What is the proper dosage and administration of clindamycin (lincosamide antibiotic) for treating infections?

Clindamycin Dosage and Administration Guidelines

The proper dosage of clindamycin varies by indication, severity of infection, and patient age, with adult dosing typically ranging from 150-450 mg orally every 6-8 hours or 600-900 mg intravenously every 6-8 hours, while pediatric dosing is generally 8-20 mg/kg/day divided into 3-4 doses for oral therapy and 25-40 mg/kg/day for intravenous therapy. 1, 2

Adult Dosing

Oral Administration

• For serious infections: 150-300 mg every 6 hours 1
• For more severe infections: 300-450 mg every 6 hours 1
• For skin and soft tissue infections (SSTI):
  • Purulent cellulitis: 300-450 mg three times daily 2
  • MRSA skin infections: 300-450 mg four times daily 2
• Should be taken with a full glass of water to avoid esophageal irritation 1

Intravenous Administration

• For complicated skin and soft tissue infections: 600 mg every 8 hours 2
• For MRSA infections: 600 mg every 8 hours 2
• For osteomyelitis: 600 mg every 8 hours 2
• For necrotizing infections: 600-900 mg every 8 hours 2

Pediatric Dosing

Oral Administration

• For serious infections: 8-16 mg/kg/day divided into 3-4 equal doses 1
• For more severe infections: 16-20 mg/kg/day divided into 3-4 equal doses 1
• For MRSA skin infections: 30-40 mg/kg/day in 3-4 divided doses 2
• Maximum daily dose should not exceed 40 mg/kg/day 2

Intravenous Administration

• For serious infections: 25-40 mg/kg/day in 3 divided doses 2
• For MRSA infections: 10-13 mg/kg/dose every 6-8 hours (not to exceed 40 mg/kg/day) 2
• For pneumonia: 40 mg/kg/day every 6-8 hours 2

Duration of Therapy

• For skin and soft tissue infections: 7-10 days depending on clinical response 2
• For β-hemolytic streptococcal infections: at least 10 days 1
• For osteomyelitis: minimum 8 weeks 2
• For bacterial vaginosis: 300 mg twice daily for 7 days 3

Special Considerations

Monitoring

• Monitor for diarrhea, which may indicate Clostridioides difficile infection; discontinue if significant diarrhea occurs 1, 4
• Higher doses (600 mg) are associated with increased frequency and severity of gastrointestinal side effects compared to lower doses (300 mg) 4

Dosing Adjustments

• No dosage adjustment needed for obesity; dose based on total body weight 1
• For patients with chronic osteomyelitis requiring home therapy, 300 mg every 4 hours may be considered to maintain adequate bone levels 5

Specific Indications

• For MRSA pneumonia in children: 10-13 mg/kg/dose every 6-8 hours (to administer 40 mg/kg/day) 2
• For anaerobic lung infections: 600 mg IV every 6 hours, then 300 mg orally every 6 hours after clinical improvement for a minimum of 4 weeks total therapy 6

Combination Therapy

• For MRSA osteomyelitis: Some experts recommend adding rifampin 600 mg daily or 300-450 mg twice daily to clindamycin 2
• For necrotizing infections: Often combined with penicillin (2-4 million units every 4-6 hours IV) 2

Contraindications and Cautions

• Avoid in patients with history of Clostridioides difficile-associated disease 2
• Potential for cross-resistance and emergence of resistance in erythromycin-resistant strains 2
• Inducible resistance in MRSA should be considered 2

Remember that clindamycin should be dosed based on total body weight regardless of obesity, and capsules should be taken with a full glass of water to avoid esophageal irritation 1.