Clindamycin Dosing Recommendations for Adults
The recommended dosage of clindamycin for adults with bacterial infections is 150-300 mg orally every 6 hours for serious infections, and 300-450 mg orally every 6 hours for more severe infections, with intravenous options of 600 mg every 8 hours for most infections and 600-900 mg every 6-8 hours for severe infections. 1, 2, 3
Oral Dosing
- For serious infections: 150-300 mg every 6 hours 1
- For more severe infections: 300-450 mg every 6 hours 1
- For skin and soft tissue infections: 300-450 mg three to four times daily 4
- Clindamycin should be taken with a full glass of water to avoid esophageal irritation 1
Intravenous Dosing
- For most infections requiring parenteral therapy: 600 mg every 8 hours 2, 3
- For skin and soft tissue infections: 600 mg every 8 hours 4
- For severe infections: 600-900 mg every 6-8 hours 2, 3
- For MRSA pneumonia: 600 mg every 8 hours 4
Indication-Specific Dosing
Skin and Soft Tissue Infections
- For MRSA/MSSA infections: 600 mg IV every 8 hours or 300-450 mg PO four times daily 4
- For purulent cellulitis: 300-450 mg PO three times daily 3
- For complicated skin infections: 600 mg IV/PO three times daily 4, 2
Bone and Joint Infections
- For osteomyelitis: 600 mg IV/PO every 8 hours 4, 3
- Minimum treatment duration of 8 weeks 4
- Consider adding rifampin 600 mg daily or 300-450 mg twice daily after clearance of bacteremia 4
Pneumonia
- For healthcare-associated MRSA pneumonia: 600 mg IV every 8 hours 4
- Treatment duration: 7-21 days depending on extent of infection 4
Duration of Therapy
- For skin and soft tissue infections: Approximately 7 days, depending on clinical response 4
- For streptococcal infections: At least 10 days 1
- For osteomyelitis: Minimum 8 weeks 4
- For pneumonia: 7-21 days 4
Important Considerations
- Assess clinical response within 48-72 hours of initiating therapy 3
- If significant diarrhea occurs during therapy, discontinue clindamycin immediately 1
- Higher doses (600 mg) are associated with increased gastrointestinal side effects compared to lower doses (300 mg) 5
- Consider transitioning from IV to oral therapy after clinical improvement 2
- For mixed infections, clindamycin is often combined with agents active against gram-negative bacteria 3
Clinical Pearls
- A study comparing 600 mg every 6 hours versus 600 mg every 8 hours found no significant differences in clinical outcomes, suggesting the 8-hour dosing interval is effective and may reduce side effects 6
- Low-dose clindamycin (150 mg/day) has been shown effective for prevention of recurrent staphylococcal skin infections in a 3-month regimen 7
- For anaerobic lung infections, clindamycin (600 mg IV every 6 hours) has demonstrated superior efficacy compared to penicillin, particularly against penicillin-resistant Bacteroides species 8
- For pelvic infections, 900 mg IV every 8 hours is the recommended dose 9
Cautions
- Clindamycin should not be used if there is concern for infective endocarditis or endovascular source of infection 4
- Almost all patients (98%) experience some gastrointestinal side effects from oral clindamycin, with higher doses causing more severe and prolonged symptoms 5
- Monitor for Clostridioides difficile infection, which can occur during or after treatment 9