Clindamycin Use in Staphylococcus epidermidis Infections

Introduction to Clindamycin Therapy

• The Infectious Diseases Society of America recommends vancomycin as empiric therapy for coagulase-negative staphylococcal infections because most are methicillin-resistant, particularly in healthcare-associated infections 1
• Clindamycin is bacteriostatic and therefore not recommended for endovascular infections such as infective endocarditis or septic thrombophlebitis 2

Appropriate Use of Clindamycin

• Clindamycin demonstrates excellent tissue penetration, particularly in bone and abscesses, though CSF penetration is limited 2
• The Infectious Diseases Society of America recommends clindamycin only when local resistance rates are <10% 3

Alternative Therapeutic Approaches

• Switch to vancomycin targeting trough levels of 10-15 mg/L for most coagulase-negative staphylococcal infections 1
• De-escalate to a semisynthetic penicillin (nafcillin, oxacillin) or first-generation cephalosporin (cefazolin) if susceptibility testing confirms methicillin susceptibility, as beta-lactams are superior to vancomycin for susceptible organisms 1
• For prosthetic valve endocarditis caused by S. epidermidis, treat for minimum 6 weeks with vancomycin plus rifampin, adding gentamicin for the first 2 weeks 1

Important Considerations for Clindamycin Use

• Always perform D-zone testing for erythromycin-resistant, clindamycin-susceptible isolates to detect inducible clindamycin resistance 2