What is the recommended dosage of Clindamycin (Clindamycin hydrochloride) for adults and children?

Clindamycin Dosage Guidelines

The recommended dosage of clindamycin for adults is 150-450 mg orally every 6 hours for mild to moderate infections, and 600-900 mg intravenously every 6-8 hours for severe infections; while for children, the recommended dosage is 8-20 mg/kg/day divided into 3-4 equal doses orally for mild to moderate infections, and 25-40 mg/kg/day divided into 3-4 doses intravenously for severe infections. 1, 2

Adult Dosing

Oral Administration

• Mild to moderate infections: 150-300 mg every 6 hours
• Severe infections: 300-450 mg every 6 hours
• Take with a full glass of water to prevent esophageal irritation

Parenteral (IV) Administration

• Moderate infections: 600 mg every 8 hours
• Severe infections: 600-900 mg every 6-8 hours
• Very severe infections: Up to 2700 mg/day divided into 2-4 doses

Pediatric Dosing

Oral Administration

• Children who can swallow capsules:
  • Serious infections: 8-16 mg/kg/day divided into 3-4 equal doses
  • More severe infections: 16-20 mg/kg/day divided into 3-4 equal doses

Parenteral (IV) Administration

• Standard dosing: 25-40 mg/kg/day in 3-4 divided doses
• For specific infections:
  • MRSA (susceptible to clindamycin): 40 mg/kg/day every 6-8 hours 3
  • Group A Streptococcus: 40 mg/kg/day every 6-8 hours 3
  • S. pneumoniae: 40 mg/kg/day every 6-8 hours 3

Dosing by Infection Type

Skin and Soft Tissue Infections

• Adults: 300-450 mg orally every 6-8 hours or 600-900 mg IV every 8 hours 3
• Children: 30-40 mg/kg/day in 3-4 divided doses orally or 25-40 mg/kg/day in 3 divided doses IV 3

Anaerobic Infections

• Adults: 600 mg IV every 6 hours (higher success rates have been demonstrated with 900 mg every 8 hours for intra-abdominal infections) 4
• Children: 25-40 mg/kg/day in 3-4 divided doses IV 5

Bone and Joint Infections

• Adults: 600-900 mg IV every 8 hours 3
• Children: 30-40 mg/kg/day in 3-4 divided doses 5

Treatment Duration

• Streptococcal infections: Minimum 10 days 1
• Skin and soft tissue infections: 5-10 days 3
• Osteomyelitis: Minimum 8 weeks 3
• Babesiosis (in combination with quinine): 7-10 days 3

Important Clinical Considerations

1. Monitoring:

   • If significant diarrhea occurs during therapy, discontinue clindamycin immediately due to risk of C. difficile-associated diarrhea 1
   • For severe infections, monitor clinical response within 48-72 hours of initiating therapy

2. Pharmacokinetics:

   • Bone and synovial fluid concentrations reach 60-85% of serum concentrations, making it effective for bone and joint infections 5
   • For 600 mg IV every 6 hours, steady-state serum concentrations range from 2.3-16.8 μg/mL 6

3. Resistance concerns:

   • Check local resistance patterns before using for empiric therapy
   • Inducible resistance can occur in MRSA strains that appear susceptible to clindamycin but resistant to erythromycin 3

4. Dosing adjustments:

   • Clindamycin should be dosed based on total body weight regardless of obesity 1
   • No dosage adjustment is typically required for renal impairment

5. Combination therapy:

   • For babesiosis: Combine with quinine (adults: 650 mg every 6-8 hours; children: 8 mg/kg every 8 hours) 3
   • For severe mixed infections: May be combined with other antibiotics for broader coverage 3

Clindamycin remains a valuable antibiotic for treating various infections, particularly those caused by anaerobic bacteria and susceptible gram-positive organisms including MRSA. Its excellent tissue penetration makes it particularly useful for bone, joint, and deep tissue infections.