From the Guidelines
For oral infections, clindamycin is typically dosed at 300-450 mg orally every 6-8 hours for adults, with a total daily dose not exceeding 1800 mg, as recommended by the Infectious Diseases Society of America guidelines 1. The dosage for children is 10-13 mg/kg/dose PO every 6-8 hours, not to exceed 40 mg/kg/day, as outlined in the guidelines for the treatment of skin and soft-tissue infections (SSTI) caused by community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) 1. Key considerations when prescribing clindamycin include:
- Potential side effects, such as gastrointestinal disturbances, particularly diarrhea, which can indicate Clostridioides difficile infection in severe cases 1
- The importance of completing the full course of antibiotics, even if symptoms improve before completion
- The possibility of combining clindamycin with other antibiotics or supplementing with surgical drainage for severe infections Some notable points from the guidelines include:
- Clindamycin is effective against b-hemolytic streptococci and CA-MRSA, making it a suitable option for empirical therapy in certain cases 1
- The clinical significance of inducible clindamycin resistance is unclear, but its presence should preclude the use of clindamycin for more serious infections 1
- Clindamycin may be used as an alternative to other antibiotics, such as TMP-SMX, doxycycline, and minocycline, which also have activity against CA-MRSA 1
From the FDA Drug Label
Adults: Serious infections – 150 to 300 mg every 6 hours. More severe infections – 300 to 450 mg every 6 hours Pediatric Patients (for children who are able to swallow capsules): Serious infections – 8 to 16 mg/kg/day (4 to 8 mg/lb/day) divided into three or four equal doses. More severe infections – 16 to 20 mg/kg/day (8 to 10 mg/lb/day) divided into three or four equal doses.
The dosing for clindamycin in oral infections is as follows:
- Adults: + Serious infections: 150 to 300 mg every 6 hours + More severe infections: 300 to 450 mg every 6 hours
- Pediatric Patients: + Serious infections: 8 to 16 mg/kg/day divided into three or four equal doses + More severe infections: 16 to 20 mg/kg/day divided into three or four equal doses 2
From the Research
Clindamycin Dosing for Oral Infections
- Clindamycin is effective against odontogenic pathogens, but its potential gastrointestinal toxicity limits its use to third- or fourth-line therapy in general dentistry 3.
- The ideal choice, regimen, and spectrum of empirical oral antibiotics as adjunctive management of acute dentoalveolar infections are unclear, but clindamycin has been shown to be effective in some studies 4, 5.
- Clindamycin alone has been compared to a combination of Penicillin and Metronidazole in the management of severe odontogenic infections, with clindamycin resulting in shorter hospital stays and lower treatment costs 5.
- Clindamycin has been recommended as an adjunctive treatment to β-lactam antibiotics in patients with severe invasive group A β-haemolytic streptococcal infections, but its role in treating patients with invasive non-group A/B β-haemolytic streptococcal infections is unclear 6.
- The use of clindamycin in the treatment of oral infections should be considered on a case-by-case basis, taking into account the severity of the infection, the patient's medical history, and the potential risks and benefits of treatment 3, 4, 5.
Specific Considerations
- Clindamycin may be considered as an alternative therapy for penicillin-allergic patients over the age of 13 who cannot tolerate erythromycin 3.
- The high incidence of gastrointestinal disturbances and superinfection commonly associated with the ingestion of tetracycline limits its role in general dental practice, and clindamycin may be a preferred alternative in some cases 3.
- The effectiveness of clindamycin in the treatment of oral infections highlights the importance of dental treatment in addressing the source of infection, and the role of antibiotics as an adjunctive therapy 4, 5.