Pediatric Dosing of Clindamycin
For pediatric patients, clindamycin should be dosed at 8-20 mg/kg/day divided into three or four equal doses for serious infections, with more severe infections requiring 16-20 mg/kg/day. 1
Recommended Dosing Guidelines
The FDA-approved dosing recommendations for clindamycin in pediatric patients are:
- Serious infections: 8 to 16 mg/kg/day divided into three or four equal doses
- More severe infections: 16 to 20 mg/kg/day divided into three or four equal doses 1
These doses are based on total body weight regardless of obesity. For children with severe allergic reactions to penicillin, the American Academy of Pediatrics (AAP) specifically recommends clindamycin at 10-20 mg/kg/day in 3 divided doses 2.
Administration Considerations
Important administration details include:
- Clindamycin capsules should be taken with a full glass of water to avoid esophageal irritation 1
- Capsules are not suitable for children who cannot swallow them whole; oral solution may be necessary in these cases 1
- For β-hemolytic streptococcal infections, treatment should continue for at least 10 days 1
Special Clinical Scenarios
Musculoskeletal Infections
For musculoskeletal infections, higher dosing may be used:
- For suspected or confirmed Staphylococcus aureus co-infection, the Infectious Diseases Society of America (IDSA) recommends clindamycin at 40 mg/kg/day every 6-8 hours 2
- However, a retrospective study found that 30 mg/kg/day was effective for musculoskeletal infections in children in MRSA-prevalent communities, with no significant difference in readmission rates compared to 40 mg/kg/day 3
Osteomyelitis
Historical data supports:
- Initial IV therapy at 50 mg/kg/day for approximately three weeks
- Followed by oral therapy at 30 mg/kg/day for an additional six weeks 4
Important Monitoring and Precautions
- Monitor for diarrhea: If significant diarrhea occurs during therapy, clindamycin should be discontinued due to risk of C. difficile-associated diarrhea 1
- Watch for neutropenia: Some studies have reported treatment-associated neutropenia (16% in one study) 5
- Monitor hemoglobin: Significant drops in hemoglobin (≥2 g/dl) have been observed in some pediatric patients (14% in one study) 5
Age-Based Considerations
- Efficacy may be reduced in very young children (1-2 years), with one study showing only 62% cure rate in this age group for malaria treatment 5
- For optimal dosing in different age groups, one pharmacokinetic modeling study suggested:
- ≤5 months: 9 mg/kg/dose every 8 hours
5 months-6 years: 12 mg/kg/dose every 8 hours
- 6-18 years: 10 mg/kg/dose every 8 hours 6
Clinical Pearls
- Clindamycin demonstrates good bone and synovial fluid penetration (60-85% of serum concentrations) 7, making it an excellent choice for bone and joint infections
- For serious infections where IV therapy is initially required, transition to oral therapy can be made after clinical improvement (typically after patient is afebrile for three days) 7
- Clindamycin provides an effective alternative for patients with penicillin allergies 7