Clindamycin Dosing for Bacterial Infections
For most serious bacterial infections requiring parenteral therapy, clindamycin should be dosed at 600 mg IV every 8 hours in adults, with treatment duration typically 7-21 days depending on infection severity and clinical response. 1, 2, 3
Adult Intravenous Dosing
Standard Serious Infections
- 600 mg IV every 8 hours for aerobic gram-positive cocci and susceptible anaerobes (excluding Bacteroides fragilis, Peptococcus, and most Clostridium species) 3
- This dosing applies to skin/soft tissue infections, pneumonia, and osteomyelitis 1, 2
Severe Infections
- 600-900 mg IV every 8 hours for proven or suspected Bacteroides fragilis, Peptococcus, or Clostridium species 1, 3
- This higher range is recommended for necrotizing infections, clostridial myonecrosis, and intra-abdominal infections 2
- Life-threatening infections may require up to 4,800 mg daily in divided doses 3
Critical Infusion Parameters
- Maximum concentration: 18 mg/mL in IV diluent 3
- Maximum infusion rate: 30 mg/minute 3
- Single IM injections should not exceed 600 mg 3
Adult Oral Dosing
Mild to Moderate Infections
- 300-450 mg PO every 6-8 hours for MSSA skin/soft tissue infections 1, 4
- Serious infections: 150-300 mg every 6 hours 4
- More severe infections: 300-450 mg every 6 hours 4
MRSA Infections
- 300-450 mg PO four times daily for purulent cellulitis and uncomplicated MRSA infections 1, 2
- Must verify local erythromycin resistance rates <10% before using for MRSA 1
Pediatric Dosing
Children ≥1 Month to 16 Years
- 20-40 mg/kg/day IV or PO in 3-4 divided doses 3
- For MRSA infections: 10-13 mg/kg/dose every 6-8 hours (maximum 40 mg/kg/day) 1, 2
- Higher doses (up to 40 mg/kg/day) reserved for severe infections 3
Neonates <1 Month
- 15-20 mg/kg/day in 3-4 divided doses 3
- For post-menstrual age (PMA) ≤32 weeks: 5 mg/kg every 8 hours 3
- For PMA >32 to ≤40 weeks: 7 mg/kg every 8 hours 3
Weight-Based Transition
- Children >40 kg can transition to adult dosing regimens 2
- Weight is more critical than age for dosing decisions 2
Infection-Specific Duration
Skin and Soft Tissue Infections
- 7 days for uncomplicated infections, adjusted based on clinical response 1
- β-hemolytic streptococcal infections require minimum 10 days 3, 4
Bone and Joint Infections
- Minimum 8 weeks for osteomyelitis 1, 2
- Some experts recommend additional 1-3 months of oral rifampin-based combination therapy for chronic infections 1
- 3-4 weeks for septic arthritis 1
Pneumonia
- 7-21 days depending on extent of infection and presence of empyema 1
- MRSA pneumonia with empyema requires antimicrobial therapy plus drainage procedures 1
Critical Warnings and Monitoring
Gastrointestinal Toxicity
- 98% of patients experience GI side effects, with higher doses causing more severe symptoms 5
- 600 mg doses cause diarrhea lasting average 5 days versus 3 days with 300 mg 5
- Discontinue immediately if significant diarrhea develops due to C. difficile risk 3, 4
Resistance Considerations
- Clindamycin is bacteriostatic with potential for cross-resistance in erythromycin-resistant strains 1
- Inducible resistance occurs in MRSA—verify susceptibility before use 1
- Should not be used for infective endocarditis or endovascular infections in children 1
Administration Requirements
- Oral capsules must be taken with full glass of water to avoid esophageal irritation 4
- Dose based on total body weight regardless of obesity 3, 4
- Assess clinical response within 48-72 hours of initiating therapy 2
Combination Therapy Considerations
Bone Infections
- Add rifampin 600 mg daily or 300-450 mg twice daily after bacteremia clearance 1, 2
- Can combine with TMP-SMX, doxycycline, or fluoroquinolones based on susceptibilities 1