Maximum Clindamycin Dosage
For adults, the maximum recommended dosage of clindamycin is 2,700 mg per day (900 mg every 8 hours intravenously), while for pediatric patients the maximum is 40 mg/kg/day. 1, 2
Adult Maximum Dosing
The FDA label confirms that doses up to 2 grams per day for 14 days have been well tolerated by healthy volunteers, though gastrointestinal side effects increase at higher doses 3
For severe infections, the standard maximum is 900 mg every 6-8 hours intravenously (2,700-3,600 mg/day), as recommended by the Infectious Diseases Society of America 1, 2
For pelvic inflammatory disease specifically, the Centers for Disease Control and Prevention recommends 900 mg every 8 hours (2,700 mg/day total) 1
For most serious infections including skin/soft tissue infections, pneumonia, and bone/joint infections, 600 mg IV/PO every 8 hours (1,800 mg/day) is the typical maximum used in clinical practice 2
For oral administration in less severe infections, 300-450 mg every 6-8 hours (1,200-1,800 mg/day) is the standard maximum 2, 4
Important Dosing Considerations for Adults
Meta-analysis data demonstrates that 900 mg every 8 hours achieves significantly higher cure rates (90.5%) compared to 600 mg every 8 hours (75.6%) for intraabdominal infections (p=0.03), suggesting the higher dose should be used for severe abdominal infections 5
For pelvic infections, both 600 mg and 900 mg every 8 hours show similar efficacy (cure rates 82.8% vs 89.4%, p=0.51), making 600 mg every 8 hours acceptable for most cases 5
Gastrointestinal side effects are dose-dependent, with 98% of patients experiencing some adverse effects, and those receiving 600 mg experiencing significantly more severe and prolonged symptoms compared to 300 mg 6
Pediatric Maximum Dosing
The absolute maximum for pediatric patients is 40 mg/kg/day, regardless of indication 1, 2
This is typically administered as 10-13 mg/kg/dose every 6-8 hours intravenously for serious infections including MRSA, pneumonia, and bacteremia 1, 2
For oral therapy in MRSA and other susceptible infections, 30-40 mg/kg/day divided into 3-4 doses is the maximum 1, 2
For Group A Streptococcal infections requiring IV therapy, 40 mg/kg/day every 6-8 hours is the maximum 1
Individual doses should not exceed 600 mg per dose for Group A Streptococcal infections 1
Special Population Considerations
Dosage schedules do not need modification in patients with renal disease, as hemodialysis and peritoneal dialysis are not effective in removing clindamycin 3
In elderly patients, the elimination half-life increases to approximately 4 hours compared to 3.2 hours in younger adults, but no dosage alteration is necessary for those with normal hepatic function and age-adjusted renal function 3
In obese patients (both pediatric and adult), clindamycin clearance and volume of distribution normalized by total body weight are comparable regardless of obesity, suggesting standard weight-based dosing applies 3
Critical Safety Warning
Oral clindamycin should be avoided unless absolutely necessary due to the high incidence (98%) of gastrointestinal side effects, with higher doses (600 mg) causing significantly longer duration of diarrhea (5 days vs 3 days) and stomach pain (7 days vs 4 days) compared to lower doses (300 mg) 6
Reserve oral clindamycin as a secondary option and prioritize first-line antibiotics when possible to reduce adverse outcomes 6