Clindamycin Dosage

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Usual Adult Dose for Babesiosis

600 mg orally every 6 to 8 hours or 1.2 grams IV twice daily, plus quinine sulfate 650 mg 3 times daily for 7 to 10 days.

Usual Adult Dose for Bacteremia

450 to 900 mg IV every 8 hours. Once the patient is stable and able to tolerate oral medications, oral clindamycin may be substituted according to the microbiology sensitivity data. An appropriate oral dosage for this patient may be 450 mg orally every 6 hours.

Clindamycin is not commonly used for bacteremia and is specifically not recommended for Staphylococcus aureus bacteremia/endocarditis.

Duration: 14 days, depending on the nature and severity of the infection

Usual Adult Dose for Bacterial Endocarditis Prophylaxis

600 mg orally 1 hour prior to the procedure. A single dose of clindamycin is appropriate for prophylaxis prior to dental, oral, upper respiratory tract and esophageal procedures in at-risk, penicillin-allergic patients. Alternatively, clindamycin may be administered intravenously in those patients unable to take clindamycin by mouth. The intravenous dosage is the same as the oral dosage but should be given 30 minutes before the procedure.

Patients who are already taking clindamycin for an infection should preferably be given another antibiotic, such as clarithromycin or azithromycin, for endocarditis prophylaxis. Alternatively, the procedure may be delayed, if possible, until 9 to 14 days after completion of therapy for infection.

Usual Adult Dose for Bacterial Vaginosis

300 mg orally twice daily. The vaginal form of clindamycin may also be appropriate.

If trichomoniasis is suspected, treatment of this patient's male sexual partner(s) is necessary if balanitis is present. Suspicion of trichomoniasis indicates metronidazole therapy for both the patient (provided the patient is not in the first trimester of pregnancy) and her male sexual partner(s).

Duration: 7 days

Usual Adult Dose for Diverticulitis

450 mg orally every 6 hours. This dosage regimen is generally appropriate for the outpatient management of diverticulitis and should be given in conjunction with trimethoprim-sulfamethoxazole. For more acutely ill patients in the inpatient setting, clindamycin 450 to 900 mg intravenously every 8 hours may be administered in conjunction with other agents (often an aminoglycoside, a 3rd generation cephalosporin, an antipseudomonal penicillin or aztreonam).

Duration: Approximately one week in the outpatient setting. For more acutely ill patients, the total duration of therapy may be 10 to 14 days.

Usual Adult Dose for Deep Neck Infection

600 mg IV every 6 to 8 hours. Once the patient is stable and able to tolerate oral medications, oral clindamycin may be substituted according to the microbiology sensitivity data. An appropriate oral dosage for this patient may be 450 mg orally every 6 hours.

Duration: 3 to 4 weeks, depending on the nature and severity of the infection

Usual Adult Dose for Intraabdominal Infection

450 to 900 mg IV every 8 hours. Once the patient is stable and able to tolerate oral medications, oral clindamycin may be substituted according to the microbiology sensitivity data. An appropriate oral dosage for this patient may be 450 mg orally every 6 hours.

For intraabdominal infections, clindamycin is almost always used with one or more additional drugs.

Duration: 7 to 14 days, depending on the nature and severity of the infection

Usual Adult Dose for Joint Infection

450 to 900 mg IV every 8 hours. Once the patient is stable and able to tolerate oral medications, oral clindamycin may be substituted according to the microbiology sensitivity data. An appropriate oral dosage for this patient may be 450 mg orally every 6 hours.

Duration: 3 to 4 weeks, depending on the nature and severity of the infection. Longer therapy, 6 weeks or more, may be required for prosthetic joint infections. In addition, removal of the involved prosthesis is usually required.

Usual Adult Dose for Malaria

Chloroquine-resistant Plasmodium falciparum: 900 mg orally every 8 hours for 5 days plus quinine sulfate 650 mg every 8 hours for 3 to 7 days.

Usual Adult Dose for Osteomyelitis

450 to 900 mg IV every 8 hours. Once the patient is stable and able to tolerate oral medications, oral clindamycin may be substituted according to the microbiology sensitivity data. An appropriate oral dosage for this patient may be 450 mg orally every 6 hours.

Duration: 4 to 6 weeks, sometimes longer, depending on the nature and severity of the infection. Chronic osteomyelitis may require an additional one to two months of oral antibiotic therapy and may benefit from surgical debridement.

The key to successful management of osteomyelitis is identification of the offending organism. If blood cultures are negative and no source of infection is obvious, bone biopsy or aspiration may be helpful in directing antibiotic therapy.

Usual Adult Dose for Pelvic Inflammatory Disease

900 mg IV every 8 hours. Once the patient is stable and able to tolerate oral medications, oral clindamycin may be substituted according to the microbiology sensitivity data. An appropriate oral dosage for this patient may be 450 mg orally every 6 hours.

