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clindamycin

Generic Name: clindamycin (klin da MYE sin)
Brand names: Cleocin HCl, Cleocin Pediatric, Cleocin Phosphate

What is clindamycin?

Clindamycin is an antibiotic that fights bacteria in the body.

Clindamycin is used to treat serious infections caused by bacteria.

Clindamycin may also be used for purposes other than those listed in this medication guide.

What is the most important information I should know about clindamycin?

Do not use this medication if you are allergic to clindamycin or lincomycin (Bactramycin, L-Mycin, Lincocin)

Do not take clindamycin together with erythromycin (E-Mycin, E.E.S., Eryc, Ery-Tab, Robimycin, and others).

Before using clindamycin, tell your doctor if you have kidney disease, liver disease, an intestinal disorder such as colitis or Crohn's disease, or a history of asthma, eczema, or allergic skin reaction.

Take this medication for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated. Clindamycin will not treat a viral infection such as the common cold or flu.

Antibiotic medicines can cause diarrhea, which may be a sign of a new infection. If you have diarrhea that is watery or has blood in it, call your doctor. Do not use any medicine to stop the diarrhea unless your doctor has told you to.

To be sure this medication is not causing harmful effects, your blood will need to be tested on a regular basis. Your kidney or liver function may also need to be tested. Do not miss any scheduled visits to your doctor.

If you need to have any type of surgery, tell the surgeon ahead of time that you are using clindamycin. You may need to stop using the medicine for a short time.

What should I discuss with my healthcare provider before taking clindamycin?

Do not use this medication if you are:

allergic to clindamycin or lincomycin (Bactramycin, L-Mycin, Lincocin); or
if you are also taking erythromycin (E-Mycin, E.E.S., Eryc, Ery-Tab, Robimycin, and others).

Before using clindamycin, tell your doctor if you are allergic to any drugs, or if you have:

colitis, Crohn's disease, or other intestinal disorder;
kidney disease;
liver disease; or
a history of asthma, eczema, or allergic skin reaction.

If you have any of these conditions, you may not be able to use clindamycin, or you may need a dosage adjustment or special tests during treatment.

FDA pregnancy category B. This medication is not expected to be harmful to an unborn baby. Tell your doctor if you are pregnant or plan to become pregnant during treatment. Clindamycin can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take clindamycin?

Take this medication exactly as it was prescribed for you. Do not take the medication in larger amounts, or take it for longer than recommended by your doctor. Follow the directions on your prescription label.

Take this medicine with a full glass of water to keep it from irritating your throat. Shake the oral suspension (liquid) well just before you measure a dose. To be sure you get the correct dose, measure the liquid with a marked measuring spoon or medicine cup, not with a regular table spoon. If you do not have a dose-measuring device, ask your pharmacist for one. Take this medication for the entire length of time prescribed by your doctor. Your symptoms may get better before the infection is completely treated. clindamycin will not treat a viral infection such as the common cold or flu.

If you need to have any type of surgery, tell the surgeon ahead of time that you are using clindamycin. You may need to stop using the medicine for a short time.

Store clindamycin at room temperature away from moisture and heat.

What happens if I miss a dose?

Take the missed dose as soon as you remember. If it is almost time for your next dose, skip the missed dose and take the medicine at your next regularly scheduled time. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention if you think you have used too much of this medicine.

Symptoms of a clindamycin overdose may include depression, changes in behavior, or seizure (convulsions).

What should I avoid while taking clindamycin?

Clindamycin side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; difficulty breathing; swelling of your face, lips, tongue, or throat. Stop using clindamycin and call your doctor at once if you have any of these serious side effects:

diarrhea that is watery or bloody;
fever, chills, body aches, flu symptoms;
nausea, stomach pain, low fever, loss of appetite, dark urine, clay-colored stools, jaundice (yellowing of the skin or eyes);
urinating less than usual or not at all; or
fever, sore throat, and headache with a severe blistering, peeling, and red skin rash.

Keep taking clindamycin and talk to your doctor if you have any of these less serious side effects:

mild nausea or stomach pain;
vaginal itching or discharge;
mild skin rash or itching; or
irritation in your throat.

Side effects other than those listed here may also occur. Talk to your doctor about any side effect that seems unusual or that is especially bothersome. You may report side effects to FDA at 1-800-FDA-1088.

Clindamycin Dosing Information

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:

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:

Usual Adult Dose for Joint Infection:

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:

Usual Adult Dose for Aspiration 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:

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.

What other drugs will affect clindamycin?

There may be other drugs that can affect clindamycin. Tell your doctor about all the prescription and over-the-counter medications you use. This includes vitamins, minerals, herbal products, and drugs prescribed by other doctors. Do not start using a new medication without telling your doctor.

Where can I get more information?

Your pharmacist has information about clindamycin written for health professionals that you may read.

Remember, keep this and all other medicines out of the reach of children. Never share your medicines with others and only use this medicine for the illness your doctor prescribed it for.
Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.