What is the recommended dose of Cleocin (clindamycin) via intramuscular (IM) injection for a 10-month-old child weighing 18 pounds?

Clindamycin IM Dosing for a 10-Month-Old Weighing 18 Pounds

For a 10-month-old child weighing 18 pounds (approximately 8.2 kg), the recommended intramuscular (IM) dose of clindamycin is 40 mg/kg/day divided every 6-8 hours, which equals approximately 80-110 mg per dose given three to four times daily. 1

Dosing Rationale

• Parenteral clindamycin for pediatric patients is dosed at 40 mg/kg/day divided every 6-8 hours according to the Pediatric Infectious Diseases Society guidelines 1
• For this 8.2 kg child:
  • Total daily dose: 8.2 kg × 40 mg/kg = 328 mg/day
  • If divided every 8 hours (3 doses/day): 109 mg per dose
  • If divided every 6 hours (4 doses/day): 82 mg per dose

Administration Considerations

• Intramuscular injections should be given deep into a large muscle mass 2
• Clindamycin has a normal half-life of two to three hours, which supports the 6-hour dosing interval 2
• The volume of injection should be minimized for IM administration in infants, as large volumes can cause pain and tissue damage 3

Clinical Considerations

• Clindamycin is particularly effective against:

  • Anaerobic bacteria
  • Gram-positive aerobes (except enterococci)
  • Methicillin-resistant Staphylococcus aureus (MRSA) when susceptible 1
  • Group A Streptococcus 4

• For specific infections, the dosing remains consistent:

  • For MRSA infections: 40 mg/kg/day divided every 6-8 hours for parenteral administration 1
  • For Group A Streptococcal infections: same dosing regimen applies 4

Important Considerations for Pediatric Dosing

• Children under 2 years require special dosing consideration as drug elimination does not change in direct proportion to weight 3
• Pharmacokinetic variability in infants is affected by size, maturation, and organ function 3
• After the initial loading dose (based on volume of distribution), subsequent doses should be determined by clearance 5
• For infants over 6 months of age, body surface area (BSA) is generally a good marker for drug dosing, but for antibiotics like clindamycin, weight-based dosing is the standard approach 5

Monitoring and Safety

• Monitor for gastrointestinal side effects, which are the most common adverse reactions to clindamycin 2
• Observe the injection site for signs of inflammation or abscess formation
• Be alert for signs of Clostridioides difficile-associated diarrhea, which can occur with clindamycin use

Remember that this dosing recommendation is based on the child's current weight, and the dose should be adjusted as the child grows.