Clindamycin: Difference between revisions
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==[[Antibiotic Spectra]]== | ==[[Antibiotic Spectra]]== | ||
{| class="wikitable" | {| class="wikitable" | ||
| align="center" style="background:#f0f0f0;"|'''''' | | align="center" style="background:#f0f0f0;"|'''[[Gram Positives]]''' | ||
| align="center" style="background:#f0f0f0;"|''' | | align="center" style="background:#f0f0f0;"|'''Sensitivity''' | ||
|- | |- | ||
| [[Strep. Group A, B, C, G]]||+ | | [[Strep. Group A, B, C, G]]||+ | ||
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| [[L. monocytogenes]]|| | | [[L. monocytogenes]]|| | ||
|} | |} | ||
==See Also== | ==See Also== | ||
Revision as of 20:39, 25 March 2014
General
- Type: Other antibiotics
- Dosage Forms: IM, IV, PO (75mg; 150mg; 300mg; 75mg/5mL)
- Common Trade Names: Cleocin
Adult Dosing
General
- PO:
- 150-450mg PO q6h
- First Dose: 150-450mg PO x 1
- Max: 450 mg/dose PO (increased risk of C. diff at higher doses)
- IM:
- 1200-2700 mg/day IM divided q6-12h
- First Dose: 600 mg IM x 1
- Max: 600 mg/dose IM
- IV
- 1200-2700 mg/day IV divided q6-12h
- First Dose: 600-900 mg IV x 1
- 4800 mg/day IV
Cellulitis Possibly due to MRSA (Unlabled Use)[1]
- 300-450mg PO q8hr x 5-10 days
Strep. Pharyngitis
- 300mg PO q8 x 10 days
Bacterial Vaginosis
- 300mg PO q12h x 7 days
PID
- PO (Mild-mod)
- 450mg PO q6h x 14 days
- Use with ceftriaxone or cefoxitin/probenecid if no proceeding IV treatment
- IV (Severe)
- 900mg IV q8
- Use with gentamicin and switch to PO after 24h of clinical improvement
Babesiosis
- 600 mg PO q8h x 7-10 days
- Alt: 300-600mg IV q6h x 7-10 days
- First Dose: 300-600mg IV x 1
- Give with quinine; use IV for severe infections
Pediatric Dosing
General Infection (Severe)
- <1 week old
- <2kg
- 10 mg/kg/day IM/IV divided q12
- First Dose: 5 mg/kg IM/IV x 1
- >2kg
- 15 mg/kg/day IM/IV divided q8h
- First Dose: 5 mg/kg IM/IV x 1
- <2kg
- 1 week - 1 month
- <1.2kg
- 10 mg/kg/day IM/IV divided q12h
- First Dose: 5 mg/kg IM/IV x 1
- 1.2-2kg
- 15 mg/kg/day IM/IV divided q8h
- First Dose: 5 mg/kg IM/IV x 1
- >2kg
- 20 mg/kg/day IM/IV divided q6-8h
- Alt: 30 mg/kg/day IM/IV divided q6h
- First Dose: 5-7.5 mg/kg IM/IV x 1
- <1.2kg
- >1 Month - Children
- 25-40 mg/kg/day IM/IV divided q6-8h
- First Dose: 6.25-13.3 mg/kg IM/IV x 1
- Max: 4.8 g/day IM/IV
- Adolescents
- 25-40 mg/kg/day IM/IV divided q6-8h
- First Dose: 6.25-13.3 mg/kg IM/IV x 1
- Max: 4.8 g/day IM/IV
General Infection (Mild-Moderate)
- Infants & Children
- PO:
- 10-25 mg/kg/day PO divided q6-8h
- First Dose: 2.5-8.3 mg/kg PO x 1
- Max: 1.8 g/day PO
- IM/IV:
- 15-25 mg/kg/day IM/IV divided q6-8
- First Dose: 3.75-8.3 mg/kg IM/IV x 1
- 4.8 g/day IM/IV
- PO:
- Adolescents
- PO:
- 150-300mg PO q6h
- First Dose: 150-300mg PO x 1
- Max: 1.8 g/day PO
- IM/IV:
- 25-40 mg/kg/day IM/IV divided q6-8h
- First Dose: 6.25-13.3 mg/kg IM/IV x 1
- Max: 4.8 g/day IM/IV
- PO:
Cellulitis Possibly due to MRSA (Unlabeled Use)[2]
- 10-13 mg/kg/dose q6-8hrs PO x 5-10 days
