Clindamycin

Clindamycin is indicated in the treatment of serious infections caused by susceptible anaerobic bacteria.

Clindamycin is also indicated in the treatment of serious infections due to susceptible strains of streptococci, pneumococci, and staphylococci. Its use should be reserved for penicillin-allergic patients or other patients for whom, in the judgment of the physician, a penicillin is inappropriate. Because of the risk of colitis, before selecting clindamycin, the physician should consider the nature of the infection and the suitability of less toxic alternatives (e.g., erythromycin).

Clindamycin is available under the following different brand names: Cleocin, Cleocin Pediatric, Clindesse, and ClindaMax Vaginal.

Adult and Pediatric Dosage Forms & Strengths

Capsule

• 75 mg
• 150 mg
• 300 mg

Injectable solution

• 150mg/mL

Oral solution

• 75 mg/5mL

Intravenous solution

• 300 mg/50mL (5% dextrose)
• 600 mg/50mL (5% dextrose)
• 900 mg/50mL (5% dextrose)

Serious Infections Caused by Anaerobic Bacteria

• Adult: 150-450 mg orally every 6-8 hours; not to exceed 1.8 g/day, OR
• 1.2-2.7 g/day intravenously (IV)/intramuscularly (IM) divided every 6-12 hours; not to exceed 4.8 g/day

Pediatric:

Younger than 7 days:

• Less than 2 kg (or older than 7 days, less than 1.2 kg): 10 mg/kg/day IV/IM divided every 12 hours
• Greater than 2 kg (or older than 7 days, 1.2-2 kg): 15 mg/kg/day IV/IM divided every 8 hours

Older than 7 days:

• Greater than 2 kg: 20 mg/kg/day IV/IM divided every 6 hours

Younger than 1 month:

• 15-20 mg/kg/day divided every 6-8 hours

Older than 1 month:

• Hydrochloride: 8-20 mg/kg/day orally
• Palmitate: 8-25 mg/kg/day divided every 6-8 hours; 37.5 mg every 6 hours minimum palmitate dose

• 450-900 mg IV every 8 hours

• Adult: 900 mg IV every 8 hours with ciprofloxacin 400 mg orally every 12 hours or doxycycline 150-300 mg orally every 12 hours
• Pediatric: 15-40 mg/kg/day IV divided every 6-8 hours
• Pediatric: 8-25 mg/kg/day orally divided every 6-8 hours

• 300 mg orally every 12 hours for 7 days

• 900 mg oral/IV 1 hour prior to the procedure; may re-dose every 6 hours if necessary

• 300 mg orally every 6 hours

• 900 mg IV every 8 hours with penicillin G

Neonatal prophylaxis

• 900 mg IV every 8 hours until delivery

May consider use in patients allergic to penicillin (IDSA guidelines)

• Chronic carrier treatment: 20-30 mg/kg/day orally divided every 8 hours; not to exceed 300 mg/dose
• Acute treatment in penicillin-allergic patients: 7 mg/kg/dose three times a day for 10 days; not to exceed 300 mg/dose

Adult:

• 150-450 mg orally every 6 hours for at least 7 days; not to exceed 1.8 g/day, OR
• 600-900 mg IV every 8 hours

Pediatric:

• 10-20 mg/kg/day orally divided every 6-8 hours, OR
• 15-25 mg/kg/day IV divided every 6-8 hours
• May adjust the dose as necessary not to exceed 40 mg/kg/day

• 900 mg IV every 8 hours with gentamicin 2 mg/kg; THEN 1.5 mg/kg every 8 hours; continue after discharge with doxycycline 100 mg orally every 12 hours to complete 14 days of therapy

• 900 mg IV every 8 hours plus oxacillin or nafcillin (2 g IV every 4 hours) or vancomycin (30 mg/kg/day IV divided every 12 hours)

• Adult: 600 mg oral/IV/IM 30-60 min before procedure
• Avoid IM injections in patients receiving anticoagulant therapy; administer orally in these circumstances; in general, administer IV only if the patient does not tolerate or is unable to absorb oral medications

Dosing considerations

• Recent AHA guidelines recommend only for high-risk patients undergoing invasive procedures

Pediatric Prophylaxis

• 20 mg/kg orally 30-60 min before procedure, OR
• 600 mg IV or orally every 6 hours for at least 6 weeks

• 600 mg IV or orally every 6 hours for at least 6 weeks

• PO: 300 mg orally every 12 hours for 7 days

• 30 mg/kg/day divided every 6-8 hours
• 300-450 mg orally every 6-8 hours with primaquine for 21 days
• 600-900 mg IV every 6-8 hours with primaquine for 21 days

• IM: No more than 600 mg per injection

• Oral: May take with food

Common side effects of clindamycin include:

• Abdominal pain
• Agranulocytosis
• Eosinophilia (transient)
• Diarrhea
• Fungal overgrowth
• Pseudomembranous colitis
• Hypersensitivity
• Stevens-Johnson syndrome
• Rashes
• Hives
• Low blood pressure (hypotension)
• Nausea
• Vomiting
• Sterile abscess at intramuscular (IM) injection site
• Blood clot
• Granulocytopenia
• Low white blood cell count (neutropenia)
• Low platelet count (thrombocytopenia)
• Polyarthritis
• Kidney dysfunction

Postmarketing side effects of clindamycin reported include:

• Metallic taste
• Clostridium difficile colitis

This document does not contain all possible side effects and others may occur. Check with your physician for additional information about side effects.

