appropriate discretion, especially in the elderly female who appears to be most at risk.