Clindamycin Dosing Guidelines
Clindamycin should be dosed at 600 mg every 8 hours intravenously or 300-450 mg four times daily orally for adults with skin and soft tissue infections, with specific adjustments based on infection type, severity, and patient factors. 1
Adult Dosing
Intravenous Administration
- For skin and soft tissue infections (SSTI): 600 mg every 8 hours 1
- For severe infections: 600-900 mg every 6-8 hours 1
- For pelvic inflammatory disease: 900 mg every 8 hours (typically with gentamicin) 1
- Duration: Continue IV therapy for at least 48 hours after clinical improvement, then transition to oral therapy 1
Oral Administration
- For methicillin-resistant Staphylococcus aureus (MRSA) infections: 300-450 mg four times daily 1
- For methicillin-susceptible Staphylococcus aureus (MSSA) infections: 300-450 mg four times daily 1
- Total duration of therapy (IV plus oral): 7-14 days depending on clinical response 1
Pediatric Dosing
Intravenous Administration
- For MRSA/MSSA infections: 25-40 mg/kg/day divided into 3 doses 1
- For severe infections: 10-13 mg/kg/dose every 8 hours (to administer 40 mg/kg/day) 1, 2
Oral Administration
- For MRSA/MSSA infections: 30-40 mg/kg/day divided into 3-4 doses 1, 2
- For Group A Streptococcus: 40 mg/kg/day in 3 doses 2
Special Considerations
Hepatic Impairment
- Dosage modification may not be necessary in patients with liver disease, as accumulation rarely occurs with q8h dosing 3, 4
- However, periodic liver enzyme determinations should be made when treating patients with severe liver disease 3, 4
Renal Impairment
Drug Interactions
- Clindamycin is metabolized predominantly by CYP3A4 and CYP3A5 3, 4
- Monitor for adverse reactions when co-administered with strong CYP3A4 inhibitors 3
- Monitor for loss of effectiveness when co-administered with strong CYP3A4 inducers like rifampicin 3, 5
- When combined with rifampicin, oral clindamycin should be avoided due to significant reduction in bioavailability 5
Administration Guidelines
Intravenous Administration
- Should not be injected undiluted as a bolus 3
- Should be infused over at least 10-60 minutes 3
- When combined with rifampicin for bone and joint infections, continuous infusion may be preferable to intermittent dosing 5
Combination Therapy
- For pelvic inflammatory disease: Combine with gentamicin (loading dose 2 mg/kg followed by maintenance dose 1.5 mg/kg every 8 hours) 1, 6
- For babesiosis: Combine with quinine (650 mg every 6-8 hours orally) 1
Monitoring and Adverse Effects
- Monitor for diarrhea, particularly in older patients with severe illness 3, 4
- During prolonged therapy, periodic liver and kidney function tests and blood counts should be performed 3, 4
- Be vigilant for pseudomembranous colitis, which can occur up to two months after discontinuation 3, 4, 7
- Use with caution in atopic individuals and those with history of gastrointestinal disease, particularly colitis 3, 4
Clinical Pearls
- Clindamycin has excellent coverage against anaerobes, gram-positive cocci, and Chlamydia trachomatis, making it preferred for serious female genital tract infections 6
- For MRSA infections in children who are stable without ongoing bacteremia, clindamycin is an important treatment option 1
- Clindamycin appears to be the therapy of choice for initial treatment of anaerobic lung infections due to penicillin-resistant Bacteroides species 8
- Surgical drainage or debridement should be performed in conjunction with antibiotic therapy when indicated 3, 4