What is the dose of Clindamycin (antibiotic) for the treatment of cellulitis?

From the Guidelines

For adult patients with cellulitis, the typical initial dose of clindamycin is 300-450 mg taken orally every 6-8 hours, as recommended by the Infectious Diseases Society of America 1. The dosage may vary depending on the severity of the infection, with more severe cases potentially requiring higher doses.

• The recommended dose for pediatric patients is 10-13 mg/kg/dose PO every 6-8 hours, not to exceed 40 mg/kg/day 1.
• Clindamycin is an appropriate choice for cellulitis when MRSA is suspected or in patients with penicillin allergies, as it works by inhibiting bacterial protein synthesis by binding to the 50S ribosomal subunit, making it effective against many gram-positive organisms including Staphylococcus and Streptococcus species.
• Common side effects include diarrhea, nausea, and abdominal pain, and patients should be advised to take the full course of antibiotics even if symptoms improve before completion.
• If severe diarrhea occurs, patients should contact their healthcare provider immediately as this could indicate Clostridioides difficile infection, a serious potential complication of clindamycin therapy. The usual duration of treatment is 5-10 days, depending on the severity of the infection and clinical response, with a 5-day course being as effective as a 10-day course if clinical improvement has occurred by 5 days 1.
• It is essential to note that the treatment should be extended if the infection has not improved within this time period, and elevation of the affected area and treatment of predisposing factors, such as edema or underlying cutaneous disorders, are also recommended 1.

From the FDA Drug Label

Adults: Serious infections – 150 to 300 mg every 6 hours. Pediatric Patients (for children who are able to swallow capsules): Serious infections – 8 to 16 mg/kg/day (4 to 8 mg/lb/day) divided into three or four equal doses. The recommended clindamycin dose for cellulitis, which can be considered a serious infection, is:

• For adults: 150 to 300 mg every 6 hours 2
• For pediatric patients: 8 to 16 mg/kg/day (4 to 8 mg/lb/day) divided into three or four equal doses 2

From the Research

Clindamycin Dosing for Cellulitis

• The optimal dose of clindamycin for the treatment of cellulitis is not explicitly stated in the provided studies, but a study from 2017 3 suggests that weight-based dosing of clindamycin is associated with better outcomes in patients with cellulitis.
• The study found that patients who received adequate dosing of clindamycin (<10 mg/kg/day) had a lower rate of clinical failure compared to those who received inadequate dosing (17% vs 30%, p = 0.032).
• Another study from 2010 4 found that clindamycin was effective in treating cellulitis, particularly in patients with moderately severe cellulitis or those who were obese.
• However, the study did not provide specific dosing recommendations for clindamycin.

Route of Administration and Duration of Therapy

• A study from 2020 5 found that the route of administration (intravenous vs oral) did not affect the outcome of treatment for cellulitis.
• The study also found that the duration of antibiotic therapy did not affect the outcome of treatment, and that a course length of > 5 days did not result in any additional benefit.
• A systematic review and meta-analysis from 2019 6 found that there was no evidence to support the superiority of any one antibiotic over another, and that the use of intravenous antibiotics over oral antibiotics and treatment duration of longer than 5 days were not supported by evidence.

Clinical Outcomes and Treatment Failure

• A study from 2017 3 found that inadequate dosing of clindamycin was independently associated with clinical failure in patients with cellulitis.
• Another study from 2010 4 found that factors associated with treatment failure included therapy with an antibiotic that was not active against community-associated MRSA and severity of cellulitis.
• A randomized clinical trial from 2017 7 found that the use of cephalexin plus trimethoprim-sulfamethoxazole compared to cephalexin alone did not result in higher rates of clinical resolution of cellulitis in the per-protocol analysis.