Clindamycin Dosing for Bacterial Infections
For serious bacterial infections in adults, clindamycin should be dosed at 600 mg IV every 8 hours or 300-450 mg orally every 6-8 hours, with treatment duration typically 7-21 days depending on infection severity and site. 1, 2, 3
Intravenous Dosing
Standard Serious Infections
- 600 mg IV every 8 hours is the recommended dose for most serious infections including skin/soft tissue infections, pneumonia, and osteomyelitis 1, 2, 3
- For more severe infections (particularly those involving Bacteroides fragilis, Peptococcus, or Clostridium species other than C. perfringens): 600-900 mg IV every 8 hours 3, 4
- Life-threatening infections may require up to 4,800 mg daily in divided doses 3
Infection-Specific IV Dosing
- MRSA skin/soft tissue infections: 600 mg IV every 8 hours 1, 2
- Necrotizing infections: 600-900 mg IV every 8 hours, often combined with penicillin for clostridial myonecrosis 2
- Pneumonia (MRSA or severe community-acquired): 600 mg IV every 8 hours for 7-21 days 1, 2
- Osteomyelitis: 600 mg IV every 8 hours for minimum 8 weeks 1, 2
Oral Dosing
Standard Dosing
- Serious infections: 150-300 mg every 6 hours 5
- More severe infections: 300-450 mg every 6 hours 5
- MRSA skin infections: 300-450 mg four times daily 1, 2
Important Administration Note
- Capsules must be taken with a full glass of water to avoid esophageal irritation 5
- Oral absorption is nearly complete, with peak levels at 45-60 minutes 6
Pediatric Dosing
Children ≥1 Month to 16 Years
- Standard dosing: 20-40 mg/kg/day IV or PO in 3-4 divided doses 3
- MRSA infections: 10-13 mg/kg/dose IV every 6-8 hours (maximum 40 mg/kg/day) 1, 2
- Severe infections: 25-40 mg/kg/day IV in 3 divided doses 1
- Oral dosing: 8-16 mg/kg/day for serious infections; 16-20 mg/kg/day for severe infections, divided into 3-4 doses 5
Neonates <1 Month
- 15-20 mg/kg/day in 3-4 equal doses 3
- For post-menstrual age ≤32 weeks: 5 mg/kg every 8 hours 3
- For post-menstrual age >32 to ≤40 weeks: 7 mg/kg every 8 hours 3
Weight-Based Transition
- Children weighing >40 kg can transition to adult dosing regimens 2
- Dosing should be based on total body weight regardless of obesity 3, 5
Treatment Duration by Infection Type
- Skin/soft tissue infections: 7 days depending on clinical response 1
- Pneumonia: 7-21 days depending on extent of infection 1
- Osteomyelitis: Minimum 8 weeks; some experts recommend additional 1-3 months of oral rifampin-based combination therapy 1, 2
- Septic arthritis: 3-4 weeks 1
- β-hemolytic streptococcal infections: At least 10 days 3, 5
Critical Limitations and Warnings
Spectrum Gaps
- No activity against aerobic gram-negative rods (e.g., E. coli) - must combine with aminoglycoside or other gram-negative coverage for mixed infections 1, 4, 6
- Bacteriostatic agent - should not be used as monotherapy for endocarditis or endovascular infections 1
- Inducible resistance in MRSA - potential cross-resistance with erythromycin-resistant strains 1
Gastrointestinal Toxicity
- 98% of patients experience some GI side effects, with higher doses causing more severe symptoms 7
- The 600 mg dose causes significantly longer diarrhea duration (5 days vs 3 days) and stomach pain (7 days vs 4 days) compared to 300 mg 7
- Discontinue immediately if significant diarrhea develops due to risk of C. difficile-associated colitis 3, 5, 4
- Consider avoiding oral clindamycin unless absolutely necessary; reserve as second-line option 7
Administration Precautions
- Do not exceed 30 mg/minute IV infusion rate 3
- Single IM injections >600 mg are not recommended 3
- IV concentration should not exceed 18 mg/mL 3