What is the recommended dosing of clindamycin (antibiotic) for the treatment of osteomyelitis (bone infection)?

From the Guidelines

Clindamycin should be dosed at 600 mg PO/IV TID for adults and 10-13 mg/kg/dose PO/IV every 6-8 hours, not to exceed 40 mg/kg/day for children, for the treatment of osteomyelitis. This dosing recommendation is based on the guidelines provided by the Infectious Diseases Society of America, as outlined in the 2011 Clinical Infectious Diseases journal article 1. The choice of clindamycin as an antimicrobial agent for treating osteomyelitis should optimally be based on the results of a bone culture, especially because of the need for long-duration therapy. If empiric therapy is necessary, the regimen should usually cover S. aureus as it is the most common pathogen.

Some key considerations when treating osteomyelitis with clindamycin include:

• The anatomic site of infection
• The local vascular supply
• The extent of both soft tissue and bone destruction
• The presence of any systemic signs of infection
• The patient’s preferences for treatment As noted in the 2016 Diabetes/Metabolism Research and Reviews article 1, any oral antibiotics selected should have good bioavailability, and clindamycin is one such option. Patients should be monitored for potential side effects, including diarrhea and Clostridioides difficile infection. For severe or complicated osteomyelitis, clindamycin may be used as part of a combination therapy regimen, particularly when polymicrobial infection is suspected or confirmed. The total duration of antibiotic therapy for osteomyelitis is generally 4-6 weeks, though some cases may require longer treatment.

From the FDA Drug Label

Adults: Serious infections – 150 to 300 mg every 6 hours. More severe infections – 300 to 450 mg every 6 hours Pediatric Patients (for children who are able to swallow capsules): Serious infections – 8 to 16 mg/kg/day (4 to 8 mg/lb/day) divided into three or four equal doses. More severe infections – 16 to 20 mg/kg/day (8 to 10 mg/lb/day) divided into three or four equal doses.

The recommended dosing of clindamycin for the treatment of osteomyelitis is:

• Adults: 150 to 300 mg every 6 hours for serious infections, and 300 to 450 mg every 6 hours for more severe infections.
• Pediatric Patients: 8 to 16 mg/kg/day divided into three or four equal doses for serious infections, and 16 to 20 mg/kg/day divided into three or four equal doses for more severe infections 2.

From the Research

Clindamycin Dosing for Osteomyelitis

• The recommended dosing of clindamycin for the treatment of osteomyelitis is as follows:
  • Intravenous dose: 50 mg/kg/day for approximately three weeks, followed by oral clindamycin palmitate at a dose of 30 mg/kg/day for an additional six weeks 3
  • Oral dose: 300 mg every four hours, which can provide adequate blood and bone levels of the drug for the treatment of chronic osteomyelitis 4

Considerations for Clindamycin Treatment

• Clindamycin has been shown to have good bone penetration and is effective against Staphylococcus aureus, including penicillin-resistant strains 3
• The treatment duration and dosage may vary depending on the individual patient and the severity of the infection
• It is essential to monitor patients for potential adverse events, such as diarrhea or manifestations of enterocolitis, although these were not reported in the study by 3

Alternative Treatment Options

• Linezolid is an alternative antibiotic that can be used to treat osteomyelitis, particularly in cases where the infection is caused by methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus faecium 5, 6
• The recommended dose of linezolid is 600 mg orally twice daily, and the treatment duration can range from 6 to 19 weeks 5 or 5 to 36 weeks 6