Clindamycin Dosing for Pediatric Patients
For pediatric patients, clindamycin should be dosed at 40 mg/kg/day divided every 6-8 hours for parenteral (IV) administration, or 30-40 mg/kg/day divided into 3-4 doses for oral administration, based on current guidelines from the Pediatric Infectious Diseases Society, Infectious Diseases Society of America, and American Academy of Pediatrics. 1, 2
Parenteral (Intravenous) Dosing
Standard Dosing
- Administer 40 mg/kg/day divided every 6-8 hours (equivalent to 10-13 mg/kg/dose every 6-8 hours, not to exceed 40 mg/kg/day total) for serious infections including MRSA, MSSA, Group A Streptococcus, and pneumonia 1, 2
- This dosing applies across most serious bacterial infections requiring IV therapy 2
Pathogen-Specific Considerations
- For MRSA infections in stable children without ongoing bacteremia: 10-13 mg/kg/dose IV every 6-8 hours 2
- For Group A Streptococcal infections: 40 mg/kg/day every 6-8 hours 1, 2
- For Streptococcus pneumoniae infections: 40 mg/kg/day every 6-8 hours 2
Oral Dosing
Standard Dosing
- For serious infections: 8-16 mg/kg/day divided into 3-4 equal doses 3
- For more severe infections: 16-20 mg/kg/day divided into 3-4 equal doses 3
- For MRSA/MSSA infections: 30-40 mg/kg/day divided into 3-4 doses 1, 2
Pathogen-Specific Oral Dosing
- For Group A Streptococcus infections: 40 mg/kg/day in 3 doses 1, 2
- For cellulitis secondary to abscess in penicillin-allergic patients: 10-20 mg/kg/day divided into 3 doses 2
Special Population: Neonates and Premature Infants
Newborn infants require significantly reduced dosing due to prolonged elimination half-life (6.3 hours vs. 3 hours in older children) and lower clearance. 4
- Recommended dose for neonates: 15-20 mg/kg/day given in 4 divided doses 4
- Maturation of clindamycin clearance reaches 50% of adult values at approximately 44 weeks postmenstrual age 5
- For infants ≤5 months: Consider 9 mg/kg/dose every 8 hours for IV administration 6
- For infants >5 months to 6 years: 12 mg/kg/dose every 8 hours 6
- For children 6-18 years: 10 mg/kg/dose every 8 hours 6
Important Clinical Considerations
Administration Guidelines
- Clindamycin should be dosed based on total body weight regardless of obesity 3
- Oral capsules should be taken with a full glass of water to avoid esophageal irritation 3
- Capsules are not suitable for children unable to swallow them whole; use clindamycin palmitate oral solution instead 3
Duration of Therapy
- For β-hemolytic streptococcal infections: Continue treatment for at least 10 days 3
- For pneumonia: 7-21 days depending on extent of infection 2
- For bacteremia and endocarditis: 2-6 weeks depending on source and presence of endovascular infection 2
- For osteomyelitis: Minimum 8-week course, though older studies used 50 mg/kg/day IV for 3 weeks followed by 30 mg/kg/day orally for 6 weeks 2, 7
Critical Caveats and Pitfalls
- Clindamycin should only be used if local MRSA clindamycin resistance rates are <10% 2
- Do not use if there is concern for infective endocarditis or endovascular source of infection 2
- Discontinue immediately if significant diarrhea occurs due to risk of Clostridioides difficile-associated diarrhea 3
- Loose stools occur in approximately 1-7% of patients, with rash developing rarely 8