Maximum Daily Dose of Clindamycin
For adults, the maximum daily dose of clindamycin is 2,700 mg per day (900 mg every 8 hours) intravenously for severe infections, or 1,800 mg per day (300-450 mg every 6 hours) orally for most infections. 1, 2, 3
Intravenous Dosing for Adults
Standard dosing for serious infections (MRSA, complicated skin/soft tissue infections, pneumonia, bone/joint infections) is 600 mg IV every 8 hours, totaling 1,800 mg daily 1, 2
For severe or life-threatening infections (necrotizing fasciitis, streptococcal toxic shock, severe osteomyelitis), the dose escalates to 900 mg IV every 8 hours, totaling 2,700 mg daily maximum 1, 2, 3
The every 6-8 hour frequency is critical because clindamycin has a short half-life (approximately 2-3 hours) requiring frequent dosing to maintain bacteriostatic concentrations 2, 4
Clinical studies demonstrate that 600 mg every 8 hours produces similar efficacy to 600 mg every 6 hours with reduced adverse effects and cost savings, supporting the 8-hourly regimen for most serious infections 5
Oral Dosing for Adults
For uncomplicated purulent cellulitis and mild-moderate infections, oral dosing is 300-450 mg every 6 hours (four times daily), totaling 1,200-1,800 mg daily 1, 2
For moderate to severe wound infections requiring oral therapy, 300 mg every 6 hours (1,200 mg daily) is recommended 2
Oral clindamycin has high bioavailability and can be used for step-down therapy after initial IV treatment, with normal adult doses of 150-300 mg four times daily being safe even in chronic renal failure 4
Pediatric Maximum Dosing
The maximum daily dose for children is 40 mg/kg/day (not to exceed 2,700 mg/day in larger adolescents), administered as 10-13 mg/kg/dose IV every 6-8 hours 1, 2
For oral therapy in children, the maximum is 30-40 mg/kg/day divided into 3-4 doses 2
The 40 mg/kg/day total is essential for serious infections; lower doses risk treatment failure 2
Important Clinical Considerations
Dosing Algorithm by Infection Severity
Mild infections (outpatient):
- Oral: 300 mg every 6 hours (1,200 mg/day) 2
Moderate infections (may require initial IV):
Severe/life-threatening infections:
- IV: 900 mg every 8 hours (2,700 mg/day maximum) 2, 3
- Examples: necrotizing fasciitis, streptococcal toxic shock, severe osteomyelitis 2
Special Situations
For pelvic inflammatory disease, the CDC recommends 900 mg IV every 8 hours (2,700 mg/day) in combination with gentamicin 2
For osteomyelitis, some experts recommend adding rifampin (600 mg daily or 300-450 mg twice daily) to clindamycin 600 mg every 8 hours 1, 2
No dose adjustment is required in renal failure, as clindamycin is excreted normally even in terminal renal failure, and normal adult doses (150-300 mg four times daily) can be given safely 4
Common Pitfalls to Avoid
Do not underdose serious infections—the IDSA guidelines recommend higher doses (600 mg IV every 8 hours or 300-450 mg PO four times daily) for MRSA and serious infections based on superior clinical outcomes 2
Do not use once or twice daily dosing—clindamycin pharmacokinetics do not support extended-interval dosing due to its short half-life 2
Do not exceed 2,700 mg/day (900 mg every 8 hours) even in severe infections, as higher doses have not demonstrated additional benefit and may increase adverse effects 2, 3
Only use clindamycin when local MRSA clindamycin resistance rates are <10%, and be aware of inducible resistance in erythromycin-resistant MRSA strains 2
Do not use clindamycin for infective endocarditis or endovascular infections, as it is inadequate for these conditions 2