Clindamycin: Difference between revisions

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==General==
==General==
*Type: Other antibiotics
*Type: Other [[antibiotic]]
*Dosage Forms: IM, IV, PO (75mg; 150mg; 300mg; 75mg/5mL)
*Dosage Forms: IM, IV, PO (75mg; 150mg; 300mg; 75mg/5mL)
*Common Trade Names: Cleocin
*Common Trade Names: Cleocin
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===[[Cellulitis]] Possibly due to [[MRSA]] (Unlabled Use)<ref>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</ref>===
===[[Cellulitis]] Possibly due to [[MRSA]] (Unlabled Use)<ref>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</ref>===
*300-450mg PO q8hr x 5-10 days
*60-120 kg: 300 mg Q8H. >120kg: 450 mg Q8H. <ref>Reduction of Inappropriate Antibiotic Use and Improved Outcomes by Implementation of an Algorithm-Based Clinical Guideline for Nonpurulent Skin and Soft Tissue Infections.  Ann Emerg Med. 2020 Feb 13. pii: S0196-0644(19)31453-2. doi: 10.1016/j.annemergmed.2019.12.012. [Epub ahead of print]</ref>


===[[Strep. Pharyngitis]]===
===[[Strep. Pharyngitis]]===
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*'''PO (Mild-mod)'''
*'''PO (Mild-mod)'''
**450mg PO q6h x 14 days
**450mg PO q6h x 14 days
**Use with ceftriaxone or cefoxitin/probenecid if no proceeding IV treatment
**Use with [[ceftriaxone]] or cefoxitin/probenecid if no proceeding IV treatment
*'''IV (Severe)'''
*'''IV (Severe)'''
**900mg IV q8
**900mg IV q8
**Use with gentamicin and switch to PO after 24h of clinical improvement
**Use with [[gentamicin]] and switch to PO after 24h of clinical improvement


===[[Babesiosis]]===
===[[Babesiosis]]===
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**''<2kg''
**''<2kg''
***10mg/kg/day IM/IV divided q12
***10mg/kg/day IM/IV divided q12
***First Dose: 5 mg/kg IM/IV x 1
***First Dose: 5mg/kg IM/IV x 1
**''>2kg''
**''>2kg''
***15 mg/kg/day IM/IV divided q8h
***15mg/kg/day IM/IV divided q8h
***First Dose: 5 mg/kg IM/IV x 1
***First Dose: 5mg/kg IM/IV x 1
*'''1 week - 1 month'''
*'''1 week - 1 month'''
**''<1.2kg''
**''<1.2kg''
***10mg/kg/day IM/IV divided q12h
***10mg/kg/day IM/IV divided q12h
***First Dose: 5 mg/kg IM/IV x 1
***First Dose: 5mg/kg IM/IV x 1
**''1.2-2kg''
**''1.2-2kg''
***15 mg/kg/day IM/IV divided q8h
***15mg/kg/day IM/IV divided q8h
***First Dose: 5 mg/kg IM/IV x 1
***First Dose: 5mg/kg IM/IV x 1
**''>2kg''
**''>2kg''
***20mg/kg/day IM/IV divided q6-8h
***20mg/kg/day IM/IV divided q6-8h
***Alt: 30mg/kg/day IM/IV divided q6h
***Alt: 30mg/kg/day IM/IV divided q6h
***First Dose: 5-7.5 mg/kg IM/IV x 1
***First Dose: 5-7.5mg/kg IM/IV x 1
*'''>1 Month - Children'''
*'''>1 Month - Children'''
**25-40mg/kg/day IM/IV divided q6-8h
**25-40mg/kg/day IM/IV divided q6-8h
**First Dose: 6.25-13.3 mg/kg IM/IV x 1  
**First Dose: 6.25-13.3mg/kg IM/IV x 1  
**Max: 4.8 g/day IM/IV
**Max: 4.8 g/day IM/IV
*'''Adolescents'''
*'''Adolescents'''
**25-40mg/kg/day IM/IV divided q6-8h
**25-40mg/kg/day IM/IV divided q6-8h
**First Dose: 6.25-13.3 mg/kg IM/IV x 1  
**First Dose: 6.25-13.3mg/kg IM/IV x 1  
**Max: 4.8 g/day IM/IV
**Max: 4.8 g/day IM/IV


