What is the recommended dose of clindamycin (Clindamycin) for severe pharyngitis?

From the Guidelines

The recommended dose of clindamycin for severe pharyngitis is 7 mg/kg/dose taken orally three times daily, with a maximum dose of 300 mg/dose, for a duration of 10 days. This dosage is based on the guidelines provided by the Infectious Diseases Society of America, as outlined in the 2012 update for the diagnosis and management of Group A Streptococcal pharyngitis 1. It's crucial to note that clindamycin is particularly useful for patients with severe penicillin allergy who cannot take beta-lactam antibiotics. The medication works by inhibiting bacterial protein synthesis, making it effective against many gram-positive organisms, including Group A Streptococcus, a common cause of bacterial pharyngitis.

Key points to consider when prescribing clindamycin for severe pharyngitis include:

• The importance of completing the full 10-day course of antibiotics, even if symptoms improve before completion, to ensure complete eradication of the infection.
• The potential for clindamycin to cause gastrointestinal side effects, such as diarrhea, and the need for patients to seek medical attention if severe diarrhea occurs, as this could indicate Clostridioides difficile infection.
• The recommendation to use clindamycin for patients with penicillin allergy, as an alternative to first-generation cephalosporins, clarithromycin, or azithromycin, based on the guidelines provided by the Infectious Diseases Society of America 1.

It's also important to emphasize the need for accurate diagnosis of streptococcal pharyngitis, as antimicrobial therapy is of no proven benefit for acute pharyngitis due to organisms other than Group A Streptococcus, and inappropriate antimicrobial use can lead to the development of antimicrobial resistance among common pathogens 1.

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 dose of clindamycin for severe pharyngitis is:

• For adults: 300 to 450 mg every 6 hours
• For pediatric patients: 16 to 20 mg/kg/day (8 to 10 mg/lb/day) divided into three or four equal doses 2

From the Research

Clindamycin Dose for Severe Pharyngitis

• The recommended dose of clindamycin for severe pharyngitis is 300 mg twice daily (BID) or 300 mg three times daily (TID) for 10 days, as indicated in studies 3, 4.
• In one study, patients with acute recurrent group A beta-hemolytic streptococci (GABHS) pharyngotonsillitis were treated with oral clindamycin 300 mg BID for 10 days, resulting in significant clinical cure rates at 12 days 3.
• Another study found that clindamycin, 6.5 mg per kg body weight BID (children) or 300 mg TID (adults) for 10 days, was effective in treating patients with bacterial treatment failure after penicillin treatment for streptococcal pharyngotonsillitis 4.
• It is essential to note that the dosage and duration of treatment may vary depending on the specific patient population and the severity of the infection.

Efficacy and Safety

• Clindamycin has been shown to be effective in treating severe pharyngitis, with high clinical and bacteriologic cure rates 3, 4.
• The safety profile of clindamycin is generally favorable, with common adverse events involving the digestive system, such as diarrhea 3.
• However, it is crucial to be aware of the potential risk of pseudomembranous colitis associated with clindamycin use, although this is an uncommon problem that responds well to treatment 5.