When used for the treatment of pelvic inflammatory disease in acutely ill women in the inpatient setting, clindamycin is generally given in conjunction with gentamicin. The combination of clindamycin and gentamicin should be continued for at least 48 hours after the patient has demonstrated clinical improvement. Thereafter, either oral clindamycin at a dosage of 450 mg every 6 hours or oral doxycycline (provided that the patient is not pregnant) may be started.

For less acutely ill women in the outpatient setting, ofloxacin in combination with clindamycin at a dosage of 450 mg orally every 6 hours may be used.

The patient's sexual partner(s) should also be evaluated.

The total recommended duration of antimicrobial therapy is 14 days.

Usual Adult Dose for Peritonitis

450 to 900 mg IV every 8 hours. In patients undergoing peritoneal dialysis, clindamycin should be administered intraperitoneally. A dosage of 300 mg should be added to each 2 liters of peritoneal dialysate.

Once the patient is stable and able to tolerate oral medications, oral clindamycin may be substituted according to the microbiology sensitivity data. An appropriate oral dosage for this patient may be 450 mg orally every 6 hours. For peritonitis, clindamycin is almost always used in conjunction with one or more additional drugs to cover aerobic Gram negative rods.

Usual Adult Dose for Pneumocystis Pneumonia

450 to 600 mg orally every 6 hours. Clindamycin is effective in combination with primaquine for the treatment of mild to moderately severe PCP in AIDS patients. Seriously ill patients should receive intravenous trimethoprim-sulfamethoxazole or pentamidine, the drugs of choice for PCP. Alternative therapies for severe cases include intravenous trimetrexate or clindamycin given in a dosage of 900 mg intravenously every 8 hours.

Duration: Therapy should be continued for approximately 21 days, depending on the nature and severity of the infection. Once treatment for PCP is completed, AIDS patients should be administered lifelong suppressive therapy. Sulfamethoxazole-trimethoprim is the agent of choice for this purpose. Alternative therapies include dapsone with or without pyrimethamine and monotherapy with aerosolized pentamidine.

Usual Adult Dose for Pneumonia

450 to 900 mg IV every 8 hours. Once the patient is stable and able to tolerate oral medications, oral clindamycin may be substituted according to the microbiology sensitivity data. An appropriate oral dosage for this patient may be 450 mg orally every 6 hours.

Duration: 10 to 21 days, depending on the nature and severity of the infection

Usual Adult Dose for Aspiration Pneumonia

450 to 900 mg IV every 8 hours. Once the patient is stable and able to tolerate oral medications, oral clindamycin may be substituted according to the microbiology sensitivity data. An appropriate oral dosage for this patient may be 450 mg orally every 6 hours.

Duration: Therapy of anaerobic lung abscess should be continued until a residual scar forms, which may take as long as 2 to 4 months. A shorter duration of therapy may be appropriate for nonnecrotizing anaerobic pneumonia.

Usual Adult Dose for Prevention of Perinatal Group B Streptococcal Disease

In patients with immediate penicillin hypersensitivity and clindamycin-susceptible isolates:
900 mg IV every 8 hours until delivery.

Usual Adult Dose for Sinusitis

150 to 300 mg orally every 6 hours. Clindamycin is generally reserved for chronic bacterial sinusitis in which anaerobic bacteria may play a role.

Duration: 2 to 4 weeks

Usual Adult Dose for Skin or Soft Tissue Infection

450 to 900 mg IV every 8 hours. Once the patient is stable and able to tolerate oral medications, oral clindamycin may be substituted according to the microbiology sensitivity data. An appropriate oral dosage for this patient may be 450 mg orally every 6 hours.

Duration: 7 to 10 days, or for 3 days after acute inflammation disappears, depending on the nature and severity of the infection. For more severe infections, such as diabetic soft tissue infections, 14 to 21 days of therapy may be required.

Usual Adult Dose for Surgical Prophylaxis

600 mg IV given once within 1 hour of incision time. This regimen is appropriate for prophylaxis prior to gastrointestinal surgery.

Usual Adult Dose for Toxoplasmosis - Prophylaxis

300 to 450 mg orally every 6 to 8 hours. This dosage of clindamycin should be given with pyrimethamine 25 to 75 mg orally once a day and leucovorin 10 mg orally once a day.

Clindamycin is recommended by the USPHS/IDSA (U.S. Public Health Service/Infectious Diseases Society of America) Prevention of Opportunistic Infections Working Group as an alternative to sulfadiazine for prophylaxis against recurrent toxoplasmosis in patients who do not tolerate sulfa drugs. Clindamycin is not recommended for prophylaxis against the first episode of toxoplasmosis gondii.

Duration: Maintenance therapy should be lifelong for AIDS patients.

