What is the recommended dose of clindamycin (Clindamycin) for Methicillin-resistant Staphylococcus aureus (MRSA) coverage in a 65-pound individual?

Recommended Dosage of Clindamycin for MRSA Coverage in a 65-Pound Individual

For a 65-pound (approximately 29.5 kg) child, the recommended dosage of clindamycin for MRSA coverage is 10-20 mg/kg/day divided into 3 doses, which equals approximately 100-200 mg orally three times per day. 1

Dosage Calculation

• The FDA-approved dosage for clindamycin in pediatric patients for serious infections is 8-16 mg/kg/day divided into three or four equal doses 2
• For more severe infections, including MRSA coverage, the dosage increases to 16-20 mg/kg/day divided into three or four equal doses 2
• For a 65-pound (29.5 kg) child:
  • At 10 mg/kg/day: 295 mg/day ÷ 3 doses = approximately 100 mg per dose
  • At 20 mg/kg/day: 590 mg/day ÷ 3 doses = approximately 200 mg per dose 1

Administration Guidelines

• Clindamycin should be taken with a full glass of water to avoid esophageal irritation 2
• The medication should be dosed based on total body weight regardless of obesity 2
• For MRSA skin and soft tissue infections, the duration of therapy is typically 7-10 days, depending on clinical response 1
• If treating β-hemolytic streptococcal infections, treatment should continue for at least 10 days 2

Important Considerations

• Clindamycin is bacteriostatic against MRSA 1
• There is potential for cross-resistance and emergence of resistance in erythromycin-resistant strains; inducible resistance in MRSA should be considered 1
• If significant diarrhea occurs during therapy, clindamycin should be discontinued due to risk of Clostridioides difficile-associated diarrhea 2
• For children who cannot swallow capsules, clindamycin palmitate oral solution may be necessary 2

Monitoring and Precautions

• D-zone testing is recommended before initiating clindamycin therapy to detect inducible clindamycin resistance, which can lead to treatment failure 3, 4
• Inducible clindamycin resistance is more common in MRSA than MSSA isolates 5, 4
• If the patient has severe infection or is not responding to oral therapy, consider switching to intravenous clindamycin at 25-40 mg/kg/day in 3 divided doses 1

Alternative Therapies

• If clindamycin resistance is detected or the patient fails to respond to therapy, alternative options include:
  • Trimethoprim-sulfamethoxazole (TMP-SMX) 1
  • Linezolid (for children >12 years: 600 mg twice daily; for children <12 years: 10 mg/kg every 8 hours) 1
  • Vancomycin (for serious infections requiring IV therapy) 1

Remember that clindamycin remains an effective option for MRSA coverage in pediatric patients when the strain is susceptible, offering the advantage of good oral bioavailability and tissue penetration 6.