Lincocin (lincomycin hydrochloride) is a lincosamide antibiotic indicated for the treatment of serious infections caused by susceptible strains of gram-positive bacteria, particularly in patients who cannot tolerate penicillin antibiotics. It functions by inhibiting bacterial protein synthesis, effectively halting the growth and proliferation of pathogenic organisms. This injectable formulation is reserved for severe infections where less potent antimicrobial agents are inappropriate, offering a critical therapeutic option for healthcare providers managing complex cases.

Features

• Active Pharmaceutical Ingredient: Lincomycin hydrochloride.
• Pharmacological Class: Lincosamide antibiotic.
• Administration Route: Intramuscular (IM) or intravenous (IV) injection.
• Available Strengths: Typically 300 mg/mL in single-dose vials and multi-dose vials.
• Mechanism of Action: Binds to the 50S subunit of the bacterial ribosome, inhibiting protein synthesis.
• Spectrum of Activity: Primarily effective against aerobic gram-positive cocci and some anaerobic bacteria.

Benefits

• Provides a potent therapeutic alternative for patients with documented hypersensitivity to penicillin or beta-lactam antibiotics.
• Demonstrates reliable bactericidal activity in vitro against susceptible strains of staphylococci, streptococci, and pneumococci.
• Effective in treating serious infections in deep-seated tissues and abscesses due to its distribution properties.
• Serves as a critical agent in the management of bone and joint infections, lower respiratory tract infections, and septicemia caused by susceptible organisms.
• Offers a defined treatment course for anaerobic infections below the diaphragm, such as those caused by Bacteroides species.

Common use

Lincocin is strictly indicated for the treatment of serious infections caused by susceptible strains of streptococci, pneumococci, and staphylococci. Its use should be reserved for cases where less potentially toxic agents are contraindicated. Common clinical applications include severe respiratory tract infections (e.g., pneumonia, empyema), septicemia, skin and soft tissue infections, and bone and joint infections. It is also employed in the treatment of serious anaerobic infections, including pelvic inflammatory disease and intra-abdominal infections such as peritonitis and abscesses.

Dosage and direction

Adults: Serious infections: 600 mg intramuscularly (IM) every 12 to 24 hours. More severe infections: 600 mg to 1 gram intravenously (IV) every 8 to 12 hours. Doses exceeding 1 gram should be administered by IV infusion only, diluted in a minimum of 100 mL of compatible solution (e.g., 5% Dextrose in Water) and infused over at least 1 hour. Children (over 1 month of age): 10 to 20 mg/kg/day IM or IV in divided doses every 12 to 24 hours. For severe infections, 20 to 30 mg/kg/day IV in divided doses every 8 to 12 hours. The dosage and duration of therapy must be determined by the treating physician based on the severity of the infection and the patient’s clinical response. Therapy should be continued for a minimum of 10 days in cases of beta-hemolytic streptococcal infections to diminish the likelihood of subsequent rheumatic fever or glomerulonephritis.

Precautions

• Use with extreme caution in patients with a history of gastrointestinal disease, particularly colitis, as antibiotic use is associated with Clostridium difficile-associated diarrhea (CDAD).
• Administer with caution to patients with significant liver or renal impairment; dosage adjustments may be necessary. Monitor hepatic and renal function during prolonged therapy.
• Reserve use for serious infections where less toxic antimicrobial agents are inappropriate. Inappropriate use increases the risk of developing drug-resistant bacteria.
• CDAD has been reported with nearly all antibacterial agents and may range in severity from mild diarrhea to fatal colitis. Evaluate any patient presenting with diarrhea during or after antibiotic administration.
• Use during pregnancy only if clearly needed. Lincomycin crosses the placental barrier. Exercise caution when administering to nursing women, as the drug is excreted in human milk.
• Prolonged use may result in overgrowth of non-susceptible organisms, including fungi. Constant observation of the patient is essential. If superinfection occurs during therapy, appropriate measures should be taken.

