Clindamycin: Difference between revisions
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==General==
==General==
*Type: Other antibiotics
*Type: Other [[antibiotic]]
*Dosage Forms: IM, IV, PO (75mg; 150mg; 300mg; 75mg/5mL)
*Dosage Forms: IM, IV, PO (75mg; 150mg; 300mg; 75mg/5mL)
*Common Trade Names: Cleocin
*Common Trade Names: Cleocin
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==Adult Dosing==
==Adult Dosing==
===General===
===General===
*'''PO:'''
*PO:
**150-450mg PO q6h
**150-450mg PO q6h
**First Dose: 150-450mg PO x 1
**First Dose: 150-450mg PO x 1
**Max: 450 mg/dose PO (increased risk of [[C. diff]] at higher doses)
**Max: 450mg/dose PO (increased risk of [[C. diff]] at higher doses)
*'''IM:'''
*IM:
**1200-2700 mg/day IM divided q6-12h
**1200-2700mg/day IM divided q6-12h
**First Dose: 600 mg IM x 1
**First Dose: 600mg IM x 1
**Max: 600 mg/dose IM
**Max: 600mg/dose IM
*'''IV'''
*IV
**1200-2700 mg/day IV divided q6-12h
**1200-2700mg/day IV divided q6-12h
**First Dose: 600-900 mg IV x 1
**First Dose: 600-900mg IV x 1
**4800 mg/day IV
**4800mg/day IV


===[[Cellulitis]] Possibly due to [[MRSA]] (Unlabled Use)<ref>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</ref>===
===Indications by Disease===
*300-450mg PO q8hr x 5-10 days
{{#ask: [[Has DrugName::Clindamycin]] [[Has Population::Adult]]
 
|?Treats disease=Disease
===[[Strep. Pharyngitis]]===
|?Has Dose=Dose
*300mg PO q8 x 10 days
|?Has Context=Context
 
|format=table
===[[Bacterial Vaginosis]]===
|limit=50
{{BV Clindamycin Adult}}
|mainlabel=-
 
|headers=show
===[[PID]]===
|sort=Treats disease
*'''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]]===
{{Babesiosis Clindamycin Adult}}


==Pediatric Dosing==
==Pediatric Dosing==
===General Infection (Severe)===
===General Infection (Severe)===
*'''<1 week old'''
*<1 week old
**''<2kg''
**''<2kg''
***10 mg/kg/day IM/IV divided q12
***10mg/kg/day IM/IV divided q12
***First Dose: 5 mg/kg IM/IV x 1
***First Dose: 5mg/kg IM/IV x 1
**''>2kg''
**''>2kg''
***15 mg/kg/day IM/IV divided q8h
***15mg/kg/day IM/IV divided q8h
***First Dose: 5 mg/kg IM/IV x 1
***First Dose: 5mg/kg IM/IV x 1
*'''1 week - 1 month'''
*1 week - 1 month
**''<1.2kg''
**''<1.2kg''
***10 mg/kg/day IM/IV divided q12h
***10mg/kg/day IM/IV divided q12h
***First Dose: 5 mg/kg IM/IV x 1
***First Dose: 5mg/kg IM/IV x 1
**''1.2-2kg''
**''1.2-2kg''
***15 mg/kg/day IM/IV divided q8h
***15mg/kg/day IM/IV divided q8h
***First Dose: 5 mg/kg IM/IV x 1
***First Dose: 5mg/kg IM/IV x 1
**''>2kg''
**''>2kg''
***20 mg/kg/day IM/IV divided q6-8h
***20mg/kg/day IM/IV divided q6-8h
***Alt: 30 mg/kg/day IM/IV divided q6h
***Alt: 30mg/kg/day IM/IV divided q6h
***First Dose: 5-7.5 mg/kg IM/IV x 1
***First Dose: 5-7.5mg/kg IM/IV x 1
*'''>1 Month - Children'''
*>1 Month - Children
**25-40 mg/kg/day IM/IV divided q6-8h
**25-40mg/kg/day IM/IV divided q6-8h
**First Dose: 6.25-13.3 mg/kg IM/IV x 1  
**First Dose: 6.25-13.3mg/kg IM/IV x 1  
**Max: 4.8 g/day IM/IV
**Max: 4.8 g/day IM/IV
*'''Adolescents'''
*Adolescents
**25-40 mg/kg/day IM/IV divided q6-8h
**25-40mg/kg/day IM/IV divided q6-8h
**First Dose: 6.25-13.3 mg/kg IM/IV x 1  
**First Dose: 6.25-13.3mg/kg IM/IV x 1  
**Max: 4.8 g/day IM/IV
**Max: 4.8 g/day IM/IV


