Rifampin and Clindamycin Don't Play Well Together

At first glance, the combination of clindamycin and rifampin seems desirable for treating patients with staphylococcal bone and periprosthetic infections due to its excellent tissue penetration, good oral bioavailability, and biofilm activity. However, rifampin is a potent inducer of the cytochrome P450 3A4 pathway, through which clindamycin — among many other agents — is also metabolized. What is the degree of this interaction?

In a pharmacokinetic modelling study based on data from two prior trials, French researchers assessed plasma drug levels in 124 patients with bone and joint infections who had received clindamycin (oral or intravenous) as monotherapy or with rifampin. The model indicated that rifampicin increased clindamycin clearanc…