Oral Clindamycin Dosing for MRSA Skin Infections
For MRSA skin infections, adults should be treated with oral clindamycin at a dose of 300-450 mg every 6 hours for 7-14 days, with more severe infections requiring the higher dose range. 1, 2
Dosing Guidelines
Adults:
- Uncomplicated MRSA skin infections: 150-300 mg every 6 hours
- More severe MRSA skin infections: 300-450 mg every 6 hours
- Duration: 7-14 days for complicated skin infections 1, 2
Children (who can swallow capsules):
- Standard 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
- Note: For children unable to swallow capsules, clindamycin palmitate oral solution should be used 2
Administration Considerations
- Take with a full glass of water to avoid esophageal irritation 2
- Absorption is nearly complete (90%) and not significantly affected by food 2
- Clindamycin should be dosed based on total body weight regardless of obesity 2
Important Monitoring and Precautions
- Monitor for Clostridium difficile colitis - discontinue if significant diarrhea occurs 1, 2
- Check for inducible clindamycin resistance before initiating therapy, as this can lead to treatment failure 3
- The risk of clindamycin treatment failure is 7.66 times higher if inducible resistance is not detected 3
Special Considerations
When to Consider Hospitalization:
- Evidence of deeper or necrotizing infection
- Systemic symptoms or hemodynamic instability
- Immunocompromised status
- Failed oral therapy
- Poor adherence to outpatient therapy 1
Adjunctive Measures for Recurrent MRSA Infections:
- Chlorhexidine body washes daily for 5-14 days
- Cover draining wounds
- Regular handwashing
- Avoid sharing personal items
- Clean high-touch surfaces 1
Clinical Evidence and Efficacy
Clindamycin has excellent coverage against gram-positive organisms, including MRSA, with additional anti-toxin effects in staphylococcal infections 1. In areas with low rates of clindamycin resistance, it has shown comparable efficacy to vancomycin for MRSA skin infections 4. Community-associated MRSA has a lower prevalence of inducible clindamycin resistance (33%) compared to hospital-associated MRSA (55%), making clindamycin particularly useful for outpatient therapy of community-acquired infections 5.
For β-hemolytic streptococcal infections, treatment should continue for at least 10 days, even if the skin infection appears to have resolved earlier 2.