What is the dose of clindamycin (antibiotic) for an infected toenail?

Clindamycin is NOT the appropriate antibiotic for an infected toenail

Clindamycin does not provide coverage against the causative organisms of toenail infections (onychomycosis), which are primarily dermatophytes, yeasts, and molds—not bacteria. 1

Understanding the Diagnosis

An "infected toenail" almost certainly refers to onychomycosis (fungal nail infection), not a bacterial infection. This is a critical distinction:

• Onychomycosis is caused by dermatophytes (most common), Candida species, or nondermatophyte molds 1
• Clindamycin is an antibacterial agent with activity against gram-positive cocci and anaerobes, but has zero antifungal activity 2, 3

Correct Treatment for Onychomycosis

First-Line Therapy

Terbinafine 250 mg daily for 12 weeks is superior to all other treatments for dermatophyte toenail infections. 1, 4

• Terbinafine demonstrates significantly better mycological cure rates (76-77%) compared to itraconazole (23-53%) 1
• Clinical cure rates with terbinafine are 21-28% versus 13-48% with itraconazole 1
• Number needed to treat is only 5 patients to achieve one additional cure compared to itraconazole 4

Second-Line Therapy

• Itraconazole is the next best alternative if terbinafine is contraindicated 1
• Fluconazole 450 mg once weekly for 6-12 months can be considered for patients unable to tolerate terbinafine or itraconazole, though it is less effective (mycological cure 47-62%, clinical cure 28-36%) 1, 5

When Clindamycin WOULD Be Appropriate

Clindamycin should only be considered if there is a bacterial soft tissue infection around the toenail (paronychia, cellulitis, or diabetic foot infection), NOT the nail itself:

For Diabetic Foot Infections with Cellulitis

• Oral clindamycin 300-450 mg every 6-8 hours for mild infections 1, 6
• IV clindamycin 600-900 mg every 8 hours for moderate-to-severe infections 1, 6
• Duration: 7-14 days depending on clinical response 6

For Simple Paronychia (Bacterial Infection Around the Nail)

• Oral clindamycin 300-450 mg four times daily for 5-10 days 6
• Only use if local MRSA clindamycin resistance rates are <10% 6

Critical Pitfall to Avoid

Do not confuse fungal nail infection (onychomycosis) with bacterial soft tissue infection. The evidence provided about clindamycin dosing for diabetic foot infections 1, 7 refers to cellulitis and soft tissue infections in diabetic patients—not nail infections themselves. Using clindamycin for onychomycosis will result in treatment failure because it lacks antifungal activity 2, 3.