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Clindamycin phosphate IV administration should be diluted, should be infused over at least 10-60 minutes (see Dilution for IV use and IV infusion rates as follows).
Dosage in Adults: Clindamycin phosphate (IM or IV administration): The usual daily adult dosage of clindamycin phosphate for infections of the intra-abdominal area, female pelvis, and other complicated or serious infections is 2400-2700 mg given in 2, 3, or 4 equal doses. Less complicated infections due to more susceptible microorganisms may respond to lower doses such as 1200-1800 mg/day administered in 2, 3 or 4 equal doses.
Doses of up to 4800 mg daily have been used successfully.
No more than 1200 mg should be administered by IV infusion in a single 1-hour period.
Single IM doses of greater than 600 mg are not recommended.
Clindamycin hydrochloride capsules (oral administration): 600-1800 mg/day divided in 2, 3 or 4 equal doses. To avoid the possibility of oesophageal irritation, clindamycin HCl capsules should be taken with a full glass of water and no less than 30 minutes before lying down.
Dosage in Children (over 1 month of age): Clindamycin should be dosed based on total body weight regardless of obesity.
Clindamycin phosphate (IM or IV administration): 20-40 mg/kg/day in 3 or 4 equal doses.
Clindamycin hydrochloride capsules (for children who are able to swallow capsules): To avoid the possibility of oesophageal irritation, clindamycin HCl capsules should be taken with a full glass of water and no less than 30 minutes before lying down.
Doses of 8-25 mg/kg/day in 3 or 4 equal doses.
Clindamycin capsules are not suitable for children who are unable to swallow them whole.
Dosage in Neonates (under 1 month of age): Clindamycin phosphate (IM or IV administration): 15-20 mg/kg/day in 3 or 4 equal doses. The lower dosage may be adequate for small premature infants.
Dosage in Elderly: Pharmacokinetic studies with clindamycin have shown no clinically important differences between young and elderly subjects with normal hepatic function and normal (age-adjusted) renal function after oral or intravenous administration. Therefore, dosage adjustments are not necessary in the elderly with normal hepatic function and normal (age-adjusted) renal function (see Pharmacology: Pharmacokinetics under Actions).
Dosage in Renal Impairment: Clindamycin dosage modification is not necessary in patients with renal insufficiency.
Dosage in Hepatic Impairment: Clindamycin dosage modification is not necessary in patients with hepatic insufficiency.
Dosage in Specific Indications: (a) Treatment of Beta-Hemolytic Streptococcal Infections: Refer to the dosage recommendations as previously mentioned under Dosage in Adults, Dosage in Children (over 1 month of age), and Dosage in Neonates (under 1 month of age). Treatment should be continued for at least 10 days.
(b) Treatment of Diabetic Foot Infections: For mild/moderate infections: Clindamycin hydrochloride capsule orally 300 mg 3-4 times daily for 7-14 days has been found to be effective.
For moderate/severe infections: see as follows.
Dosage regimen could be tailored according to patient medical condition and response. The general care of the patient would have some effects to the improvement of successful therapy.
(c) Inpatient Treatment of Pelvic Inflammatory Disease: Clindamycin phosphate 900 mg (IV) every 8 hours daily plus an antibiotic with an appropriate Gram-negative aerobic spectrum administered IV, e.g., gentamicin 2.0 mg/kg followed by 1.5 mg/kg every 8 daily hours in patients with normal renal function. Continue (IV) drugs for at least 4 days and at least 48 hours after the patient improves. Then continue oral clindamycin hydrochloride 450-600 mg q6h daily to complete 10-14 days total therapy.
(d) Treatment of Chlamydia trachomatis Cervicitis: Clindamycin hydrochloride capsules orally 450-600 mg 4 times daily for 10-14 days.
(e) Treatment of Toxoplasmic Encephalitis in Patients with AIDS: Clindamycin phosphate IV or clindamycin hydrochloride orally 600-1200 mg every 6 hours for 2 weeks followed by 300-600 mg orally every 6 hours. The usual total duration of therapy is 8 to 10 weeks. The dose of pyrimethamine is 25 to 75 mg orally each day for 8 to 10 weeks. Folinic acid 10 to 20 mg/day should be given with higher doses of pyrimethamine.
(f) Treatment of Pneumocystis carinii Pneumonia in Patients with AIDS: Clindamycin phosphate IV 600 to 900 mg every 6 hours or 900 mg IV every 8 hours or clindamycin hydrochloride 300 to 450 mg orally every 6 hours for 21 days and Primaquine 15 to 30 mg dose orally once daily for 21 days.
(g) Treatment of Acute Streptococcal Tonsillitis/Pharyngitis: Clindamycin hydrochloride capsules 300 mg orally twice daily for 10 days.
(h) Treatment of Malaria: Clindamycin hydrochloride capsules (oral administration): Uncomplicated Malaria/P. falciparum: Adults: Quinine sulfate: 650 mg orally three times daily for 3 or 7 days plus clindamycin: 20 mg base/kg/day orally divided three times daily for 7 days.
Children: Quinine sulfate: 10 mg/kg orally three times daily for 3 or 7 days plus clindamycin: 20 mg base/kg/day orally divided three times daily for 7 days.
Severe Malaria: Adults: Quinidine gluconate: 10 mg/kg loading dose IV over 1-2 hours, then 0.02 mg/kg/min continuous infusion for at least 24 hours (for alternative dosing regimen refer to quinidine label). Once parasite density <1% and patient can take oral medication, complete treatment with oral quinine, dose as previously mentioned, plus clindamycin: 20 mg base/kg/day orally divided three times daily for 7 days. If the patient is not able to take oral medication, give 10 mg base/kg clindamycin loading dose IV followed by 5 mg base/kg IV every 8 hours. Avoid rapid IV administration. Switch to oral clindamycin (oral dose as previously mentioned) as soon as patient can take oral medication. Treatment course = 7 days.
Children: Quinidine gluconate: Same mg/kg dosing and recommendations as for adults plus clindamycin: 20 mg base/kg/day orally divided three times daily for 7 days. If patient not able to take oral medication, give 10 mg base/kg clindamycin loading dose IV followed by 5 mg base/kg IV every 8 hours. Avoid rapid IV administration. Switch to oral clindamycin (oral dose as previously mentioned) as soon as patient can take oral medication. Treatment course = 7 days.
(i) Prophylaxis of Endocarditis in Patients Sensitive to Penicillin: Clindamycin hydrochloride capsules (oral administration): Adults: 600 mg 1 hour before procedure; children: 20 mg/kg 1 hour before procedure. Alternatively, when parenteral administration is required: clindamycin phosphate 600 mg IV 1 hour before procedure.
(j) Prophylaxis of Infection in Head and Neck Surgery: Clindamycin phosphate 900 mg diluted in 1000 mL normal saline for use as an intraoperative irrigant in contaminated head and neck surgery prior to wound closure.
Dilution for IV use and IV infusion rates: The concentration of clindamycin in diluent for infusion should not exceed 18 mg/mL and INFUSION RATES SHOULD NOT EXCEED 30 MG PER MINUTE. The usual infusion rates are as follows: See Table 5.
Click on icon to see table/diagram/imageAdministration of more than 1200 mg in a single 1-hour infusion is not recommended.
