Clindamycin Dosing for Bursitis
For bursitis treatment, clindamycin should be dosed at 600 mg intravenously every 8 hours or 300-450 mg orally three times daily for adults. 1
Adult Dosing Recommendations
- For skin and soft tissue infections including bursitis, the recommended intravenous dose is 600 mg every 8 hours 1
- For oral therapy, 300-450 mg three times daily is recommended 1, 2
- For more severe infections, the dose can be increased to 600-900 mg every 6-8 hours intravenously 1, 2
- According to FDA labeling, serious infections can be treated with 150-300 mg orally every 6 hours, while more severe infections require 300-450 mg every 6 hours 3
- Total duration of therapy is typically 7-14 days depending on clinical response 2, 4
Pediatric Dosing Recommendations
- For children with skin and soft tissue infections, the recommended intravenous dose is 25-40 mg/kg/day divided into 3 doses 1
- For oral therapy in children, 10-20 mg/kg/day in 3 divided doses is recommended 1, 2
- According to FDA labeling, serious infections in children require 8-16 mg/kg/day divided into three or four equal doses, while more severe infections need 16-20 mg/kg/day divided into three or four equal doses 3
- Clindamycin should be dosed based on total body weight regardless of obesity 3, 5
Treatment Approach for Septic Bursitis
- Prompt initiation of antibiotic therapy is crucial, as delayed treatment correlates with prolonged culture positivity (r = 0.68, P < 0.001) 4
- Treatment should include both antibiotic therapy and drainage of the bursa 6, 7
- In cases of septic bursitis without extensive cellulitis, clindamycin monotherapy may be sufficient 6
- For more severe presentations with extensive cellulitis, combination therapy may be warranted 6, 7
- Serial bursal aspirations should be performed to monitor treatment response 4
- Treatment should continue for at least 5 days after documented culture sterility to ensure complete resolution 4
Important Clinical Considerations
- Distinguishing between septic and aseptic bursitis is crucial before initiating antibiotic therapy 7, 8
- Common physical findings in septic bursitis include tenderness (88%), erythema/cellulitis (83%), warmth (84%), and evidence of trauma or skin lesion (50%) 7
- Staphylococcus aureus is the most common pathogen in septic bursitis (94.4% of culture-positive cases) 6, 7
- For beta-hemolytic streptococcal infections, treatment should continue for at least 10 days 3, 5
- Monitor for significant diarrhea during therapy, which may indicate Clostridioides difficile infection and would necessitate discontinuation of clindamycin 3, 5
Transition from IV to Oral Therapy
- Intravenous therapy should be continued for at least 48 hours after clinical improvement before transitioning to oral therapy 2
- When transitioning from IV to oral therapy, maintain the same total daily dose divided appropriately 2, 5
- Total duration of therapy (IV plus oral) should be 7-14 days, depending on clinical response 2, 4