Clindamycin Tablet Dosing for Bacterial Infections
For adults with bacterial infections, oral clindamycin should be dosed at 300-450 mg every 6 hours (four times daily) for most infections, with treatment duration of 7-14 days depending on clinical response and infection severity. 1
Adult Oral Dosing by Infection Type
Skin and Soft Tissue Infections
- Uncomplicated purulent cellulitis/abscess (after drainage): 300-450 mg three times daily for 5-10 days 1
- Complicated skin and soft tissue infections: 300-450 mg four times daily (every 6 hours) for 7-14 days 1, 2
- MRSA infections: 300-450 mg four times daily, only if local clindamycin resistance rates are <10% 1, 2
Wound Infections
- Mild to moderate wound infections: 300 mg every 6 hours (four times daily) for 7-14 days 1
- Diabetic foot infections (mild severity): 300 mg every 6 hours, providing excellent coverage against MRSA and beta-hemolytic streptococci 1
Bone and Joint Infections
- Osteomyelitis: 600 mg three times daily (every 8 hours) for at least 8 weeks 2
- Consider adding rifampin 600 mg daily or 300-450 mg twice daily after bacteremia clearance 2
Maximum Dosing Limits
- Maximum single oral dose: 600 mg 1
- The 600 mg dosing every 8 hours is typically reserved for severe infections and is more commonly given intravenously 2
Treatment Duration Guidelines
- Most skin and soft tissue infections: 7 days 1
- Complicated infections: Up to 14 days 1
- Osteomyelitis: Minimum 8 weeks 1, 2
- Abscess with cellulitis: 5-10 days, with 5 days sufficient if improvement occurs 1
Critical Resistance Considerations
Clindamycin should only be used when local MRSA clindamycin resistance rates are <10%. 1 Be aware of inducible resistance in erythromycin-resistant MRSA strains—this is a common pitfall that can lead to treatment failure. 1
Transition from IV to Oral Therapy
- Oral clindamycin has high bioavailability and can be used for most mild to moderate infections 1
- Transition to oral therapy after at least 48 hours of clinical improvement on IV therapy 1
- The total duration includes both IV and oral administration combined 1
Pediatric Dosing (for reference)
- Children >40 kg: Transition to adult dosing regimens 2
- Children <40 kg: 10-13 mg/kg/dose every 6-8 hours (maximum 40 mg/kg/day) 1, 2
- Oral dosing for MRSA/MSSA: 30-40 mg/kg/day divided into 3-4 doses 1
Important Clinical Caveats
Gastrointestinal Side Effects
Nearly 98% of patients experience some GI side effects from oral clindamycin, with higher doses (600 mg) causing significantly more severe and prolonged symptoms compared to lower doses (300 mg). 3 The 600 mg dose was associated with 5 days of diarrhea versus 3 days with 300 mg, and 7 days of stomach pain versus 4 days. 3
When NOT to Use Clindamycin
- No gram-negative coverage: Clindamycin has no activity against aerobic gram-negative rods like E. coli—must combine with aminoglycoside or fluoroquinolone if gram-negative coverage needed 4, 5
- Endocarditis concerns: Do not use if there is concern for infective endocarditis or endovascular source of infection 1
- High local resistance: Avoid if local MRSA clindamycin resistance exceeds 10% 1
Monitoring for Treatment Response
Clinical improvement should be evident within 48-72 hours. 1, 4 If no improvement occurs, consider inadequate source control (e.g., undrained abscess), deeper infection requiring imaging, or resistant organisms. 1
Source Control is Essential
For abscesses, incision and drainage is the cornerstone of treatment and may be sufficient alone for simple abscesses without extensive cellulitis. 1 Multiple studies demonstrate 85-90% cure rates with drainage alone, though antibiotics may prevent short-term development of new lesions. 1 Antibiotics provide limited benefit without adequate drainage. 1