Oral Clindamycin Dosage for MRSA Wound Infections
For adults with MRSA wound infections, the recommended oral dosage of clindamycin is 300-450 mg every 6 hours for more severe infections, or 150-300 mg every 6 hours for less serious infections. 1
Adult Dosing Guidelines
The FDA-approved dosing for oral clindamycin in adults is as follows:
- For serious infections: 150 to 300 mg every 6 hours
- For more severe infections: 300 to 450 mg every 6 hours 1
While the Infectious Diseases Society of America (IDSA) recommends clindamycin dosing at 600 mg every 8 hours for MRSA wound infections 2, the FDA-approved labeling provides the definitive dosing guidance for oral administration.
Important Considerations Before Prescribing
- Ensure local MRSA resistance rates are low (<10%) before initiating clindamycin therapy 2
- Clindamycin should be taken with a full glass of water to avoid esophageal irritation 1
- For β-hemolytic streptococcal infections, treatment should continue for at least 10 days 1
Treatment Duration
For MRSA wound infections, treatment duration typically ranges:
- Uncomplicated skin and soft tissue infections: 5-10 days
- Complicated skin and soft tissue infections: 7-14 days 2
Pediatric Dosing
For pediatric patients who can swallow capsules:
- 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
Alternatively, the IDSA recommends 10-13 mg/kg/dose every 6-8 hours (total daily dose of 40 mg/kg/day) 2
Critical Adjunctive Therapy
Surgical drainage of abscesses is the mainstay of therapy and should be performed whenever feasible 2. Antibiotics alone may be insufficient without adequate drainage of purulent collections.
Monitoring and Safety
Adverse Effects to Monitor
- Clostridium difficile colitis: This is a significant risk with clindamycin therapy 2
- If significant diarrhea occurs during therapy, clindamycin should be discontinued immediately 1
Resistance Concerns
Inducible clindamycin resistance can lead to treatment failure in staphylococcal infections. This is particularly important in MRSA strains, where both inducible and constitutive clindamycin resistance rates are significantly higher than in MSSA 3.
Special Situations
Consider hospitalization if there is evidence of:
- Deeper or necrotizing infection
- Systemic symptoms
- Hemodynamic instability
- Immunocompromised status
- Poor adherence to outpatient therapy 2
For severe infections or those with systemic involvement, combination therapy with rifampin (600 mg daily or 300-450 mg twice daily) may be considered 2.