From the Guidelines
Clindamycin should not be administered orally twice daily, as the recommended dosing regimen is 300-400 mg every 6 hours, or 3-4 times daily, to maintain adequate blood levels and prevent treatment failure and antibiotic resistance. The standard oral dosing regimen for adults is 150-450 mg every 6-8 hours, depending on the severity of the infection being treated, as seen in the guidelines for managing skin and soft tissue infections 1. Twice-daily dosing would not maintain adequate blood levels of the antibiotic throughout the 24-hour period, potentially leading to treatment failure and increasing the risk of antibiotic resistance.
The pharmacokinetics of oral clindamycin show that it has a relatively short half-life of approximately 2-3 hours, which necessitates more frequent dosing to maintain therapeutic concentrations. According to the Infectious Diseases Society of America guidelines for skin and soft tissue infections, clindamycin is recommended at a dose of 300-400 mg every 6 hours, or 3-4 times daily, for adults 1. If adherence to a three or four times daily regimen is challenging for the patient, it would be better to consider alternative antibiotics with longer half-lives that allow for less frequent dosing rather than reducing the frequency of clindamycin administration.
Some key points to consider when administering clindamycin include:
- The recommended dose for adults is 300-400 mg every 6 hours, or 3-4 times daily 1
- The recommended dose for children is 20 mg/kg/day in 3 divided doses, with a maximum dose of 300 mg per dose 1
- Clindamycin has a relatively short half-life of approximately 2-3 hours, necessitating more frequent dosing to maintain therapeutic concentrations
- Alternative antibiotics with longer half-lives may be considered if adherence to the recommended dosing regimen is challenging for the patient. Always follow the specific dosing instructions provided by the prescriber or as indicated in current clinical guidelines for the particular infection being treated.
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 The answer is no, clindamycin cannot be administered orally twice daily, as the recommended dosing frequency is every 6 hours, which is equivalent to 4 times a day for serious infections and more severe infections 2.
From the Research
Administration of Clindamycin
- Clindamycin can be administered orally, with studies indicating its effectiveness in various dosing schedules 3, 4, 5, 6, 7.
- The oral bioavailability of clindamycin has been compared in healthy volunteers and patients with AIDS, with results showing a higher bioavailability in AIDS patients 6.
- A study comparing the clinical and bacteriologic efficacy of oral clindamycin 300 mg BID with oral amoxicillin/clavulanic acid 1 g BID in the treatment of acute recurrent pharyngotonsillitis found that clindamycin achieved comparable rates of bacteriologic eradication and clinical cure 5.
- Another study examined the effect of a hospitalwide change in clindamycin dosing schedule from 600 mg every 6 hours to 600 mg every 8 hours and found no differences in measured clinical outcomes between the two groups 7.
Dosing Schedule
- Clindamycin has been administered orally at various dosing schedules, including 300 mg every 6 hours 3, 300 mg every 8 hours 4, and 300 mg BID (twice daily) 5.
- A study found that clindamycin dosed at 300 mg i.v. or p.o., q8h or q12h, provides adequate coverage against certain bacteria 4.
- The efficacy and safety of oral clindamycin 300 mg BID have been demonstrated in the treatment of acute recurrent pharyngotonsillitis 5.
Safety and Efficacy
- Clindamycin has been shown to be well tolerated in various studies, with adverse events reported in a minority of patients 5, 6, 7.
- The clinical efficacy of clindamycin has been demonstrated in the treatment of various infections, including anaerobic lung infections 3 and acute recurrent pharyngotonsillitis 5.