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*'''Infants & Children'''
*'''Infants & Children'''
**'''PO:'''
**'''PO:'''
***10-25 mg/kg/day PO divided q6-8h
***10-25mg/kg/day PO divided q6-8h
***First Dose: 2.5-8.3 mg/kg PO x 1
***First Dose: 2.5-8.3mg/kg PO x 1
***Max: 1.8 g/day PO
***Max: 1.8 g/day PO
**'''IM/IV:'''  
**'''IM/IV:'''  
***15-25 mg/kg/day IM/IV divided q6-8
***15-25mg/kg/day IM/IV divided q6-8
***First Dose: 3.75-8.3 mg/kg IM/IV x 1
***First Dose: 3.75-8.3mg/kg IM/IV x 1
***4.8 g/day IM/IV
***4.8 g/day IM/IV
*'''Adolescents'''
*'''Adolescents'''
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**'''IM/IV:'''
**'''IM/IV:'''
***25-40mg/kg/day IM/IV divided q6-8h
***25-40mg/kg/day IM/IV divided q6-8h
***First Dose: 6.25-13.3 mg/kg IM/IV x 1
***First Dose: 6.25-13.3mg/kg IM/IV x 1
***Max: 4.8 g/day IM/IV
***Max: 4.8 g/day IM/IV


===[[Cellulitis]] Possibly due to [[MRSA]] (Unlabeled Use)<ref>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</ref>===
===[[Cellulitis]] Possibly due to [[MRSA]] (Unlabeled Use)<ref>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</ref>===
*10-13 mg/kg/dose q6-8hrs PO x 5-10 days
*10-13mg/kg/dose q6-8hrs PO x 5-10 days
*First Dose: 2.5-4.3 mg/kg PO x 1
*First Dose: 2.5-4.3mg/kg PO x 1
*Max: 40mg/kg/day
*Max: 40mg/kg/day


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**Give by intermittent infusion over >10-60 minutes
**Give by intermittent infusion over >10-60 minutes
**Max rate: 30mg/minute (do not exceed 1200mg/hour)
**Max rate: 30mg/minute (do not exceed 1200mg/hour)
**Final concentration should not exceed 18 mg/mL
**Final concentration should not exceed 18mg/mL
 
==Mechanism of Action==
*Disrupts protein synthesis by binding the 50s ribosome subunit


==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
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<references/>
<references/>
[[Category:Pharmacology]]
[[Category:Pharmacology]]
[[Category:ID]]

Latest revision as of 13:10, 6 March 2021

General

  • Type: Other antibiotic
  • 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: 450mg/dose PO (increased risk of C. diff at higher doses)
  • IM:
    • 1200-2700mg/day IM divided q6-12h
    • First Dose: 600mg IM x 1
    • Max: 600mg/dose IM
  • IV
    • 1200-2700mg/day IV divided q6-12h
    • First Dose: 600-900mg IV x 1
    • 4800mg/day IV

Cellulitis Possibly due to MRSA (Unlabled Use)[1]

  • 60-120 kg: 300 mg Q8H. >120kg: 450 mg Q8H. [2]

Strep. Pharyngitis

  • 300mg PO q8 x 10 days

Bacterial Vaginosis

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 (650mg TID); use IV for severe infections

Pediatric Dosing

General Infection (Severe)

  • <1 week old
    • <2kg
      • 10mg/kg/day IM/IV divided q12
      • First Dose: 5mg/kg IM/IV x 1
    • >2kg
      • 15mg/kg/day IM/IV divided q8h
      • First Dose: 5mg/kg IM/IV x 1
  • 1 week - 1 month
    • <1.2kg
      • 10mg/kg/day IM/IV divided q12h
      • First Dose: 5mg/kg IM/IV x 1
    • 1.2-2kg
      • 15mg/kg/day IM/IV divided q8h
      • First Dose: 5mg/kg IM/IV x 1
    • >2kg
      • 20mg/kg/day IM/IV divided q6-8h
      • Alt: 30mg/kg/day IM/IV divided q6h
      • First Dose: 5-7.5mg/kg IM/IV x 1
  • >1 Month - Children
    • 25-40mg/kg/day IM/IV divided q6-8h
    • First Dose: 6.25-13.3mg/kg IM/IV x 1
    • Max: 4.8 g/day IM/IV
  • Adolescents
    • 25-40mg/kg/day IM/IV divided q6-8h
    • First Dose: 6.25-13.3mg/kg IM/IV x 1
    • Max: 4.8 g/day IM/IV

General Infection (Mild-Moderate)

  • Infants & Children
    • PO:
      • 10-25mg/kg/day PO divided q6-8h
      • First Dose: 2.5-8.3mg/kg PO x 1
      • Max: 1.8 g/day PO
    • IM/IV:
      • 15-25mg/kg/day IM/IV divided q6-8
      • First Dose: 3.75-8.3mg/kg IM/IV x 1
      • 4.8 g/day IM/IV
  • Adolescents
    • PO:
      • 150-300mg PO q6h
      • First Dose: 150-300mg PO x 1
      • Max: 1.8 g/day PO
    • IM/IV:
      • 25-40mg/kg/day IM/IV divided q6-8h
      • First Dose: 6.25-13.3mg/kg IM/IV x 1
      • Max: 4.8 g/day IM/IV

