From the Guidelines
Clindamycin is generally effective against MRSA (Methicillin-resistant Staphylococcus aureus) and is often used as a treatment option, particularly for less severe skin and soft tissue infections. However, it's not typically the first-line treatment for severe MRSA infections. The usual adult dose for MRSA skin infections is 300-450 mg orally every 6-8 hours for 7-10 days, as recommended by the Infectious Diseases Society of America 1. For more severe infections, intravenous administration may be necessary. It's essential to note that clindamycin resistance can occur, so susceptibility testing is recommended before use 1. Additionally, clindamycin carries a risk of Clostridioides difficile-associated diarrhea, so patients should be monitored for this side effect. The effectiveness of clindamycin against MRSA is due to its ability to inhibit bacterial protein synthesis, but it's bacteriostatic rather than bactericidal, which may limit its use in certain severe infections.
Some key points to consider when using clindamycin for MRSA infections include:
- Clindamycin is effective against MRSA, but its use should be guided by susceptibility testing 1
- The usual adult dose is 300-450 mg orally every 6-8 hours for 7-10 days 1
- Clindamycin carries a risk of Clostridioides difficile-associated diarrhea, and patients should be monitored for this side effect 1
- Clindamycin is bacteriostatic rather than bactericidal, which may limit its use in certain severe infections 1
It's also important to consider the potential for clindamycin resistance, particularly in areas with high rates of MRSA resistance 1. In such cases, alternative treatment options may be necessary. Overall, clindamycin can be an effective treatment option for MRSA infections, but its use should be guided by careful consideration of the patient's individual needs and the potential risks and benefits of treatment.
From the Research
Effectiveness of Clindamycin Against MRSA
- Clindamycin has been shown to be effective against MRSA in several studies 2, 3, 4.
- A retrospective cohort study found that clindamycin was as effective as vancomycin in treating MRSA skin infections in hospitalized adults 2.
- Another study found that clindamycin was effective in treating MRSA infections in children, but noted that there is a risk of resistance developing during treatment 3.
- Clindamycin resistance has been increasing among MRSA isolates, particularly in the northeastern United States 5.
Mechanisms of Resistance
- Inducible clindamycin resistance is a concern, as it can develop during treatment 4, 5.
- The D-test can be used to detect inducible clindamycin resistance 3, 5.
- Erythromycin resistance is often linked to clindamycin resistance, and the D-test can help identify strains that are at risk of developing resistance 3, 4.
Clinical Use of Clindamycin
- Clindamycin is an option for treating MRSA infections, particularly in cases where other antibiotics are not effective or are not tolerated 2, 4, 6.
- However, clinicians should be aware of the potential for resistance and monitor patients closely for signs of treatment failure 3, 5.
- Clindamycin may be used in combination with other antibiotics to treat more severe infections 6.