Clindamycin Pediatric Dosing
For pediatric patients, clindamycin should be dosed at 30-40 mg/kg/day orally divided into 3-4 doses, or 40 mg/kg/day intravenously divided every 6-8 hours (10-13 mg/kg/dose), based on the Infectious Diseases Society of America and Pediatric Infectious Diseases Society guidelines. 1, 2
Route-Specific Dosing
Intravenous Administration
- Standard dosing: 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) 1, 2
- This dosing applies to serious infections including MRSA/MSSA bacteremia, pneumonia, and Group A Streptococcal infections 1
Oral Administration
- Standard dosing: 30-40 mg/kg/day divided into 3-4 doses 1, 2
- For children able to swallow capsules, the FDA label specifies:
- Important caveat: The higher guideline-recommended doses (30-40 mg/kg/day) reflect contemporary MRSA treatment standards and should be prioritized over the lower FDA label ranges for serious infections 1, 2
Pathogen-Specific Considerations
MRSA Infections
- Parenteral: 40 mg/kg/day divided every 6-8 hours 1, 2
- Oral: 30-40 mg/kg/day divided into 3-4 doses 1, 2
- Only use if local MRSA clindamycin resistance rates are <10% 1
Group A Streptococcus
- Parenteral: 40 mg/kg/day divided every 6-8 hours 1, 2
- Oral: 40 mg/kg/day in 3 doses 1, 2
- Treatment should continue for at least 10 days per FDA guidance 3
Methicillin-Susceptible Staphylococcus aureus (MSSA)
Special Population: Neonates
For newborn infants, significantly reduced dosing is required due to prolonged elimination half-life (6.3 hours vs. 3 hours in older children). 4
- Recommended dose: 15-20 mg/kg/day divided into 4 doses 4
- Standard pediatric dosing results in supratherapeutic levels (12.7-40 mcg/mL vs. therapeutic range of 2-10 mcg/mL) due to immature clearance mechanisms 4
- Clearance is approximately 50% lower than in older children 4
Duration of Therapy
Infection-Specific Durations
- Pneumonia: 7-21 days depending on extent of infection 1
- Bacteremia: 2-6 weeks depending on source and presence of endovascular infection 1
- Osteomyelitis: Minimum 8 weeks 1
- Skin and soft tissue infections: 5-10 days, with 5 days sufficient if clinical improvement occurs 1
- Group A Streptococcal infections: At least 10 days 3
Transition Strategy
- Continue IV therapy for at least 48 hours after clinical improvement 1
- Transition to oral therapy once patient is afebrile for 24 hours and clinically improving 1
- Clinical improvement should be evident within 48-72 hours; if not, consider inadequate source control or deeper infection 1
Critical Contraindications and Precautions
When NOT to Use Clindamycin
- Do not use if there is concern for infective endocarditis or endovascular source of infection 1
- Do not use if local MRSA clindamycin resistance rates exceed 10% 1
- Clindamycin can be considered only in children whose bacteremia rapidly clears and is not related to an endovascular focus 1
Administration Considerations
- Dose based on total body weight regardless of obesity 3
- Capsules should be taken with a full glass of water to avoid esophageal irritation 3
- For children unable to swallow capsules, use clindamycin palmitate oral solution as capsules do not provide exact mg/kg doses 3
Common Pitfalls to Avoid
Underdosing in serious infections: The contemporary guideline-recommended doses (30-40 mg/kg/day oral, 40 mg/kg/day IV) are higher than older FDA label ranges and should be used for MRSA and serious infections 1, 2
Overdosing neonates: Failure to reduce dosing in newborns leads to toxic levels; use only 15-20 mg/kg/day in this population 4
Using clindamycin for endovascular infections: This is contraindicated and associated with treatment failure 1
Inadequate source control: Antibiotics alone are insufficient for abscesses; drainage is essential and may achieve 85-90% cure rates even without antibiotics 1
Ignoring local resistance patterns: Clindamycin should not be used empirically if local MRSA resistance exceeds 10% 1