What is the maximum recommended daily dose of clindamycin for a 15‑month‑old child?

Maximum Daily Dose of Clindamycin for a 15-Month-Old

For a 15-month-old child, the maximum daily dose of clindamycin is 40 mg/kg/day, divided into 3 or 4 equal doses every 6-8 hours. 1

Standard Dosing Framework

• The FDA-approved dosing for pediatric patients 1 month to 16 years is 20-40 mg/kg/day divided into 3 or 4 equal doses, with higher doses reserved for more severe infections 2

• For serious infections including MRSA and Group A Streptococcus, the recommended dose is 40 mg/kg/day divided every 6-8 hours for parenteral administration, or 30-40 mg/kg/day divided into 3-4 doses for oral therapy 1

Practical Dosing Example

For a typical 15-month-old weighing approximately 10-11 kg:

• Maximum daily dose = 40 mg/kg/day × 10 kg = 400 mg/day total
• Divided every 8 hours (3 doses): 133 mg per dose
• Divided every 6 hours (4 doses): 100 mg per dose 1

Route-Specific Considerations

Parenteral (IV/IM) Administration

• The standard range is 20-40 mg/kg/day in 3-4 equal doses, with the maximum 40 mg/kg/day used for severe infections 2
• Single IM injections greater than 600 mg are not recommended (though this rarely applies to toddlers given their lower weight-based total doses) 2

Oral Administration

• For MRSA and Group A Streptococcus infections, oral clindamycin is dosed at 30-40 mg/kg/day in 3-4 divided doses 1

Important Clinical Caveats

• Clindamycin should be dosed based on total body weight regardless of obesity 2

• If diarrhea occurs during therapy, clindamycin must be discontinued immediately due to the risk of Clostridioides difficile-associated colitis 2

• For Group A Streptococcal infections (such as an alternative for penicillin-allergic patients with scarlet fever), treatment should continue for at least 10 days 2

• Neonates and very young infants have prolonged elimination half-lives (approximately 6.3 hours vs. 2-3 hours in older children), requiring reduced dosing of 15-20 mg/kg/day in premature and term newborns 3

When Maximum Dosing Is Indicated

Use the full 40 mg/kg/day dose for:

• Proven or suspected MRSA infections 1
• Severe Group A Streptococcal infections in penicillin-allergic patients 1
• Serious anaerobic infections including Bacteroides fragilis 2
• Osteomyelitis (historically dosed at 50 mg/kg/day IV in some studies, though current guidelines support 40 mg/kg/day as the standard maximum) 4

Dosing Pitfall to Avoid

• Do not extrapolate newborn dosing (15-20 mg/kg/day) to a 15-month-old child – by 15 months, hepatic and renal maturation is sufficient to handle the standard pediatric dose of 20-40 mg/kg/day 5, 3