Cellulitis Possibly due to MRSA (Unlabeled Use)[3]

  • 10-13mg/kg/dose q6-8hrs PO x 5-10 days
  • First Dose: 2.5-4.3mg/kg PO x 1
  • Max: 40mg/kg/day

Otitis Media, Acute

  • 2mo-5yo
    • 30-40mg/kg/day PO divided q8h x 10 days
  • 6-12yo
    • 30-40mg/kg/day PO divided q8h x 5-10 days

Sinusitis

  • 30-40mg/kg/day PO divided q8h x 10-14 days
  • Use with cefixime or cefpodoxime

Streptococcal Pharyngitis

  • 7mg/kg PO q8h x 10 days
  • Max: 300mg/dose

Community-Acquired Pneumonia (>3mo)

  • IV (Mod-Severe): 40mg/kg/day IV divided q6-8h x 10-14 days
  • PO (Mild): 30-40mg/kg/day PO divided q6-8h x 7-10 days

Babesiosis

  • 20-40mg/kg/day PO/IV divided q6-8h x 7-10 days
  • Max: 600mg/dose
  • Info: Use with quinine

Special Populations

  • Pregnancy Rating: B
  • Lactation risk categories: L4; 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

Common

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 600mg per injection
  • IV:
    • Do NOT give as bolus
    • Give by intermittent infusion over >10-60 minutes
    • Max rate: 30mg/minute (do not exceed 1200mg/hour)
    • Final concentration should not exceed 18mg/mL

Mechanism of Action

  • Disrupts protein synthesis by binding the 50s ribosome subunit

Antibiotic Sensitivities[4]

Group Organism Sensitivity
Gram Positive Strep. Group A, B, C, G S
Strep. Pneumoniae S
Viridans strep X1
Strep. anginosus gp X1
Enterococcus faecalis R
Enterococcus faecium R
MSSA S
MRSA R
CA-MRSA I
Staph. Epidermidis R
C. jeikeium R
L. monocytogenes X1
Gram Negatives N. gonorrhoeae R
N. meningitidis R
Moraxella catarrhalis R
H. influenzae R
E. coli R
Klebsiella sp R
E. coli/Klebsiella ESBL+ R
E coli/Klebsiella KPC+ R
Enterobacter sp, AmpC neg R
Enterobacter sp, AmpC pos R
Serratia sp X1
Serratia marcescens R
Salmonella sp R
Shigella sp R
Proteus mirabilis X1
Proteus vulgaris R
Providencia sp. X1
Morganella sp. X1
Citrobacter freundii X1
Citrobacter diversus X1
Citrobacter sp. X1
Aeromonas sp X1
Acinetobacter sp. R
Pseudomonas aeruginosa R
Burkholderia cepacia R
Stenotrophomonas maltophilia R
Yersinia enterocolitica R
Francisella tularensis X1
Brucella sp. R
Legionella sp. X1
Pasteurella multocida X1
Haemophilus ducreyi X2
Vibrio vulnificus X1
Misc Chlamydophila sp I
Mycoplasm pneumoniae R
Rickettsia sp X1
Mycobacterium avium X1
Anaerobes Actinomyces S
Bacteroides fragilis I
Prevotella melaninogenica S
Clostridium difficile X1
Clostridium (not difficile) I
Fusobacterium necrophorum S
Peptostreptococcus sp. S

Key

  • S susceptible/sensitive (usually)
  • I intermediate (variably susceptible/resistant)
  • R resistant (or not effective clinically)
  • S+ synergistic with cell wall antibiotics
  • U sensitive for UTI only (non systemic infection)
  • X1 no data
  • X2 active in vitro, but not used clinically
  • X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
  • X4 active in vitro, but not clinically effective for strep pneumonia

See Also

References

  1. ↑ 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
  2. ↑ Reduction of Inappropriate Antibiotic Use and Improved Outcomes by Implementation of an Algorithm-Based Clinical Guideline for Nonpurulent Skin and Soft Tissue Infections. Ann Emerg Med. 2020 Feb 13. pii: S0196-0644(19)31453-2. doi: 10.1016/j.annemergmed.2019.12.012. [Epub ahead of print]
  3. ↑ 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
  4. ↑ Sanford Guide to Antimicrobial Therapy 2014
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