An antibiotic belonging to the lincosamide family is lincomycin (Lincocin). Serious susceptible infections that are resistant to penicillins are treated with it. Serious upper respiratory tract infections, skin infections, and bone infections are all treated with it.

Lincomycin Uses:

• Serious Bacterial infections:

  • It is approved for the treatment of severe infections brought on by pneumococcal, staphylococcal, and streptococcal susceptible strains.
  • It should be used only in those patients in whom penicillins can not be given either due to resistance or hypersensitivity reactions.

Lincomycin Dose in Adults:

Lincomycin Dose in the treatment of serious bacterial infection:

Note: The dosing frequency may be adjusted/ increased in severe infections.

• IM: 600 mg once or twice daily
• IV: 600 mg to 1 g twice or thrice daily (maximum dose: 8 g daily)
• Ophthalmic: Subconjunctival injection: 75 mg as a single dose (ocular fluid levels with sufficient minimum inhibitory concentrations [MICs] last for at least five hours)

Lincomycin Dose in Children:

Lincomycin Dose in the treatment of Bacterial infection (serious):

Note: The dosing frequency may be adjusted/ increased in severe infecfions.

• Infants >1 month, Children, and Adolescents:

  • IM: Once or twice per day, 10 mg/kg.
  • IV: split dosages of 10 to 20 mg/kg/day, given twice or three times per day.
  • The daily dose cap is 8 gm.

Lincomycin Pregnancy Category: C

• Lincomycin can pass through the placental barrier and be found in cord blood as well as amniotic fluid.
• You may also find benzyl alcohol in the injection, which could cross the placenta.

Use during breastfeeding:

• It is excreted from breast milk.
• The company states that the concentrations vary from 0.5 to 2 mcg/mL.
• The manufacturer advises weighing the advantages and disadvantages of giving medications to the baby against the possibility of major adverse reactions in the mother.

Lincomycin Dose in Kidney Disease:

• Mild to moderate impairment:

  • The manufacturer's labelling does not mention dosage modifications.

• Severe impairment:

  • In cases of severe renal impairment, use with caution. It's possible to cut the dose by 70% to 75%.

• End-stage renal disease (ESRD) on hemodialysis:

  • The manufacturer's labelling does not mention dosage modifications.
  • The drug is not removed by hemodialysis and should be used with caution.

• Peritoneal dialysis:

  • The manufacturer's labelling does not mention dosage modifications.
  • The drug is not removed by peritoneal dialysis and should be used with caution.

Dose in Liver disease:

• No dosage adjustments have been recommended by the manufacturer.
• It should be used with caution.

Side effects of Lincomycin:

• Gastrointestinal:

  • Colitis
  • Severe colitis

Contraindications to Lincomycin:

• Hypersensitivity to lincomycin or clindamycin or any other component of the formulation
• Canadian labeling: Additional contraindications not in US labeling
  • Newborns
  • Patients with pre-existing candida infections

Warnings and precautions

• Colitis: [US Boxed Warning]

  • Clostridium difficile associated diarrhea (CDAD), can occur either during or after treatment.
  • CDAD can be life-threatening and severe.
  • For serious infections, which require more toxic treatments, the treatment should not be performed.
  • It should be avoided for mild upper respiratory tract infections or other mild infections.
  • CDAD can persist up to 2 months after an antibiotic course has ended.

• Hypersensitivity reactions

  • There have been reports of hypersensitivity reactions to it, including shock and anaphylaxis as well as severe skin-related adverse effects such as Stevens-Johnson Syndrome [SJS], toxic epidermal necrolysis (TEN), acute generalized exanthematous pustulosis[AGEP] and erythema multiflora.
  • If there are any allergic reactions, the treatment should be stopped immediately.

• Superinfection

  • Extended use of the drug can lead to secondary opportunistic infections, such as fungal infections or resistant bacteria. 
  • Antifungal therapy must be administered to patients with candida infections.

• Allergies

  • Patients with severe allergies should be cautious.

• Asthma

  • Patients with a history or asthma should be cautious.

• Gastrointestinal Disease:

  • Patients who have a history of gastrointestinal diseases such ulcerative colitis should exercise caution.

• Hepatic impairment

  • Patients with liver disease should be cautious as the half-life may be extended up to 2 times.

• Renal impairment

  • Patients with kidney disease should be cautious. The half-life of this drug could be extended.
  • Adjusting the dosage may be necessary for patients with severe renal impairment.

Lincomycin: Drug Interaction

Monitoring parameters:

• Monitor for diarrhea or a change in bowel frequency or consistency;
• Baseline renal function (serum creatinine) and liver function tests (LFTs);
• During prolonged treatment, periodically monitor:
  • renal function and LFTs,
  • complete blood cell count  (CBC) with differential;
  • serum lincomycin during high-dose therapy in patients with renal and/or hepatic impairment.

How to administer Lincomycin (Lincocin)?

Intravenous Injection:

• Administer as a slow intravenous infusion over at least one hour per gram.
• Avoid injecting undiluted drug or bolus administration.
• Bolus administration or an Intravenous push may result in hypotension and cardiopulmonary arrest.

Intramuscular:

• Inject as a deep IM injection into a large muscle mass.

Ophthalmic, subconjunctival:

• Administer beneath the conjunctiva.

Mechanism of action of Lincomycin (Lincocin):

• Lincosamide antibiotic was isolated from Streptomyces Lincolnensis. 
• Lincomycin binds to the 50S subunit in bacterial ribosomes.
• This alters the process for peptide chain initiation and inhibits bacterial protein production.
• Antibiotics that act by binding to the 50S ribosomes (such as erythromycin and lincomycin) should not be concomitantly used.

Metabolism:

• It is metabolized in the liver.

Half-life elimination, serum:

• About 5 hours that is prolonged with renal or hepatic impairment

Time to peak, serum:

• IM: 1 hour

Excretion:

• Urine (2% to 30%);
• bile

International Brand Names of Lincomycin:

• Lincocin
• Albiotic
• Biolincom
• Cillimicina
• Cillimycin
• Clordelin
• Formicina
• Frademicina
• Libiocid
• Licoxin
• Limidrax
• Linatron
• Linbacyc
• Linco ANB
• Lincobiotic
• Lincocin
• Lincocina
• Lincocine
• Lincodar
• Lincofan
• Lincomed
• Lincono
• Lincophar
• Lincoplus
• Lincosa
• Lincosan
• Lincoway
• Linkam
• Lintropsin
• Medoglycin
• Mycoxin
• Neloren
• Nolipo
• Princol
• Tamcocin
• Zencocin

Lincomycin Brand Names in Pakistan: