Clindamycin

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: 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]

  • 300-450mg PO q8hr x 5-10 days

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)[2]

  • 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

Antibiotic Sensitivities[3]

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. 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
  3. Sanford Guide to Antimicrobial Therapy 2014