Clindamycin Indications and Usage

Primary Indications

• The Infectious Diseases Society of America recommends clindamycin for serious skin and soft tissue infections caused by susceptible strains of staphylococci and streptococci, particularly useful for coverage of anaerobes and aerobic gram-positive cocci, including most S. aureus strains 1
• Clindamycin can be used for MRSA skin infections at a dosage of 300-450 mg orally three times daily or 600 mg/kg every 8 hours intravenously, as recommended by the Infectious Diseases Society of America 2
• The American College of Clinical Pharmacology recommends clindamycin in combination with penicillin for necrotizing fasciitis and/or streptococcal toxic shock syndrome caused by group A streptococci, with a strength of evidence of A-II recommendation 1, 3

Special Considerations

• The Infectious Diseases Society of America recommends clindamycin as part of combination therapy with agents effective against both aerobes and anaerobes for mixed infections, such as polymicrobial necrotizing fasciitis 5
• For community-acquired mixed infections, the Infectious Diseases Society of America recommends a combination of ampicillin-sulbactam plus clindamycin plus ciprofloxacin, with a strength of evidence of A-III recommendation 1
• The American College of Clinical Pharmacology recommends clindamycin (600-900 mg/kg every 8 hours IV) for Clostridium infections, often with penicillin 6

Dosage Considerations

• The Infectious Diseases Society of America recommends an adult dosage of 300-450 mg orally three times daily or 600-900 mg/kg every 8 hours intravenously 2
• The American Academy of Pediatrics recommends a pediatric dosage of 25-40 mg/kg/day in 3 divided doses intravenously or 10-20 mg/kg/day in 3 divided doses orally 2

Limitations and Precautions

• The Infectious Diseases Society of America notes that clindamycin's bacteriostatic nature makes it unsuitable for endovascular infections such as infective endocarditis or septic thrombophlebitis 7
• The American College of Clinical Pharmacology warns of the potential for cross-resistance and emergence of resistance in erythromycin-resistant strains, with inducible resistance in MRSA 2
• The Infectious Diseases Society of America recommends the D-zone test for detection of inducible clindamycin resistance in erythromycin-resistant, clindamycin-susceptible isolates 7