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[Pharmacology](https://durgical.com/en/pharmacology/) · Class

# Lincosamides

Clindamycin and lincomycin block the peptidyl transferase centre of the 50S ribosome. Strong against anaerobes and gram-positive cocci.

Updated 2026-11-01

## What they are

A small family of antibiotics in which clindamycin is the one used today. They are mainly bacteriostatic and are valued for anaerobes, streptococci and many staphylococci, and for reducing toxin production in severe streptococcal infections.

## Mechanism of action

They bind the 23S rRNA at the peptidyl transferase centre of the 50S subunit, next to the macrolide site, and stop the peptide bond from forming. Methylation of the 23S rRNA (erm genes) gives cross-resistance with macrolides and streptogramin B (the MLSB phenotype), which can be inducible.

Target: 23S rRNA of the bacterial 50S ribosomal subunit (peptidyl transferase centre)

## Key points

- Boxed warning: Clostridioides difficile infection, from mild diarrhoea to fatal colitis.
- Covers anaerobes above the diaphragm well (aspiration, lung abscess, dental infections).
- Added to penicillin in necrotising fasciitis and streptococcal toxic shock to switch off toxin synthesis.
- The D-test detects inducible clindamycin resistance in erythromycin-resistant staphylococci.
- Does not reach the cerebrospinal fluid, so it is not used for meningitis.

## Drugs in this class

- [**Clindamycin** A lincosamide for anaerobes, staphylococci and streptococci, added in necrotising fasciitis to stop toxins. Its main… Bacterial ribosome, 50S subunit (23S rRNA, peptidyl transferase centre)](https://durgical.com/en/pharmacology/clindamycin/)

## Others in the class

- lincomycin

## Test yourself

Think of the answer, then tap the question to see it.

## What is the boxed warning of clindamycin?

Clostridioides difficile infection, which can range from diarrhoea to fatal colitis.

## Why is clindamycin added to penicillin in necrotising fasciitis?

It stops bacterial protein synthesis, including toxins, regardless of the growth phase.

## What does a positive D-test mean?

An erythromycin-resistant staphylococcus can switch on clindamycin resistance (inducible MLSB), so clindamycin may fail.

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Educational content on how drugs work; not a prescribing guide and no substitute for a health professional's advice. No doses are given.

Sources: [DailyMed - CLINDAMYCIN HYDROCHLORIDE capsule](https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=1dbd8448-c1e5-46df-8060-50ef82380445) (DailyMed (U.S. National Library of Medicine), 2026); [Clindamycin: MedlinePlus Drug Information](https://medlineplus.gov/druginfo/meds/a682399.html) (MedlinePlus (U.S. National Library of Medicine), 2026); [eEML - Electronic Essential Medicines List](https://list.essentialmeds.org/?query=clindamycin) (World Health Organization, 2025).

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