What is the recommended dose of Clindamycin (Clindamycin) intravenous (IV) for pediatric patients?

Clindamycin IV Dosing for Pediatric Patients

For most pediatric patients aged 1 month to 16 years, administer clindamycin IV at 40 mg/kg/day divided every 6-8 hours (10-13 mg/kg/dose), which translates to either 3 or 4 doses per day depending on the dosing interval selected. 1, 2, 3

Age-Based Dosing Algorithm

Infants Less Than 1 Month Old

• Neonates ≤32 weeks post-menstrual age (PMA): 5 mg/kg every 8 hours (15 mg/kg/day total) 3
• Neonates >32 to ≤40 weeks PMA: 7 mg/kg every 8 hours (21 mg/kg/day total) 3
• The reduced dosing in neonates reflects prolonged elimination half-life (6.3 hours vs. 3 hours in older children) and lower clearance rates, requiring 15-20 mg/kg/day to avoid supratherapeutic levels 4

Children 1 Month to 16 Years

• Standard dosing: 20-40 mg/kg/day divided into 3-4 equal doses 3
• For serious infections (MRSA, pneumonia, bacteremia): Use the higher end at 40 mg/kg/day, administered as 10-13 mg/kg/dose every 6-8 hours 1, 2
• Maximum daily dose: Do not exceed 40 mg/kg/day for most infections 1

Practical Dosing Examples

Every 8-Hour Dosing (3 doses/day)

• For a child requiring 40 mg/kg/day: administer approximately 13 mg/kg per dose every 8 hours 1
• Example: An 8.2 kg child would receive 109 mg per dose (328 mg/day total) 2

Every 6-Hour Dosing (4 doses/day)

• For a child requiring 40 mg/kg/day: administer 10 mg/kg per dose every 6 hours 1
• Example: An 8.2 kg child would receive 82 mg per dose (328 mg/day total) 2

Infection-Specific Considerations

MRSA Infections

• Stable patients without ongoing bacteremia: 10-13 mg/kg/dose IV every 6-8 hours (40 mg/kg/day total) 1
• Clindamycin should only be used when local MRSA clindamycin resistance rates are <10% 1
• Be aware of inducible resistance in erythromycin-resistant MRSA strains 1

Group A Streptococcal Infections

• Parenteral dosing: 40 mg/kg/day divided every 6-8 hours 1, 2
• Treatment should continue for at least 10 days for β-hemolytic streptococcal infections 3

Pneumonia

• Recommended dose: 10-13 mg/kg/dose every 6-8 hours, not to exceed 40 mg/kg/day 1
• Treatment duration ranges from 7-21 days depending on extent of infection 1

Osteomyelitis

• Higher doses of 50 mg/kg/day IV have been used successfully in some studies, though this exceeds standard FDA recommendations 5
• Minimum 8-week course is recommended 1
• Consider transition to oral therapy (30-40 mg/kg/day) after initial IV treatment 6

IV Administration Guidelines

Dilution and Infusion Rates

• Concentration: Should not exceed 18 mg/mL in diluent 3
• Infusion rate: Should not exceed 30 mg per minute 3
• Standard infusion times: 3
  • 300 mg dose: infuse over 10 minutes in 50 mL
  • 600 mg dose: infuse over 20 minutes in 50 mL
  • 900 mg dose: infuse over 30 minutes in 50-100 mL
  • 1200 mg dose: infuse over 40 minutes in 100 mL

Important Administration Caveats

• Never give single IM injections >600 mg 3
• Doses should be based on total body weight regardless of obesity 3
• Alternatively, dosing can be calculated using body surface area: 350 mg/m²/day for serious infections, 450 mg/m²/day for severe infections 3

Transition to Oral Therapy

• Switch to oral clindamycin (30-40 mg/kg/day divided into 3-4 doses) when clinically appropriate 1, 2
• Oral clindamycin has high bioavailability and can be used for most mild to moderate infections 1
• The decision to transition should be based on clinical improvement, typically after at least 48 hours of IV therapy 1

Critical Pitfalls to Avoid

• Underdosing serious infections: Always use 40 mg/kg/day for MRSA, pneumonia, and other serious bacterial infections rather than the lower 20 mg/kg/day dose 1, 2
• Neonatal overdosing: Failure to reduce dosing in neonates can lead to toxic serum levels due to immature clearance mechanisms 4, 7
• Ignoring local resistance patterns: Do not use clindamycin empirically if local MRSA resistance rates exceed 10% 1
• Inadequate source control: For abscesses, drainage is essential—antibiotics alone provide limited benefit 1
• Discontinuation for diarrhea: If diarrhea occurs during therapy, discontinue the antibiotic immediately due to risk of Clostridioides difficile infection 3