Pediatric Dosing of Clindamycin for Dental Infections/Abscesses
For pediatric patients with dental infections or abscesses, clindamycin should be dosed at 8-20 mg/kg/day divided into three or four equal doses for serious infections, and 16-20 mg/kg/day divided into three or four equal doses for more severe infections. 1
Dosing Guidelines
FDA-Approved Dosing
- For serious infections: 8 to 16 mg/kg/day (4 to 8 mg/lb/day) divided into three or four equal doses 1
- For more severe infections: 16 to 20 mg/kg/day (8 to 10 mg/lb/day) divided into three or four equal doses 1
- Clindamycin should be dosed based on total body weight regardless of obesity 1
- To avoid esophageal irritation, clindamycin should be taken with a full glass of water 1
Clinical Practice Guidelines
- For oral administration in pediatric MRSA infections, clindamycin is typically dosed at 30-40 mg/kg/day divided into 3-4 doses 2, 3
- For methicillin-susceptible Staphylococcus aureus infections in children, oral clindamycin should be given at 30-40 mg/kg/day in 3-4 doses 2
- For Group A Streptococcus infections, oral clindamycin can be administered at 40 mg/kg/day in 3 doses 2
Administration Considerations
- Clindamycin capsules are not suitable for children who are unable to swallow them whole; oral solution may be necessary in these cases 1
- For β-hemolytic streptococcal infections, treatment should continue for at least 10 days 1
- If significant diarrhea occurs during therapy, clindamycin should be discontinued due to risk of C. difficile-associated diarrhea 1
Efficacy in Dental Infections
- Clindamycin has demonstrated effectiveness against common pathogens in odontogenic infections, including both aerobic and anaerobic bacteria 4
- The antibiotic has high oral absorption and significant tissue penetration, including into bone, making it particularly suitable for dental infections 4
- Clindamycin has been shown to be comparable to other antibiotics like amoxicillin/clavulanic acid in achieving clinical success in acute odontogenic infections 5
Special Considerations
- Monitor for development of resistance during therapy, especially when treating erythromycin-resistant MRSA infections 6
- For severe infections requiring parenteral therapy, clindamycin can be administered at 40 mg/kg/day divided every 6-8 hours 2, 3
- Consider transitioning from IV to oral therapy after clinical improvement 2
Potential Adverse Effects
- Most common adverse events include diarrhea, raised liver enzymes, and headache 5
- Severe diarrhea or colitis can occur during or after treatment, requiring prompt discontinuation 1
- Despite historical concerns, a study of children receiving high doses of clindamycin for osteomyelitis (50 mg/kg/day IV followed by 30 mg/kg/day orally) reported no cases of diarrhea or enterocolitis 7