Clindamycin Dose for Cesarean Section Prophylaxis
For patients with penicillin/cephalosporin allergy undergoing cesarean section, administer clindamycin 900 mg IV as a single slow infusion 30-60 minutes before skin incision. 1
Standard Dosing Regimen
Clindamycin 900 mg IV administered as a slow infusion is the recommended dose for antibiotic prophylaxis in cesarean delivery when patients have documented penicillin or cephalosporin allergies 1, 2
The antibiotic should be given 30-60 minutes before skin incision, not after cord clamping, as preoperative administration significantly reduces maternal infectious morbidity 1, 3
Alternative Regimen for Allergic Patients
Clindamycin 900 mg IV plus gentamicin 5 mg/kg/day (single dose) may be used as combination therapy for broader coverage in allergic patients 4, 1
This combination provides coverage against both aerobic and anaerobic organisms from skin and vaginal flora 4
Duration and Re-dosing
Single dose only is required for standard cesarean procedures 1, 2
No additional doses are needed if the procedure duration is less than 4 hours 1
For prolonged procedures, the evidence does not specifically address clindamycin re-dosing, though general surgical principles suggest re-dosing may be considered if duration exceeds typical half-life considerations 2
Important Clinical Context
Why Not Cefazolin?
Cefazolin 2g IV is the first-line agent for cesarean prophylaxis in non-allergic patients, as it provides superior coverage and has the strongest evidence base 1, 5
Clindamycin is specifically reserved for patients with documented penicillin/cephalosporin allergies 1, 2
Timing Rationale
Administration before skin incision rather than after cord clamping reduces composite maternal infectious morbidity (RR 0.57), endometritis (RR 0.54), and wound infection (RR 0.59) without increasing neonatal sepsis 3
The shift to preoperative administration is supported by high-quality evidence and is now standard practice 1, 3
Special Circumstances
For women in labor or with ruptured membranes, consider that first-line therapy would include azithromycin added to cefazolin; however, the equivalent regimen for allergic patients would be clindamycin plus gentamicin 1
Morbid obesity (BMI >35) may warrant consideration of higher doses, though specific evidence for clindamycin dose adjustment in this population is limited 2
Common Pitfalls to Avoid
Do not delay administration until after cord clamping - this outdated practice significantly increases infection risk 1, 3
Ensure slow IV infusion of clindamycin to avoid infusion-related reactions 4
Verify true allergy status before using second-line agents, as the risk of surgical site infection increases by 50% when second-line antibiotics are used instead of cefazolin 5