Clindamycin Dosing for Pediatric Patients
The recommended dose of clindamycin for pediatric patients is 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. 1
Dosing Guidelines
The FDA-approved dosing recommendations for clindamycin in pediatric patients are as follows:
- 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 1
Important considerations:
- Clindamycin should be dosed based on total body weight regardless of obesity
- To avoid esophageal irritation, clindamycin hydrochloride capsules should be taken with a full glass of water
- Clindamycin capsules are not suitable for children who cannot swallow them whole; oral solution may be necessary in these cases
- For β-hemolytic streptococcal infections, treatment should continue for at least 10 days 1
Administration Routes and Formulations
Oral Administration
- Appropriate for less severe infections or as step-down therapy after initial IV treatment
- Available as capsules or oral solution
- Oral solution is preferred for younger children who cannot swallow capsules
Intravenous Administration
- Recommended for serious infections due to anaerobic bacteria
- May be initiated intravenously and then transitioned to oral therapy once clinical improvement is observed
Clinical Applications and Considerations
Musculoskeletal Infections
- Clindamycin has excellent bone penetration, achieving 60-85% of serum concentrations in bone and synovial fluid 2
- For osteomyelitis, a common regimen includes:
- Initial IV therapy: 50 mg/kg/day divided into 3-4 doses for approximately 3 weeks
- Followed by oral therapy: 30 mg/kg/day for an additional 6 weeks 3
MRSA Infections
- While traditional dosing recommends up to 40 mg/kg/day for MRSA infections, research has shown that 30 mg/kg/day may be effective for outpatient treatment of musculoskeletal MRSA infections 4
Important Safety Considerations
- Monitor for significant diarrhea during therapy, which may indicate Clostridioides difficile-associated diarrhea (CDAD)
- If significant diarrhea occurs, clindamycin should be discontinued immediately 1
- Despite concerns about pseudomembranous colitis, this is relatively uncommon with appropriate use and monitoring 5
Practical Dosing Tips
- When calculating doses, round to convenient volumes for administration
- For IV administration, ensure proper dilution according to package insert
- When transitioning from IV to oral therapy, maintain similar total daily doses adjusted for bioavailability
- Serum concentrations following appropriate dosing are typically 8-32 fold higher than the minimum inhibitory concentrations for susceptible organisms 2