===General Infection (Mild-Moderate)===
===General Infection (Mild-Moderate)===
*'''Infants & Children'''
*Infants & Children
**'''PO:'''
**PO:
*** 10-25 mg/kg/day PO divided q6-8h
***10-25mg/kg/day PO divided q6-8h
***First Dose: 2.5-8.3 mg/kg PO x 1
***First Dose: 2.5-8.3mg/kg PO x 1
***Max: 1.8 g/day PO
***Max: 1.8 g/day PO
**'''IM/IV:'''
**IM/IV:  
***15-25 mg/kg/day IM/IV divided q6-8
***15-25mg/kg/day IM/IV divided q6-8
***First Dose: 3.75-8.3 mg/kg IM/IV x 1
***First Dose: 3.75-8.3mg/kg IM/IV x 1
***4.8 g/day IM/IV
***4.8 g/day IM/IV
*'''Adolescents'''
*Adolescents
**'''PO:'''
**PO:
***150-300mg PO q6h
***150-300mg PO q6h
***First Dose: 150-300mg PO x 1
***First Dose: 150-300mg PO x 1
***Max: 1.8 g/day PO
***Max: 1.8 g/day PO
**'''IM/IV:'''
**IM/IV:
***25-40 mg/kg/day IM/IV divided q6-8h
***25-40mg/kg/day IM/IV divided q6-8h
***First Dose: 6.25-13.3 mg/kg IM/IV x 1
***First Dose: 6.25-13.3mg/kg IM/IV x 1
***Max: 4.8 g/day IM/IV
***Max: 4.8 g/day IM/IV


===[[Cellulitis]] Possibly due to [[MRSA]] (Unlabeled Use)<ref>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</ref>===
*10-13 mg/kg/dose q6-8hrs PO x 5-10 days
*First Dose: 2.5-4.3 mg/kg PO x 1
*Max: 40 mg/kg/day
===[[Otitis Media]], Acute===
*2mo-5yo
**30-40 mg/kg/day PO divided q8h x 10 days
*6-12yo
**30-40 mg/kg/day PO divided q8h x 5-10 days
===[[Sinusitis]]===
*30-40 mg/kg/day PO divided q8h x 10-14 days
*Use with cefixime or cefpodoxime
===[[Streptococcal Pharyngitis]]===
*7 mg/kg PO q8h x 10 days
*Max: 300mg/dose


===Community-Acquired [[Pneumonia]] (>3mo)===
*'''IV (Mod-Severe):''' 40 mg/kg/day IV divided q6-8h x 10-14 days
*'''PO (Mild):''' 30-40 mg/kg/day PO divided q6-8h x 7-10 days


===[[Babesiosis]]===
===Indications by Disease===
*20-40 mg/kg/day PO/IV divided q6-8h x 7-10 days
{{#ask: [[Has DrugName::Clindamycin]] [[Has Population::Pediatric]]
*Max: 600 mg/dose
|?Treats disease=Disease
*Info: Use with quinine
|?Has Dose=Dose
|?Has Context=Context
|format=table
|limit=50
|mainlabel=-
|headers=show
|sort=Treats disease
}}


