Clindamycin Dosing and Therapy Recommendations
Adult Dosing
- The American College of Physicians and Infectious Diseases Society of America recommends 600 mg IV/PO every 8 hours for most serious infections, including skin and soft tissue infections, pneumonia, bone and joint infections, and MRSA infections 1, 2, 3
- For less severe infections, 300-450 mg PO every 6-8 hours may be appropriate, with a strength of evidence based on clinical practice guidelines 1
Pediatric Dosing
- The Infectious Diseases Society of America recommends 10-13 mg/kg/dose IV/PO every 6-8 hours, with a maximum of 40 mg/kg/day total, for MRSA infections, pneumonia, bacteremia, and complicated skin/soft tissue infections 1, 2, 3
- For oral therapy in MRSA infections, 30-40 mg/kg/day divided into 3-4 doses is recommended, with a strength of evidence based on clinical practice guidelines 2, 3, 4
Duration of Therapy
- The Infectious Diseases Society of America recommends a duration of therapy of 7-21 days for pneumonia, 2-6 weeks for bacteremia and endocarditis, and at least 8 weeks for osteomyelitis 2, 3
- For most uncomplicated infections, a duration of 7-14 days is recommended, with a strength of evidence based on clinical practice guidelines 2
Pathogen-Specific Coverage
- Clindamycin has excellent coverage against MRSA and β-hemolytic streptococci, making it ideal for empiric therapy when both pathogens are suspected, with a strength of evidence based on in vitro susceptibility data 1, 2
Combination Therapy Considerations
- For pelvic inflammatory disease, clindamycin should be combined with gentamicin, with a loading dose of 2 mg/kg, then 1.5 mg/kg every 8 hours, based on clinical practice guidelines 2
- For severe stoma infections with suspected gram-negative involvement, clindamycin 600 mg IV every 8 hours should be combined with gentamicin 5-7 mg/kg every 24 hours, with a strength of evidence based on clinical practice guidelines 2