Usual Adult Dose for Bacterial Infection

Oral:
Serious infection: 150 to 300 mg orally every 6 hours
More severe infection: 300 to 450 mg orally every 6 hours

Parenteral:
Serious infection: 600 to 1,200 mg via IV infusion or IM injection per day, in 2 to 4 equally divided doses
Severe infection: 1,200 to 2,700 mg via IV infusion or IM injection per day, in 2 to 4 equally divided doses
More severe infection: Up to 4,800 mg via IV infusion per day

Comments:

• A single IM injection greater than 600 mg is not recommended
• A single 1 hour IV infusion greater than 1,200 mg is not recommended
• In the treatment of anaerobic infections, parenteral clindamycin should be used initially and then patients changed to oral therapy when clinically appropriate.
• Clindamycin should be reserved for penicillin-allergic patients or other patients for whom a penicillin is not appropriate.
• Combination therapy with additional antibiotics may be required according to standard treatment protocols. Treatment should be guided by culture and susceptibility studies.

• Staphylococci, streptococci, and pneumococci, including serious respiratory tract infections and skin and soft tissue infections
• Anaerobes, including serious respiratory tract infections, serious skin and soft tissue infections, septicemia, intraabdominal infections, and infections of the female pelvis and genital tract.
• Bone and joint infections including acute hematogenous osteomyelitis caused by Staphylococcus aureus and as adjunctive therapy in the surgical treatment of chronic bone and joint infections

Usual Pediatric Dose for Bacterial Infection

Oral:
Body weight 10 kg or less:
Minimum recommended dose: 37.5 mg orally three times a day

Body weight 11 kg or more:
Serious infection: 8 to 12 mg/kg orally per day, in 3 to 4 equally divided doses
Severe infection: 13 to 16 mg/kg orally per day, in 3 to 4 equally divided doses
More severe infection: 17 to 25 mg/kg orally per day, in 3 to 4 equally divided doses

An alternate regimen:
Serious infection: 8 to 16 mg/kg orally per day, in 3 to 4 equally divided doses
More severe infection: 16 to 20 mg/kg orally per day, in 3 to 4 equally divided doses

Parenteral:
Up to 1 month of age: 15 to 20 mg/kg via IV infusion per day in 3 to 4 equally divided doses; the lower dose may be sufficient for small premature neonates.

1 month to 16 years:
Body weight dosing: 20 to 40 mg/kg via IV infusion or IM injection per day, in 3 to 4 equally divided doses. The higher doses would be used for more severe infections

Body surface area dosing:
Serious infection: 350 mg/m2 via IV infusion or IM injection per day
Severe infection: 450 mg/m2 via IV infusion or IM injection per day

17 years or older: Usual adult dose

Duration: At least 10 days for beta-hemolytic streptococcal infections

Comments:

• A single IM injection greater than 600 mg is not recommended
• A single 1 hour IV infusion greater than 1,200 mg is not recommended
• Parenteral therapy can be changed to oral therapy as clinically indicated.
• Clindamycin should be reserved for penicillin-allergic patients or other patients for whom a penicillin is not appropriate.
• Combination therapy with additional antibiotics may be required according to standard treatment protocols. Treatment should be guided by culture and susceptibility studies.

• Staphylococci, streptococci, and pneumococci, including serious respiratory tract infections and skin and soft tissue infections
• Anaerobes, including serious respiratory tract infections, serious skin and soft tissue infections, septicemia, intraabdominal infections, and infections of the female pelvis and genital tract.
• Bone and joint infections including acute hematogenous osteomyelitis caused by Staphylococcus aureus and as adjunctive therapy in the surgical treatment of chronic bone and joint infections

Renal Dose Adjustments

No adjustment recommended

Liver Dose Adjustments

No adjustment recommended; however, liver function monitoring is recommended in patients with severe liver disease. Accumulation of clindamycin has not been demonstrated when dosed every 8 hours.

Precautions

US BOXED WARNING(S):

• Clostridium difficile associated diarrhea (CDAD) has been reported with the use of nearly all antibacterial agents, including clindamycin and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C difficile.
• Because clindamycin therapy has been associated with severe colitis which may end fatally, it should be reserved for serious infections where less toxic antimicrobial agents are inappropriate. It should not be used in patients with nonbacterial infections such as most upper respiratory tract infections.
• C difficile produces toxins A and B which contribute to the development of CDAD. Hypertoxin producing strains of C difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use.
• Careful medical history is necessary since CDAD has been reported to occur over two months after the administration of antibacterial agents. If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C difficile may need to be discontinued. Appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C difficile, and surgical evaluation should be instituted as clinically indicated.

Dialysis

No adjustment recommended

Other Comments

Administration advice:

• Oral clindamycin should be administered with a full glass of water (to avoid esophageal irritation) and may be taken with or without food.
• Intravenous doses should be diluted and administered as an infusion over 10 to 60 minutes, at a rate not exceeding 30 mg/min.
• Intramuscular doses should be administered as a deep IM injection.

• The manufacturer's product information should be consulted
• Clindamycin for intravenous use must be diluted prior to administration
• The concentration of clindamycin in diluent for IV infusion should not exceed 18 mg/mL.

• Clindamycin does not penetrate the blood brain barrier in therapeutically effective quantities and should not be used in the treatment of meningitis.
• Local administration reactions such as pain, induration, and sterile abscess after IM injection may be minimized or avoided through administration via deep IM injection, and thrombophlebitis after IV infusion by avoiding prolonged use of indwelling catheters.

• Gastrointestinal: Diarrhea
• Hematologic: Blood counts
• Hepatic: Liver function tests

• Avoid use of antidiarrheal medicines.
• If you get severe diarrhea, tell your doctor, pharmacist, or nurse immediately.
• Complete the whole course of therapy as directed by your doctor; although you may feel better early in the course of therapy, skipping doses or not completing the course may reduce the effectiveness of the treatment and increase the likelihood that bacteria will develop resistance and not be treatable by this medicine or other antibacterial medicines in the future.

Frequently asked questions

• What are the best antibiotics for a tooth infection?
• What is the best antibiotic to treat strep throat?
• Why can't you lay down after taking clindamycin?
• Is clindamycin a strong antibiotic?
• Can I take clindamycin if I am allergic to penicillin?
• Is clindamycin a penicillin?
• Can clindamycin be used to treat chlamydia?