Clindamycin: Difference between revisions
ClaireLewis (talk | contribs) No edit summary |
|||
(22 intermediate revisions by 4 users not shown) | |||
Line 1: | Line 1: | ||
==General== | ==General== | ||
*Type: Other | *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 | ||
Line 9: | Line 9: | ||
**150-450mg PO q6h | **150-450mg PO q6h | ||
**First Dose: 150-450mg PO x 1 | **First Dose: 150-450mg PO x 1 | ||
**Max: | **Max: 450mg/dose PO (increased risk of [[C. diff]] at higher doses) | ||
*'''IM:''' | *'''IM:''' | ||
**1200- | **1200-2700mg/day IM divided q6-12h | ||
**First Dose: | **First Dose: 600mg IM x 1 | ||
**Max: | **Max: 600mg/dose IM | ||
*'''IV''' | *'''IV''' | ||
**1200- | **1200-2700mg/day IV divided q6-12h | ||
**First Dose: 600- | **First Dose: 600-900mg IV x 1 | ||
** | **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>=== | ===[[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>=== | ||
Line 26: | Line 26: | ||
===[[Bacterial Vaginosis]]=== | ===[[Bacterial Vaginosis]]=== | ||
{{BV Clindamycin Adult}} | |||
===[[PID]]=== | ===[[PID]]=== | ||
*'''PO (Mild-mod)''' | *'''PO (Mild-mod)''' | ||
**450mg PO q6h x 14 days | **450mg PO q6h x 14 days | ||
**Use with ceftriaxone or cefoxitin/probenecid if no proceeding IV treatment | **Use with [[ceftriaxone]] or cefoxitin/probenecid if no proceeding IV treatment | ||
*'''IV (Severe)''' | *'''IV (Severe)''' | ||
**900mg IV q8 | **900mg IV q8 | ||
**Use with gentamicin and switch to PO after 24h of clinical improvement | **Use with [[gentamicin]] and switch to PO after 24h of clinical improvement | ||
===[[Babesiosis]]=== | ===[[Babesiosis]]=== | ||
{{Babesiosis Clindamycin Adult}} | |||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
Line 46: | Line 43: | ||
*'''<1 week old''' | *'''<1 week old''' | ||
**''<2kg'' | **''<2kg'' | ||
*** | ***10mg/kg/day IM/IV divided q12 | ||
***First Dose: | ***First Dose: 5mg/kg IM/IV x 1 | ||
**''>2kg'' | **''>2kg'' | ||
*** | ***15mg/kg/day IM/IV divided q8h | ||
***First Dose: | ***First Dose: 5mg/kg IM/IV x 1 | ||
*'''1 week - 1 month''' | *'''1 week - 1 month''' | ||
**''<1.2kg'' | **''<1.2kg'' | ||
*** | ***10mg/kg/day IM/IV divided q12h | ||
***First Dose: | ***First Dose: 5mg/kg IM/IV x 1 | ||
**''1.2-2kg'' | **''1.2-2kg'' | ||
*** | ***15mg/kg/day IM/IV divided q8h | ||
***First Dose: | ***First Dose: 5mg/kg IM/IV x 1 | ||
**''>2kg'' | **''>2kg'' | ||
*** | ***20mg/kg/day IM/IV divided q6-8h | ||
***Alt: | ***Alt: 30mg/kg/day IM/IV divided q6h | ||
***First Dose: 5-7. | ***First Dose: 5-7.5mg/kg IM/IV x 1 | ||
*'''>1 Month - Children''' | *'''>1 Month - Children''' | ||
**25- | **25-40mg/kg/day IM/IV divided q6-8h | ||
**First Dose: 6.25-13. | **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- | **25-40mg/kg/day IM/IV divided q6-8h | ||
**First Dose: 6.25-13. | **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 | ||
Line 74: | Line 71: | ||
*'''Infants & Children''' | *'''Infants & Children''' | ||
**'''PO:''' | **'''PO:''' | ||
*** 10- | ***10-25mg/kg/day PO divided q6-8h | ||
***First Dose: 2.5-8. | ***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- | ***15-25mg/kg/day IM/IV divided q6-8 | ||
***First Dose: 3.75-8. | ***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''' | ||
Line 87: | Line 84: | ||
***Max: 1.8 g/day PO | ***Max: 1.8 g/day PO | ||
**'''IM/IV:''' | **'''IM/IV:''' | ||
***25- | ***25-40mg/kg/day IM/IV divided q6-8h | ||
***First Dose: 6.25-13. | ***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>=== | ===[[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- | *10-13mg/kg/dose q6-8hrs PO x 5-10 days | ||
*First Dose: 2.5-4. | *First Dose: 2.5-4.3mg/kg PO x 1 | ||
*Max: | *Max: 40mg/kg/day | ||
===[[Otitis Media]], Acute=== | ===[[Otitis Media]], Acute=== | ||
*2mo-5yo | *2mo-5yo | ||
**30- | **30-40mg/kg/day PO divided q8h x 10 days | ||
*6-12yo | *6-12yo | ||
**30- | **30-40mg/kg/day PO divided q8h x 5-10 days | ||
===[[Sinusitis]]=== | ===[[Sinusitis]]=== | ||
