Clindamycin Dosing Guidelines
For adult patients, clindamycin should be dosed at 150-300 mg every 6 hours orally for serious infections, and 300-450 mg every 6 hours orally for more severe infections. 1
Adult Dosing
- For skin and soft tissue infections, the Infectious Diseases Society of America recommends 600 mg every 8 hours intravenously or 300-450 mg four times daily orally 2
- For severe infections, higher doses of 600-900 mg every 6-8 hours are recommended 2
- For pelvic inflammatory disease, the Centers for Disease Control and Prevention recommends 900 mg every 8 hours, typically in combination with gentamicin 2, 3
- Intravenous therapy should continue for at least 48 hours after clinical improvement before transitioning to oral therapy 2
- Total duration of therapy (IV plus oral) typically ranges from 7-14 days depending on clinical response 2
- For β-hemolytic streptococcal infections, treatment should continue for at least 10 days 1
Pediatric Dosing
- For children with serious infections: 8-16 mg/kg/day divided into three or four equal doses orally 1
- For more severe pediatric infections: 16-20 mg/kg/day divided into three or four equal doses orally 1
- For MRSA/MSSA infections in pediatric patients: 25-40 mg/kg/day divided into 3 doses 2
- For parenteral administration in pediatric MRSA infections: 40 mg/kg/day divided every 6-8 hours 2
- For oral administration in pediatric MRSA infections: 30-40 mg/kg/day divided into 3-4 doses 2
- For dental infections in children: 30-40 mg/kg/day in 3-4 divided doses 4
- Clindamycin should be dosed based on total body weight regardless of obesity 1
Special Considerations
- To avoid esophageal irritation, clindamycin hydrochloride capsules should be taken with a full glass of water 1
- Clindamycin capsules are not suitable for children who cannot swallow them whole; oral solution may be necessary in these cases 1
- If significant diarrhea occurs during therapy, clindamycin should be discontinued due to risk of Clostridioides difficile infection 1, 5
- Higher doses (600 mg) are associated with increased frequency and severity of gastrointestinal side effects compared to lower doses (300 mg) 5
Combination Therapy
- For pelvic inflammatory disease: Combine clindamycin with gentamicin (loading dose 2 mg/kg followed by maintenance dose 1.5 mg/kg every 8 hours) 2
- For babesiosis: Combine clindamycin with quinine (650 mg every 6-8 hours orally for adults; 8 mg/kg every 8 hours for children) 2
- For serious anaerobic infections: Clindamycin is often combined with an aminoglycoside for treatment of pelvic infections 3
Pathogen-Specific Considerations
- For Group A Streptococcal infections in children: Oral clindamycin at 40 mg/kg/day in 3 doses 2, 6
- For anaerobic lung infections: 600 mg IV every 6 hours initially, followed by 300 mg orally every 6 hours 7
- Clindamycin is particularly effective against anaerobic bacteria, especially beta-lactamase-producing Bacteroides species, and has good activity against aerobic gram-positive cocci 3