What is the recommended dose of Clindamycin (Clinda) for an infected cat scratch?

Clindamycin Dosing for Infected Cat Scratch

For an infected cat scratch, clindamycin is NOT the first-line antibiotic—amoxicillin-clavulanate is preferred for prophylaxis and treatment of animal bite/scratch infections. However, if clindamycin is used (e.g., for penicillin allergy or MRSA coverage), the dose is 300-450 mg orally three times daily for adults or 10-20 mg/kg/day divided into three doses for children. 1, 2

Important Distinction: Type of Infection

For Simple Infected Cat Scratch (Wound Infection)

• First-line therapy is amoxicillin-clavulanate 875/125 mg twice daily, which provides optimal coverage against Pasteurella multocida and other common pathogens from cat scratches 1, 3
• Clindamycin has good activity against staphylococci, streptococci, and anaerobes but misses P. multocida, making it suboptimal as monotherapy 1
• If clindamycin must be used (penicillin allergy without anaphylaxis history):
  • Adults: 300 mg three times daily orally 1
  • Children: 10-20 mg/kg/day divided into 3 doses orally 1
  • Duration: 7-10 days for most wound infections 1, 3

For Cat Scratch Disease (Bartonella henselae)

• This is a completely different entity from a simple infected scratch—it presents with lymphadenopathy weeks after exposure 4, 5
• Azithromycin is the recommended treatment, NOT clindamycin:
  • Adults >45 kg: 500 mg day 1, then 250 mg days 2-5 1, 3
  • Children <45 kg: 10 mg/kg day 1, then 5 mg/kg days 2-5 1, 3
• Clindamycin has no established role in cat scratch disease treatment 4, 5

Clindamycin Dosing Details (When Indicated)

Oral Dosing

• Adults with serious infections: 150-300 mg every 6 hours 2
• Adults with severe infections: 300-450 mg every 6 hours 2
• For SSTI specifically: 300-450 mg three times daily 1
• Children (who can swallow capsules): 8-16 mg/kg/day divided into 3-4 doses for serious infections; 16-20 mg/kg/day for severe infections 2
• Take with full glass of water to avoid esophageal irritation 2

IV Dosing (Hospitalized Patients)

• Adults: 600 mg every 6-8 hours IV 1
• Children: 10-13 mg/kg/dose every 8 hours IV (or 25-40 mg/kg/day in 3 divided doses) 1

Critical Caveats

When Clindamycin Should NOT Be Used

• Avoid as monotherapy for animal bites/scratches due to poor Pasteurella coverage 1
• If empirical MRSA coverage is needed along with Pasteurella coverage, combine clindamycin with a fluoroquinolone or use alternative regimens 1
• Monitor for C. difficile-associated diarrhea—discontinue immediately if significant diarrhea develops 2

Resistance Concerns

• Clindamycin has potential for cross-resistance with erythromycin-resistant strains and inducible resistance in MRSA 1
• Should only be used empirically for MRSA if local resistance rates are low (<10%) 1

Special Populations

• Diabetic patients with infected cat scratches require more aggressive treatment (1-2 weeks minimum, up to 3-4 weeks if extensive) due to impaired immune response 3
• Tetracyclines (doxycycline) should not be used in children <8 years 1
• Evaluate tetanus status and rabies risk for all cat scratches 3

Preferred Alternatives to Clindamycin

For penicillin-allergic patients with infected cat scratches:

• Doxycycline 100 mg twice daily (excellent Pasteurella activity) 1, 3
• Fluoroquinolones (ciprofloxacin 500-750 mg twice daily or levofloxacin 750 mg daily) with good Pasteurella coverage 1
• TMP-SMX plus metronidazole for combined aerobic/anaerobic coverage 1