What is the recommended dosing of clindamycin (antibiotic) for the treatment of cellulitis?

Clindamycin Dosing for Cellulitis

For cellulitis treatment in adults, clindamycin should be dosed at 300-450 mg orally three times daily (every 8 hours) for mild to moderate infections, or 600 mg intravenously every 8 hours for severe infections, with a recommended duration of 5 days, extending treatment if the infection has not improved within this period. 1, 2

Adult Dosing Recommendations

Oral Therapy (Outpatient/Mild-Moderate Infections)

• Dose: 300-450 mg three times daily (every 8 hours) 1
• Duration: 5 days (extend if no improvement) 1

Intravenous Therapy (Severe Infections)

• Dose: 600-900 mg every 8 hours 1
• Duration: 5-7 days (extend if no improvement) 1

Pediatric Dosing Recommendations

• Oral therapy: 10-13 mg/kg/dose every 6-8 hours, not to exceed 40 mg/kg/day 1
• IV therapy: 25-40 mg/kg/day in 3 divided doses 1

Clinical Decision Algorithm

1. Assess severity of cellulitis:

   • Mild (no systemic signs): Oral therapy
   • Moderate-severe (systemic signs, rapidly progressive): IV therapy
   • Severe (immunocompromised, hemodynamically unstable): IV therapy + hospitalization

2. Consider MRSA risk factors:

   • Clindamycin is appropriate for both streptococcal and MRSA coverage 1
   • Particularly valuable when both pathogens need coverage 1

3. Weight-based considerations:

   • Ensure adequate dosing of ≥10 mg/kg/day for adults 3
   • Inadequate dosing is associated with clinical failure (OR = 2.01) 3

Important Clinical Considerations

• Clindamycin provides excellent coverage against both streptococci (primary cause of cellulitis) and MRSA when present 1
• Weight-based dosing is critical - patients receiving inadequate doses (<10 mg/kg/day) have significantly higher failure rates 3
• The FDA-approved labeling states clindamycin should be dosed based on total body weight regardless of obesity 2
• For β-hemolytic streptococcal infections, treatment should continue for at least 10 days 2

Common Pitfalls and Caveats

• C. difficile risk: Monitor for significant diarrhea during therapy; discontinue if it occurs 2
• Inducible resistance: Be aware of potential for inducible clindamycin resistance in MRSA strains 1
• Duration: While 5 days is recommended for most cases, treatment should be extended if the infection has not improved 1
• Adjunctive measures: Elevation of affected area and treatment of predisposing factors (edema, toe web abnormalities) are important 1
• Follow-up: Ensure close follow-up, especially for outpatients on shorter courses 1

Recent evidence suggests that shorter courses (5-6 days) are as effective as longer courses for nonpurulent cellulitis, provided patients can self-monitor and have close follow-up 1.