Usual Adult Dose for Toxoplasmosis

600 mg orally or IV every 6 hours. Adjunctive therapy with pyrimethamine should be given in a dosage of 200 mg orally once, followed by 50 to 100 mg orally once a day. Folinic acid (leucovorin) 10 mg orally once a day should be administered to prevent pyrimethamine-induced bone marrow toxicity.

The optimal dosage of clindamycin for CNS toxoplasmosis has not been determined. A regimen of 900 to 1200 mg every 8 hours has been used in some studies.

Clindamycin has no established role in the systemic treatment of toxoplasmosis and is most often used in patients intolerant of sulfadiazine or other sulfa medications and in the treatment of HIV-related central nervous system toxoplasmosis.

Duration: 3 to 6 weeks, depending on the nature and severity of the infection. Once treatment is completed, AIDS patients should be administered lifelong suppressive therapy.

Usual Adult Dose for Bacterial Infection

300 to 900 mg IV every 8 hours. Once the patient is stable and able to tolerate oral medications, oral clindamycin may be substituted according to the microbiology sensitivity data. An appropriate oral dosage for this patient may be 300 to 450 mg orally every 6 hours.

Duration: 7 to 14 days, depending on the nature and severity of the infection

Usual Pediatric Dose for Babesiosis

5 mg/kg (maximum dose 600 mg) every 6 hours plus quinine 8.3 mg/kg (maximum dose 650 mg) every 8 hours for 7 to 10 days.

Usual Pediatric Dose for Bacterial Endocarditis Prophylaxis

1 year or older: As an alternative in penicillin-allergic patients, 20 mg/kg (maximum 600 mg) IV once within 30 minutes before procedure, or orally within 1 hour before procedure.

Usual Pediatric Dose for Surgical Prophylaxis

1 year or older: As an alternative in penicillin-allergic patients, 20 mg/kg (maximum 600 mg) IV once within 30 minutes before procedure, or orally within 1 hour before procedure.

Renal Dose Adjustments

No adjustment recommended

Liver Dose Adjustments

Since clindamycin is primarily metabolized by the liver, the normally recommended dosages may require moderate reductions in patients with liver disease. The patient's clinical response and tolerance to clindamycin should be monitored and additional dosage adjustments be made if necessary. Accumulation of clindamycin has not been demonstrated when dosed every 8 hours.

Dose Adjustments

Single IM injections >600 mg are not recommended.

Precautions

If diarrhea occurs during therapy, this antibiotic should be discontinued.

Clostridium difficile associated diarrhea (CDAD) has been reported with almost all antibiotics and may potentially be life-threatening. Therefore, it is important to consider this diagnosis in patients who present with diarrhea following clindamycin therapy. Clindamycin therapy has been associated with severe colitis which may end fatally; therefore, it should be reserved for serious infections where less toxic antimicrobial agents are inappropriate. It should not be used in patients with nonbacterial infections such as most upper respiratory tract infections. Diarrhea, colitis, and Clostridium difficile pseudomembranous colitis have been observed to begin up to several weeks following discontinuation of clindamycin. Mild cases generally improve with discontinuation of the drug, while severe cases may require supportive therapy and treatment with an antimicrobial agent effective against C difficile. Hypertoxin producing strains of C difficile cause increased morbidity and mortality; these infections can be resistant to antimicrobial treatment and may necessitate colectomy.

Severely ill elderly patients may tolerate diarrhea less well. When clindamycin is indicated in these patients, they should be carefully monitored for change in bowel frequency.

Clindamycin should be prescribed cautiously for patients with a history of gastrointestinal disease, particularly colitis, and in atopic individuals.

Clindamycin should not be used in the treatment of meningitis because it does not diffuse adequately into the cerebrospinal fluid.

Some capsule formulations contain tartrazine dye (FD&C yellow No. 5) which may cause allergic reactions in sensitive patients. Some injectable formulations contain benzyl alcohol which may cause fatal gasping syndrome in premature infants.

Clindamycin should not be administered undiluted as an intravenous bolus injection. It should be infused over 10 to 60 minutes; the infusion rate should not exceed 30 mg/minute. The concentration should not exceed 18 mg/mL.

During prolonged therapy, periodic liver and kidney function tests and blood counts should be performed.

To reduce the risk of development of drug resistant organisms, antibiotics should only be used to treat or prevent proven or suspected infections caused by bacteria. Culture and susceptibility information should be considered when selecting treatment or, if no data are available, local epidemiology and susceptibility patterns may be considered when selecting empiric therapy. Patients should be advised to avoid missing doses and to complete the entire course of therapy.

Dialysis

No adjustment recommended

Other Comments

In cases of beta-hemolytic streptococcal infections, treatment should be continued for at least 10 days.

Oral capsules should be taken with a full glass of water to avoid esophageal irritation.

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