- First Dose: 2.5-4.3 mg/kg PO x 1
- Max: 40 mg/kg/day
Otitis Media, Acute
- 2mo-5yo
- 30-40 mg/kg/day PO divided q8h x 10 days
- 6-12yo
- 30-40 mg/kg/day PO divided q8h x 5-10 days
Sinusitis
- 30-40 mg/kg/day PO divided q8h x 10-14 days
- Use with cefixime or cefpodoxime
Streptococcal Pharyngitis
- 7 mg/kg PO q8h x 10 days
- Max: 300mg/dose
Community-Acquired Pneumonia (>3mo)
- IV (Mod-Severe): 40 mg/kg/day IV divided q6-8h x 10-14 days
- PO (Mild): 30-40 mg/kg/day PO divided q6-8h x 7-10 days
Babesiosis
- 20-40 mg/kg/day PO/IV divided q6-8h x 7-10 days
- Max: 600 mg/dose
- Info: Use with quinine
Special Populations
- Pregnancy: B
- Lactation: Possibly unsafe (enters breast milk/not recommended)
- Renal Dosing (Adult & Pediatric)
- No adjustment
- No supplement for hemodialysis or peritoneal dialysis
- Hepatic Dosing (Adult & Pediatric)
- No adjustment
- Geriatric: See adult dosing
Contraindications
Black Box
- High risk for C. difficile associated diarrhea
- Reserve for serious infections where there is not alternative
- Discontinue immediately if significant diarrhea, abdominal cramps, or passage of blood or mucus with use
General
- Allergy to class/drug
- Ulcerative colitis
Adverse Reactions
Serious
- C. difficile associated diarrhea
- Thrombocytopenia
- Anaphylaxis
- Stevens-Johnson Syndrome
- Granulocytopenia
- Esophagitis
Common
- Diarrhea
- Nausea and Vomiting
- Abdominal Pain
- Rash
- Puritis
- Jaundice
- Urticaria
- Hypotension
- Thrombophlebitis (IV use)
Pharmacology
- Half-life: 2.4-3h
- Metabolism: Liver; CYP450
- Excretion: Urine, feces
- Mechanism of Action: Bacteriostatic or bactericidal, depending on bug/concentration
Administration
- PO:
- Give with full glass of water (minimize esophageal ulceration)
- Give spread around the day to promote constant serum levels
- IM:
- Give to deep I.M. sites
- Rotate sites
- Do not exceed 600 mg per injection
- IV:
- Do NOT give as bolus
- Give by intermittent infusion over >10-60 minutes
- Max rate: 30 mg/minute (do not exceed 1200 mg/hour)
- Final concentration should not exceed 18 mg/mL
Antibiotic Spectra
| Gram Positives | Sensitivity |
| Strep. Group A, B, C, G | + |
| Strep. Pneumoniae | + |
| Viridans strep | |
| Strep. milleri | |
| Enterococcus faecalis | 0 |
| Enterococcus faecium | 0 |
| Staph. aureus (MSSA) | + |
| Staph. aureus (MRSA) | 0 |
| Staph. aureus (CA-MRSA) | +/- |
| Staph. Epidermidis | 0 |
| C. jeikeium | 0 |
| L. monocytogenes |
See Also
Source
- Epocrates
- Lexicomp
- ↑ Liu C, Bayer A, Cosgrove SE, et al, “Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus aureus Infections in Adults and Children: Executive Summary,” Clin Infect Dis, 2011, 52(3):285-92. PubMed 21217178
- ↑ Liu C, Bayer A, Cosgrove SE, et al, “Clinical Practice Guidelines by the Infectious Diseases Society of America for the Treatment of Methicillin-Resistant Staphylococcus aureus Infections in Adults and Children: Executive Summary,” Clin Infect Dis, 2011, 52(3):285-92. PubMed 21217178