If your doctor has directed you to use this medication for diabetes, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first.

Severe Interactions of clindamycin include:

None.

Serious Interactions of clindamycin include:

• abobotulinumtoxina
• atracurium
• bcg vaccine live
• cholera vaccine
• cisatracurium
• incobotulinumtoxina
• onabotulinumtoxina
• pancuronium
• rapacuronium
• rimabotulinumtoxinb
• rocuronium
• succinylcholine
• tubocurarine
• typhoid vaccine live
• vecuronium

Moderate Interactions of clindamycin include:

• bazedoxifene/conjugated estrogens
• conjugated estrogens
• dienogest/estradiol valerate
• digoxin
• estradiol
• estrogens conjugated synthetic
• estropipate
• ethinylestradiol
• mestranol
• mipomersen
• nitazoxanide
• ospemifene
• sodium picosulfate/magnesium oxide/anhydrous citric acid
• warfarin

Mild Interactions of clindamycin include:

• balsalazide
• biotin
• erythromycin base
• erythromycin ethylsuccinate
• erythromycin lactobionate
• erythromycin stearate
• food
• pantothenic acid
• pyridoxine
• pyridoxine (antidote)
• thiamine

This document does not contain all possible interactions. Therefore, before using this product, tell your doctor or pharmacist of all the products you use. Keep a list of all your medications with you, and share the list with your doctor and pharmacist. Check with your physician if you have health questions or concerns.

Warnings

Clostridium difficile-associated diarrhea (CDAD) has been reported and may range in severity from mild diarrhea to fatal colitis.

C difficile produces toxins A and B, which contribute to CDAD; hypertoxin-producing C difficile strains increase morbidity and mortality (more likely to be refractory to antimicrobial therapy and may require colectomy).

If CDAD suspected or confirmed, ongoing antibiotic use not directed against C difficile may need to be discontinued.

This medication contains clindamycin. Do not take Cleocin, Cleocin Pediatric, Clindesse, or ClindaMax Vaginal if you are allergic to clindamycin or any ingredients contained in this drug.

Keep out of reach of children. In case of overdose, get medical help or contact a Poison Control Center immediately.

Contraindications

Hypersensitivity to clindamycin, lincomycin, or formulation components

Effects of Drug Abuse

None.

Short-Term Effects

See "What Are Side Effects Associated with Using Clindamycin?"

Long-Term Effects

Risk of potentially fatal pseudomembranous colitis, fungal or bacterial superinfection on prolonged use; discontinue therapy if significant abdominal cramps, diarrhea, or passage of blood and mucus occurs.

See "What Are Side Effects Associated with Using Clindamycin?"

Cautions

Endocarditis prophylaxis: Use only for high-risk patients, per recent AHA guidelines.

Risk of potentially fatal pseudomembranous colitis, fungal or bacterial superinfection on prolonged use; discontinue therapy if significant abdominal cramps, diarrhea, or passage of blood and mucus occurs.

May increase risk of drug-resistant bacteria if prescribed in the absence of proven or strongly suspected bacterial infection.

Use caution in hepatic impairment, monitor for hepatic abnormalities; periodic liver enzyme determinations should be made when treating patients with severe liver disease.

Not for use in meningitis due to inadequate penetration into CSF.

Severe skin reactions including toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (DRESS), and Stevens-Johnson syndrome (SJS), some with fatal outcome, reported; permanently discontinue if reactions occur.

Parenteral product contains benzyl alcohol, which has been associated with gasping syndrome and death in newborns.

Use with caution in patients with history of gastrointestinal disease, especially colitis.

Not for administration as a bolus; infuse over 10-60 minutes.

Consider possibility of clostridium difficile in all patients who present with diarrhea following antibiotic use.

Serious anaphylactic reactions require immediate emergency treatment with epinephrine; oxygen and intravenous corticosteroids should also be administered as indicated.

Prescribe with caution in atopic individuals.

Indicated surgical procedures should be performed in conjunction with antibiotic therapy.

Clindamycin dosage modification may not be necessary in patients with renal disease.

Discontinue therapy permanently and institute appropriate therapy if anaphylactic or severe hypersensitivity reaction occurs.

Pregnancy and Lactation

Clindamycin may be acceptable for use during pregnancy. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

In clinical trials with pregnant women, the systemic administration of clindamycin during the second and third trimesters, has not been associated with an increased frequency of congenital abnormalities

Clindamycin is excreted in breast milk; the manufacturer suggests discontinuing the drug or do not nurse (AAP Committee states compatible with nursing).