*30- | *30-40mg/kg/day PO divided q8h x 10-14 days | ||
*Use with cefixime or cefpodoxime | *Use with cefixime or cefpodoxime | ||
===[[Streptococcal Pharyngitis]]=== | ===[[Streptococcal Pharyngitis]]=== | ||
* | *7mg/kg PO q8h x 10 days | ||
*Max: 300mg/dose | *Max: 300mg/dose | ||
===Community-Acquired [[Pneumonia]] (>3mo)=== | ===Community-Acquired [[Pneumonia]] (>3mo)=== | ||
*'''IV (Mod-Severe):''' | *'''IV (Mod-Severe):''' 40mg/kg/day IV divided q6-8h x 10-14 days | ||
*'''PO (Mild):''' 30- | *'''PO (Mild):''' 30-40mg/kg/day PO divided q6-8h x 7-10 days | ||
===[[Babesiosis]]=== | ===[[Babesiosis]]=== | ||
*20- | *20-40mg/kg/day PO/IV divided q6-8h x 7-10 days | ||
*Max: | *Max: 600mg/dose | ||
*Info: Use with quinine | *Info: Use with quinine | ||
==Special Populations== | ==Special Populations== | ||
*Pregnancy: B | *[[Pregnancy Rating]]: B | ||
*Lactation: | *[[Lactation risk categories]]: L4; enters breast milk/not recommended | ||
*Renal Dosing (Adult & Pediatric) | *Renal Dosing (Adult & Pediatric) | ||
**No adjustment | **No adjustment | ||
Line 166: | Line 163: | ||
==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 | **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: | **Max rate: 30mg/minute (do not exceed 1200mg/hour) | ||
**Final concentration should not exceed | **Final concentration should not exceed 18mg/mL | ||
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>== | |||
{| class="wikitable" | |||
| align="center" style="background:#f0f0f0;"|'''Group''' | |||
| align="center" style="background:#f0f0f0;"|'''Organism''' | |||
| align="center" style="background:#f0f0f0;"|'''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=== | |||
{{Template:Antibacterial Spectra Key}} | |||
==See Also== | ==See Also== | ||
*[[Antibiotics (Main)]] | *[[Antibiotics (Main)]] | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Pharmacology]] | ||
[[Category:ID]] |
Revision as of 17:39, 20 September 2019
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
Cellulitis Possibly due to MRSA (Unlabled Use)[1]
- 300-450mg PO q8hr x 5-10 days
Strep. Pharyngitis
- 300mg PO q8 x 10 days
Bacterial Vaginosis
- Clindamycin 300mg PO BID x 7 days
PID
- 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
- 600 mg PO q8h x 7-10 days
- Alt: 300-600mg IV q6h x 7-10 days
- First Dose: 300-600mg IV x 1
- Give with Quinine (650mg TID); use IV for severe infections
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
- <2kg
- 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
- <1.2kg
- >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
- PO:
- 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
- PO:
Cellulitis Possibly due to MRSA (Unlabeled Use)[2]
- 10-13mg/kg/dose q6-8hrs PO x 5-10 days
- First Dose: 2.5-4.3mg/kg PO x 1
- Max: 40mg/kg/day
Otitis Media, Acute
- 2mo-5yo
- 30-40mg/kg/day PO divided q8h x 10 days
- 6-12yo
- 30-40mg/kg/day PO divided q8h x 5-10 days
Sinusitis
- 30-40mg/kg/day PO divided q8h x 10-14 days
- Use with cefixime or cefpodoxime
Streptococcal Pharyngitis
- 7mg/kg PO q8h x 10 days
- Max: 300mg/dose
Community-Acquired Pneumonia (>3mo)
- IV (Mod-Severe): 40mg/kg/day IV divided q6-8h x 10-14 days
- PO (Mild): 30-40mg/kg/day PO divided q6-8h x 7-10 days
Babesiosis
- 20-40mg/kg/day PO/IV divided q6-8h x 7-10 days
- Max: 600mg/dose
- Info: Use with quinine
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
- C. difficile associated diarrhea
- Thrombocytopenia
- Anaphylaxis
- Stevens-Johnson Syndrome
- Granulocytopenia
- Esophagitis
Common
- Diarrhea
- Nausea and Vomiting
- Abdominal Pain
- Rash
- Puritis
- Jaundice
- Urticaria
- Hypotension
- Thrombophlebitis (IV use)
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
Antibiotic Sensitivities[3]
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
- ↑ 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
- ↑ 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
- ↑ Sanford Guide to Antimicrobial Therapy 2014