From the Guidelines
Clindamycin can be effective against MRSA, but its use should be guided by susceptibility testing due to the potential for resistance, as noted in the 2014 practice guidelines for the diagnosis and management of skin and soft tissue infections by the Infectious Diseases Society of America 1.
Key Considerations
- Clindamycin works by inhibiting bacterial protein synthesis, which can be effective against many MRSA strains.
- However, some MRSA infections may be resistant to clindamycin, and the guidelines mention the potential of cross-resistance and emergence of resistance in erythromycin-resistant strains, as well as inducible resistance in MRSA 1.
- For adults, a typical oral dose of clindamycin for MRSA skin infections is 300-450 mg taken every 6-8 hours, as outlined in the guidelines 1.
Important Factors
- The risk of causing Clostridioides difficile (C. diff) infections, especially with prolonged use, should be considered when prescribing clindamycin.
- Other antibiotics like vancomycin, daptomycin, or linezolid may be preferred in certain situations, particularly for more severe or invasive infections, as they are also listed in the guidelines for MRSA treatment 1.
- The choice of antibiotic should always be based on the specific infection, patient factors, and local resistance patterns, emphasizing the need for susceptibility testing and careful consideration of treatment options.
Treatment Approach
- Clindamycin can be an option for treating MRSA skin and soft tissue infections, especially in cases where other antibiotics are not suitable, but its use must be judicious and guided by the most recent and highest quality evidence, such as the 2014 guidelines from the Infectious Diseases Society of America 1.
- Healthcare providers should be aware of the potential for resistance and monitor patients closely for signs of treatment failure or adverse effects, adjusting the treatment plan as necessary to ensure the best outcomes in terms of morbidity, mortality, and quality of life.
From the Research
Effectiveness of Clindamycin Against MRSA
- Clindamycin has been shown to be effective against MRSA in some studies, with no significant differences in clinical outcomes compared to vancomycin in hospitalized patients with MRSA skin infections 2.
- However, the emergence of inducible and constitutive resistance to clindamycin has led to clinical challenges, and the D-test is necessary to detect inducible clindamycin resistance in MRSA isolates 3, 4.
- Studies have demonstrated that clindamycin's activity against MRSA strains with inducible resistance is partially impacted by inoculum size, and alternatives such as daptomycin and vancomycin may be more effective 5.
- Clindamycin remains a treatment option for MRSA infections, but clinicians should be aware of the risk of resistance and use the D-test to detect inducible resistance 6.
Key Findings
- A retrospective cohort study found no significant differences in clinical outcomes between vancomycin and clindamycin for the treatment of MRSA skin infections in hospitalized patients 2.
- A cross-sectional study found that 34.17% of MRSA isolates showed constitutive clindamycin resistance, while 22.15% displayed inducible clindamycin resistance 3.
- An in vitro pharmacodynamic study found that clindamycin's activity against MRSA strains with inducible resistance was partially impacted by inoculum size 5.
- A study of Staphylococcus aureus isolates found that 10% of isolates showed inducible clindamycin resistance, and the D-test should be used as a mandatory method in routine disc diffusion testing to detect inducible resistance 4.
- A study of clindamycin-susceptible MRSA organisms from children found that 38% were erythromycin-resistant, and the D-test was positive in 31 of 33 erythromycin-resistant isolates 6.