==Special Populations==
==Special Populations==
*Pregnancy: B
*[[Pregnancy Rating]]: B
*Lactation: Possibly unsafe (enters breast milk/not recommended)
*[[Lactation risk categories]]: L4; enters breast milk/not recommended
*Renal Dosing (Adult & Pediatric)
*Renal Dosing (Adult & Pediatric)
**No adjustment
**No adjustment
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==Administration==
==Administration==
*'''PO: '''
*PO:  
**Give with full glass of water (minimize esophageal ulceration)
**Give with full glass of water (minimize esophageal ulceration)
**Give spread around the day to promote constant serum levels
**Give spread around the day to promote constant serum levels
*'''IM:'''
*IM:
**Give to deep I.M. sites
**Give to deep I.M. sites
**Rotate sites
**Rotate sites
**Do not exceed 600 mg per injection
**Do not exceed 600mg per injection
*'''IV:'''
*IV:  
**Do NOT give as bolus
**Do NOT give as bolus
**Give by intermittent infusion over >10-60 minutes
**Give by intermittent infusion over >10-60 minutes
**Max rate: 30 mg/minute (do not exceed 1200 mg/hour)
**Max rate: 30mg/minute (do not exceed 1200mg/hour)
**Final concentration should not exceed 18 mg/mL
**Final concentration should not exceed 18mg/mL
 
==Mechanism of Action==
*Disrupts protein synthesis by binding the 50s ribosome subunit


==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>==
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*[[Antibiotics (Main)]]
*[[Antibiotics (Main)]]


==Source==
==References==
*Epocrates
*Lexicomp
<references/>
<references/>
[[Category:Drugs]]
[[Category:Pharmacology]]
[[Category:ID]]

Latest revision as of 09:09, 22 March 2026

General

  • Type: Other antibiotic
  • 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

Indications by Disease

DiseaseDoseContext
Acute necrotizing ulcerative gingivitis300mg PO three times dailyUncomplicated
Acute tetanus600mg IV (7.5mg/kg) q6hrsActive tetanus alt
Anthrax900mg IV q8hrsInhalation/cutaneous with systemic illness; combined with Ciprofloxacin or Doxycycline
Babesiosis600mg PO q8hrs x 7-10 days (or 300-600mg IV q6hrs)Severe parasitemia over 4 percent with Quinine
Bacterial vaginosis300 mg PO BID for 7 daysAlternative
Bacterial vaginosiscream 2%, one full applicator (5 g) intravaginally Nightly for 7 daysFirst Line, Topical
Cellulitis600mg IV q8hrsInpatient
Cellulitis450mg PO TIDOutpatient
Dental abscess450 mg PO q8 hours x 7-14 daysOutpatient
Diabetic foot infection450mg PO q8hrs daily x 14 daysMild DFI
Diabetic foot infection450mg PO q8hrsModerate DFI
Endocarditis600mg (20mg/kg) PO or IVDental Procedure Prophylaxis
Erysipelas450mg (5mg/kg) PO q8hrs x 10 daysPCN Allergic
Felon450mg PO q8hrs x 7 daysOutpatient
Impetigo450mg PO q8hrs (or 10mg/kg PO q6hrs) x 10 daysOral therapy
Ludwig's angina600 mg IV q6 hrsImmunocompetent, Penicillin allergy
Mammalian bites450mg (5mg/kg) PO q8hrs x 7 daysHuman bites alt
Mammalian bites600mg IV q8hrsSevere mammalian bite infection alt
Mammalian bites450mg (5mg/kg) PO q8hrs x 7 daysCat and dog bites alt
Mastitis450mg PO q8hrsAlso provides MRSA coverage
Mastoiditis600mg IV q8 hoursEmpiric
Neutropenic fever450mg PO q8hrsOutpatient alt with Ciprofloxacin
Open fracture900 mg IV (immediately and q8 hours x 3 total doses)Grade I & II, Cephalosporin allergy
Pelvic inflammatory disease900mg IV q8hrInpatient alternative; combined with Gentamicin
Periorbital cellulitis300mg Q8HOutpatient
Peritonsillar abscess300mg PO Q6hrs x7-10dOutpatient
Peritonsillar abscess600-900mg IV TIDInpatient
Pneumocystis jirovecii pneumonia900mg IV q8hrsSevere disease with Primaquine
Pneumocystis jirovecii pneumonia450mg PO q8hrsMild disease with Primaquine
Pneumonia (main)600mg IVICU, Low Risk (PCN allergy)
Postpartum endometritis900mg IV q8hrsPreferred first line; <48hrs postpartum
Septic bursitis600 mg IV three times dailyInpatient
Septic bursitis300 mg PO three times daily x 14 daysOutpatient
Streptococcal pharyngitis7 mg/kg/dose TID (maximum = 300 mg/dose) x 10 daysPenicillin Allergy (anaphylaxis)
Suppurative parotitis450mg PO three times dailyOutpatient
Toxoplasmosis600mg PO or IV q6hrsImmunosuppressed alt