Contraindications

Lincocin is contraindicated in patients with a known hypersensitivity to lincomycin, clindamycin, or any component of the formulation. It should not be administered to patients with a history of regional enteritis, ulcerative colitis, or antibiotic-associated colitis.

Possible side effect

The most common side effects are related to the gastrointestinal tract. Other reactions have been reported.

• Gastrointestinal: Diarrhea, nausea, vomiting, abdominal pain or cramps, tenesmus, glossitis, stomatitis, pruritus ani. Severe, persistent diarrhea may be symptomatic of CDAD.
• Hematologic: Neutropenia, leukopenia, agranulocytosis, thrombocytopenic purpura, aplastic anemia.
• Hypersensitivity Reactions: Skin rashes, urticaria, angioedema, serum sickness, anaphylaxis.
• Cardiovascular: Hypotension has been reported following rapid IV administration.
• Local Reactions: Pain, induration, and sterile abscess at the site of IM injection. Thrombophlebitis following IV infusion.
• Other: Vertigo, dizziness, tinnitus.

Drug interaction

• Kaolin-Pectin: Orally administered kaolin-pectin can significantly reduce the absorption of oral lincomycin. This is less relevant for the injectable form but is a notable pharmacological interaction.
• Neuromuscular Blocking Agents: Lincocin has neuromuscular blocking properties that may enhance the action of other neuromuscular blocking agents (e.g., tubocurarine, pancuronium), potentially leading to profound skeletal muscle weakness and respiratory depression.
• Erythromycin and Chloramphenicol: These agents are antagonistic to lincomycin in vitro and their concurrent use is not recommended.
• Opioid Antitussives: Antipersistaltic agents may delay the clearance of the toxin produced by C. difficile, potentially worsening CDAD.

Missed dose

As Lincocin is typically administered in a clinical setting by a healthcare professional, missed doses are less common. If a dose is delayed or missed according to the prescribed schedule, it should be administered as soon as it is practical. However, if it is almost time for the next scheduled dose, the missed dose should be skipped. The regular dosing schedule should be resumed. The patient should not administer a double dose to make up for a missed one. Always follow the specific instructions provided by the treating physician.

Overdose

Symptoms of overdose are primarily an extension of the drug’s known adverse effects. These may include severe gastrointestinal effects (e.g., profuse diarrhea, colitis) and neuromuscular effects. There is no specific antidote for lincomycin overdose. Management consists of immediate discontinuation of the drug and institution of supportive and symptomatic therapy. Hemodialysis and peritoneal dialysis are not effective in removing lincomycin from the blood. In cases of CDAD, appropriate treatment with fluids, electrolytes, protein supplementation, and an antibiotic effective against C. difficile should be instituted.

Storage

Store at controlled room temperature, 20° to 25°C (68° to 77°F). The solution is stable at room temperature for the period stated on the package. Protect from freezing and excessive heat. Parenteral products should be inspected visually for particulate matter and discoloration prior to administration. Diluted IV solutions are stable for 24 hours at room temperature. Do not use if the solution is discolored or contains a precipitate.

Disclaimer

This information is for educational and professional reference purposes only and is not a substitute for the professional judgment of a healthcare provider. The content provided does not constitute medical advice. The prescribing physician is responsible for determining the appropriate dosage, considering the patient’s individual circumstances, contraindications, and the latest official prescribing information. The reader is advised to consult the full manufacturer’s prescribing information for complete details on indications, dosage, warnings, precautions, and adverse reactions before administering this drug.

Reviews

“Lincocin remains a valuable agent in our formulary for managing serious gram-positive infections in penicillin-allergic patients, particularly osteomyelitis. Its potency is undeniable, though it requires vigilant monitoring for gastrointestinal complications.” – Infectious Disease Specialist, University Hospital “A critical tool for anaerobic infections in abdominal surgery. We use it judiciously due to the C. diff risk, but its efficacy in this specific niche is well-established and reliable.” – General Surgeon “While we have newer agents, Lincocin’s role in eradicating susceptible streptococcal strains in severe presentations is still relevant. It demands respect for its side effect profile.” – Clinical Pharmacist