Does Clindamycin (clindamycin) cover Staphylococcus aureus?

From the Guidelines

Clindamycin is effective against Staphylococcus aureus, including some methicillin-resistant strains (MRSA), as evidenced by the 2011 clinical practice guidelines by the Infectious Diseases Society of America 1. The guidelines recommend clindamycin as an oral antibiotic for empirical therapy for CA-MRSA, with a typical adult dose of 300-450 mg PO TID and a pediatric dose of 10-13 mg/kg/dose PO every 6-8 h, not to exceed 40 mg/kg/day. Key points to consider when using clindamycin for Staphylococcus aureus infections include:

• Clindamycin is active against b-hemolytic streptococci, and its clinical significance of inducible clindamycin resistance is unclear, but its presence should preclude the use of clindamycin for more-serious infections 1.
• The medication works by binding to the 50S ribosomal subunit, inhibiting bacterial protein synthesis.
• Potential side effects include diarrhea, pseudomembranous colitis (C. difficile infection), and allergic reactions.
• For serious infections, susceptibility testing is recommended before using clindamycin as monotherapy, and it's often used in combination with other antibiotics for severe infections. Some important considerations for the use of clindamycin in clinical practice, as outlined in the guidelines, include:
• The need to include coverage against b-hemolytic streptococci in addition to CA-MRSA, which may vary depending on local epidemiology and the type of SSTI.
• The potential for resistance, with approximately 10-20% of S. aureus isolates showing resistance to clindamycin.
• The importance of monitoring for potential side effects, particularly C. difficile infection, which may occur more frequently with clindamycin compared to other oral agents 1.

From the FDA Drug Label

Clindamycin has been shown to be active against most of the isolates of the following microorganisms, both in vitro and in clinical infections [see Indications and Usage (1)]: Gram-positive bacteria Staphylococcus aureus (methicillin-susceptible strains) Clindamycin is also indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci, and staphylococci

Clindamycin covers Staphylococcus aureus, but only methicillin-susceptible strains 2.

From the Research

Clindamycin Coverage for Staph Aureus

• Clindamycin can serve as an alternative treatment for staphylococcal infections, including those caused by Staphylococcus aureus 3.
• However, the use of clindamycin is limited by the risk of inducible clindamycin resistance, which can lead to treatment failure 4, 5.
• Studies have shown that clindamycin can be effective against community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA) isolates, but its activity is impacted by inoculum size and the presence of inducible resistance 6.
• The D-test can be used to detect inducible clindamycin resistance, and it is recommended to perform this test routinely to rule out clindamycin susceptibility testing 3.
• Other antibiotics, such as vancomycin, linezolid, and daptomycin, have been shown to be effective against MRSA-caused complicated skin and soft tissue infections, and may be preferred over clindamycin in certain cases 7.

Indications and Limitations

• Clindamycin is not considered a first-line drug for single Staphylococcus aureus infections, but it may be used in cases of penicillin allergy or in combination with other antibiotics for mixed staphylococcal and anaerobic infections 4.
• Clindamycin is not suitable for the treatment of S. epidermidis infections, especially septicemia and endocarditis, due to a high rate of resistance 4.
• The use of clindamycin is also limited by the risk of Clostridium difficile diarrhea, which can be a significant complication, especially in ambulatory long-term treatment of diabetic osteitis and chronic osteomyelitis 4.