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


Indications by Disease

DiseaseDoseContext
Acute otitis media10mg/kg PO three times dailyPenicillin Allergy
Acute tetanus10-13mg/kg IV q8hrs (max 900mg/dose)Pediatric Active tetanus alt
Anthrax7.5mg/kg q6hrsPediatric; combined with Ciprofloxacin or Doxycycline
Babesiosis20-40mg/kg/day PO divided TID x 7-10 days (max 600mg/dose)Pediatric, with Quinine
Cellulitis30-40mg/kg/day PO divided TID (max 1.8g/day)Pediatric Outpatient
Cellulitis10-13mg/kg IV q8hrs (max 900mg/dose)Pediatric Inpatient
Dental abscess30mg/kg/day PO divided TID x 7-10 days (max 1.8g/day)Pediatric Outpatient
Endocarditis20mg/kg PO or IV (max 600mg)Pediatric Dental Prophylaxis, PCN Allergy
Erysipelas30mg/kg/day PO divided TID x 10 days (max 1.8g/day)Pediatric PCN Allergy
Impetigo30mg/kg/day PO divided TID (max 1.8g/day)Pediatric Oral, MRSA
Infectious tenosynovitis10mg/kg IV four times dailyPediatrics
Ludwig's angina10-13mg/kg IV q8hrs (max 900mg/dose)Pediatric PCN Allergy
Mammalian bites30mg/kg/day PO divided TID (max 1.8g/day)Pediatric PCN allergy
Mammalian bites30mg/kg/day PO divided TID (max 1.8g/day)Pediatric Human bites alt
Mastoiditis10-13mg/kg IV q8hrs (max 900mg/dose)Pediatric
Open fracture10mg/kg IV (max 900mg) immediately then q8hrs x 3 dosesPediatric Grade I & II, allergy
Osteomyelitis10mg/kg IV PO four times dailySickle Cell Disease
Periorbital cellulitis30 to 40 mg/kg per day in three to four equally divided doses, maximum 1.8 grams per dayOutpatient
Peritonsillar abscess30-40mg/kg/day PO divided TID (max 1.8g/day)Pediatric Outpatient
Peritonsillar abscess10-13mg/kg IV q8hrs (max 900mg/dose)Pediatric Inpatient
Pharyngitis7mg/kg/dose PO q8h x 10 days'"`UNIQ--ref-0000003E-QINU`"'; Max: 300mg/doseStreptococcal Pharyngitis
Septic bursitis10mg/kg IV three times dailyInpatient
Sinusitis30-40mg/kg/day PO divided q8h x 10-14 days; Use with cefixime or cefpodoximeSinusitis
Streptococcal pharyngitis7mg/kg/dose PO TID x 10 days (max 300mg/dose)Pediatric PCN Allergy (severe)
Suppurative parotitis10mg/kg PO four times dailyOutpatient
Toxoplasmosis20-30mg/kg/day PO/IV divided q6hrs (max 2.4g/day)Pediatric Sulfa Allergy alt

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

Mechanism of Action

  • Disrupts protein synthesis by binding the 50s ribosome subunit

Antibiotic Sensitivities[1]

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. ↑ Sanford Guide to Antimicrobial Therapy 2014
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