What is the recommended dosage of Clindamycin (generic name) for a 5-year-old patient weighing 47 pounds, given a concentration of 75mg/5mL?

Clindamycin Dosing Calculation for 5-Year-Old, 47 lb Patient

For this 5-year-old patient weighing 47 pounds (21.3 kg), administer clindamycin 170-340 mg orally every 8 hours (or 128-255 mg every 6 hours), which translates to 11-23 mL of the 75mg/5mL suspension every 8 hours, depending on infection severity. 1, 2, 3

Weight-Based Dosing Framework

For serious infections:

• Standard dosing: 8-16 mg/kg/day divided into 3-4 doses 3
• For this patient: 170-340 mg/day total
• Divided every 8 hours (3 doses): 57-113 mg per dose = 3.8-7.5 mL per dose
• Divided every 6 hours (4 doses): 43-85 mg per dose = 2.9-5.7 mL per dose

For more severe infections (MRSA, complicated infections):

• Higher dosing: 16-20 mg/kg/day divided into 3-4 doses 3
• Alternatively: 30-40 mg/kg/day for MRSA per guidelines 1, 2
• For this patient: 340-850 mg/day total
• Divided every 8 hours (3 doses): 113-283 mg per dose = 7.5-19 mL per dose
• Divided every 6 hours (4 doses): 85-213 mg per dose = 5.7-14 mL per dose

Practical Dosing Recommendations by Indication

For uncomplicated skin/soft tissue infections:

• Use 8-12 mg/kg/day: 170-255 mg/day = 5.7-8.5 mL every 8 hours 3

For MRSA or complicated infections:

• Use 30-40 mg/kg/day: 640-850 mg/day = 14-19 mL every 8 hours 1, 2
• This aligns with guideline recommendations for MRSA coverage 1, 2

For Group A Streptococcal infections:

• Use 40 mg/kg/day in 3 doses: 850 mg/day = 19 mL every 8 hours 1, 2

Critical Dosing Considerations

Total body weight should be used for dosing regardless of obesity status 3, 4

Maximum daily dose considerations:

• FDA labeling suggests 8-20 mg/kg/day range for pediatrics 3
• Guidelines support up to 40 mg/kg/day for serious infections 1, 2
• The 40 mg/kg/day ceiling (850 mg/day for this patient) should not be exceeded 1, 2

Administration Guidelines

The suspension must be taken with a full glass of water to avoid esophageal irritation 3

Duration of therapy:

• Most infections: 7-10 days 2
• β-hemolytic streptococcal infections: minimum 10 days 3
• Osteomyelitis: minimum 8 weeks 2

Important Safety Caveats

Discontinue immediately if significant diarrhea develops, as this may indicate Clostridioides difficile-associated colitis 3

Clindamycin should only be used when local MRSA resistance rates to clindamycin are <10% 2

Check for inducible clindamycin resistance (D-test) in erythromycin-resistant MRSA strains 2

Conversion Reference for 75mg/5mL Suspension

• 75 mg = 5 mL
• 1 mg = 0.067 mL
• For quick calculation: (dose in mg) × 0.067 = volume in mL