Adult Dosing
Bacterial infections caused by susceptible bacteria
- 600-1200 mg/day IM/IV divided q6-12 hrs
- More severe infections: 1200-2700 mg/day IM/IV divided q6-12 hrs
- For life-threatening infections, 4800 mg/day IV may be used
- Max: 600 mg/dose IM; 4800 mg daily IV
Notes: Dilute prior to IV administration, concentration in diluents for infusion should not exceed 18 mg/mL, avoid infusion rate >30mg/min
Severe PID
- Adults & Adolescents: 900 mg IV q8 hrs with gentamicin; may switch to PO after 24 hrs if clinical improvement
Prevention of perinatal group B streptococcal disease (Not FDA approved)
- 900 mg IV to mother q8 hrs until delivery
CNS toxoplasmosis (Not FDA approved)
- 600 mg IV q6 hrs with leucovorin/pyrimethamine
Babesiosis (Not FDA approved)
- 300-600 mg IV q6 hrs with quinine x 7-10 days
Tetanus [Non-FDA Approved]
- 600 mg/dose IV given q6h or 900 mg/dose given q8hrs, Max: 4800 mg/day
Orbital cellulitis [Non-FDA Approved]
Epiglottitis [Non-FDA Approved]
- More severe infections: 1.2-2.7 g/day IM/IV divided q6-12 hrs (Max 4.8 g/day)
Malaria [Non FDA-Approved]
- 10 mg base/kg loading dose IV, followed by 5 mg base/kg IV q8 hrs; switch to oral clindamycin when patient can tolerate
Pediatric Dosing
Bacterial infections caused by susceptible bacteria
- < 1 mo: 15-20 mg/kg/day IM/IV divided q6-8 hrs
- 1 mo-16 yrs: 20-40 mg/kg/day IM/IV divided q6-8 hrs; alt: 350 mg/m2/day IM/IV divided q6-8 hrs for serious infections, 450 mg/m2/day IM/IV divided q6-8 hrs for more severe infections
Note: Clindamycin must be diluted prior to IV administration to a conc. not more than 18 mg/mL. Max infusion rate: 30 mg/min.
Tetanus [Non-FDA Approved]
- <1 mo: 15-20 mg/kg/day IM/IV divided q6-8hrs
- 1 mo-16 yrs: 20-40 mg/kg/day IM/IV divided q6-8hrs
Orbital cellulitis [Non-FDA Approved]
- 20-40 mg/kg/day IV divided q6-8h [Max 4800 mg/day, generally no need to exceed 2700 mg/day]
Epiglottitis [Non-FDA Approved]
- <1 mo: 15-20 mg/kg/day IM/IV divided q6-8 hrs
- 1 mo-16 yrs: 20-40 mg/kg/day IM/IV divided q6-8 hrs
Malaria [Non FDA-Approved]
- 10 mg base/kg loading dose IV, then 10 mg/kg/dose q8 hours; switch to oral clindamycin when patient can tolerate
[Outline]
- Clostridium difficile associated diarrhea which may vary in severity from mild to fatal colitis, has been reported with use of all antibiotics. Maintain appropriate fluid and electrolyte levels, protein supplementation, along with antibiotics for C. difficile as needed [U.S. Black Box Warning]
- To reduce the development of drug-resistant bacteria, use only to treat infections proven or strongly suspected to be caused by susceptible bacteria. Obtain susceptibility tests before starting therapy
- Clindamycin does not diffuse into the CSF, do not use for treatment of meningitis
- Provide immediate emergency treatment with epinephrine, oxygen and intravenous corticosteroids on occurrence of serious anaphylactoid reactions
- Carefully monitor geriatric patients for change in bowel frequency
- Overgrowth of nonsusceptible organisms may occur; take appropriate measures on occurrence of superinfections
- Monitor patient for signs of anaphylaxis or allergic reactions; discontinue therapy if serious reactions occur
- Monitor LFTs in severe hepatic impairment; BUN/serum creatinine, CBC if prolonged therapy
- Strictly avoid administration of undiluted solution by IV bolus. Infuse over at least 10 to 60 min. More than 1,200 mg per hour not recommended.
- Administer by deep IM injection and avoid prolonged use of indwelling IV catheters
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- History of GI disease
- Atopic individuals
- Concomitant use of neuromuscular blocking agents
Pregnancy Category:B
Breastfeeding: Clindamycin can cause adverse effects on the breastfed infant's gastrointestinal flora. Monitor infants for diarrhea, candidiasis or colitis. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT). This drug is compatible and considered safe with breastfeeding based upon data from AAP Policy Guidelines (available at http://aappolicy.aappublications.org/cgi/content/full/pediatrics;108/3/776 last accessed 12 November 2010)
