What is the treatment for cellulitis using Clindamycin (clindamycin phosphate)?

From the Guidelines

Clindamycin is an effective antibiotic option for treating cellulitis, particularly in patients with beta-lactam allergies or when MRSA is suspected, with a recommended treatment duration of 5-6 days, as supported by recent guidelines 1. The typical adult dosage is 300-450 mg orally every 6-8 hours for mild to moderate infections, or 600-900 mg intravenously every 8 hours for severe infections. When prescribing clindamycin, patients should be instructed to take the full course of antibiotics even if symptoms improve before completion. Common side effects include diarrhea, nausea, and abdominal pain. Patients should be warned about the risk of Clostridioides difficile-associated diarrhea, which can occur during or after treatment. If severe or bloody diarrhea develops, patients should stop the medication and seek medical attention immediately. Clindamycin works by binding to the 50S ribosomal subunit of bacteria, inhibiting protein synthesis. It has good tissue penetration, particularly in skin and soft tissue infections, and covers many gram-positive organisms including Staphylococcus aureus (including MRSA) and Streptococcus species, which are common causes of cellulitis. Some key points to consider when treating cellulitis with clindamycin include:

• The patient's ability to self-monitor and have close follow-up with primary care 1
• The presence of penetrating trauma, evidence of MRSA infection elsewhere, nasal colonization with MRSA, injection drug use, or systemic inflammatory response syndrome, which may require additional antimicrobial coverage 1
• The potential for Clostridioides difficile-associated diarrhea, which can be severe and require immediate medical attention 1

From the FDA Drug Label

Clindamycin Injection, USP is indicated in the treatment of serious infections caused by susceptible strains of the designated organisms in the conditions listed below: Skin and skin structure infections caused by Streptococcus pyogenes, Staphylococcus aureus, and anaerobes. Gynecological infections including endometritis, nongonococcal tubo-ovarian abscess, pelvic cellulitis, and postsurgical vaginal cuff infection caused by susceptible anaerobes

Clindamycin is indicated for the treatment of skin and skin structure infections, including those caused by Streptococcus pyogenes, Staphylococcus aureus, and anaerobes.

• Clindamycin can be used to treat cellulitis caused by susceptible strains of bacteria, including Streptococcus pyogenes and Staphylococcus aureus 2.
• The use of clindamycin should be reserved for patients who are allergic to penicillin or for whom a penicillin is inappropriate.
• It is essential to perform bacteriologic studies to determine the causative organisms and their susceptibility to clindamycin before initiating treatment.

From the Research

Clindamycin for Cellulitis

• Clindamycin is an antibiotic that has been studied for the treatment of cellulitis, a common skin infection 3, 4.
• A study published in 2010 found that clindamycin was effective in treating cellulitis, particularly in patients with community-associated methicillin-resistant Staphylococcus aureus (MRSA) infections 3.
• Another study published in 2017 found that weight-based dosing of clindamycin was associated with better outcomes in patients hospitalized with cellulitis 4.

Comparison with Other Antibiotics

• Clindamycin has been compared to other antibiotics, such as trimethoprim-sulfamethoxazole and cephalexin, in the treatment of cellulitis 3, 5.
• A systematic review and meta-analysis published in 2019 found that there was no evidence to support the superiority of any one antibiotic over another, including clindamycin, in the treatment of cellulitis 5.

Route of Administration and Duration of Therapy

• The route of administration and duration of therapy for clindamycin in the treatment of cellulitis have also been studied 6, 5.
• A study published in 2020 found that oral clindamycin was as effective as intravenous clindamycin in treating cellulitis, and that the duration of therapy did not affect outcomes 6.
• The systematic review and meta-analysis published in 2019 found that there was no evidence to support the use of intravenous antibiotics over oral antibiotics, or treatment durations longer than 5 days, in the treatment of cellulitis 5.

Clinical Outcomes

• Clinical outcomes in patients treated with clindamycin for cellulitis have been reported in several studies 3, 4, 7.
• A review published in 2021 noted that clindamycin is a commonly used antibiotic for the treatment of cellulitis, and that clinical outcomes are generally good, but that the diagnosis and management of cellulitis can be challenging 7.