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  • CLASSES

    Anaerobicides
    Gynecological Antibiotics and Sulfonamides
    Lincosamide Antibiotics
    Topical Antiinfectives for Acne

    BOXED WARNING

    C. difficile-associated diarrhea, Crohn's disease, diarrhea, pseudomembranous colitis, ulcerative colitis

    Clindamycin topical products (topical solution, gel, and lotion) and vaginal (cream, ovules) are contraindicated in patients with a history of regional enteritis (Crohn's disease) or ulcerative colitis, or a history of pseudomembranous colitis; other product preparations warn against use in patients with pseudomembranous colitis. Clindamycin has been associated with severe colitis, more so than some other antimicrobials. Consider pseudomembranous colitis in patients presenting with diarrhea after antibacterial use. Careful medical history is necessary as pseudomembranous colitis has been reported to occur over 2 months after the administration of antibacterial agents. Almost all antibacterial agents, including clindamycin, have been associated with pseudomembranous colitis or C. difficile-associated diarrhea (CDAD) which may range in severity from mild to life-threatening. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile.

    DEA CLASS

    Rx

    DESCRIPTION

    Oral/parenteral/topical/vaginal antibiotic derived from lincomycin
    Commonly used for anaerobic infections; also used for skin and soft tissue infections, osteomyelitis, septic arthritis, pneumonia, and gynecologic infections
    Diarrhea is common with clindamycin, and it has been associated with severe C. difficile colitis

    COMMON BRAND NAMES

    Cleocin, Cleocin Ovules, Cleocin Pediatric, Cleocin T, CLIN, Clinda-Derm, Clindacin ETZ, Clindacin PAC, Clindacin-P, Clindagel, ClindaMax, ClindaReach, Clindesse, Clindets, Evoclin, PledgaClin, XACIATO

    HOW SUPPLIED

    Cleocin Ovules Vaginal Supp: 100mg
    Cleocin Pediatric/Clindamycin/Clindamycin Palmitate Hydrochloride Oral Gran F/Recon: 5mL, 75mg
    Cleocin T/Clindacin ETZ/Clindacin PAC/Clindacin-P/Clindamycin/Clindamycin Phosphate/ClindaReach/Clindets/PledgaClin Topical Swab: 1%
    Cleocin T/Clinda-Derm/Clindamycin/Clindamycin Phosphate Topical Sol: 1%
    Cleocin T/Clindagel/ClindaMax/Clindamycin/Clindamycin Phosphate Topical Gel: 1%
    Cleocin T/ClindaMax/Clindamycin/Clindamycin Phosphate Topical Lotion: 1%
    Cleocin/CLIN/Clindamycin/Clindamycin Phosphate Intramuscular Inj Sol: 1mL, 150mg
    Cleocin/CLIN/Clindamycin/Clindamycin Phosphate/Clindamycin Phosphate, Dextrose/Clindamycin Phosphate, Sodium Chloride/Clindamycin, Dextrose/Clindamycin, Sodium Chloride Intravenous Inj Sol: 1mL, 150mg, 12-0.9%, 12-5%, 18-0.9%, 18-5%, 6-0.9%, 6-5%
    Cleocin/ClindaMax/Clindamycin/Clindamycin Phosphate/Clindesse Vaginal Cream: 2%
    Cleocin/Clindamycin/Clindamycin Hydrochloride Oral Cap: 75mg, 150mg, 300mg
    Clindamycin/Clindamycin Phosphate/Evoclin Topical Foam: 1%
    XACIATO Vaginal Gel: 2%

    DOSAGE & INDICATIONS

    For the treatment of bacteremia and sepsis.
    For the treatment of bacteremia.
    Intravenous dosage
    Adults

    600 to 900 mg IV every 8 to 12 hours. For life-threatening infections, doses up to 4,800 mg/day IV have been used.

    Adolescents 17 years

    600 to 900 mg IV every 8 to 12 hours. For life-threatening infections, doses up to 4,800 mg/day IV have been used in adults. Treat for 7 to 14 days as an alternative option for S. aureus bacteremia.

    Infants, Children, and Adolescents 1 month to 16 years

    40 mg/kg/day (Max: 2,700 mg/day) IV divided every 6 to 8 hours. Treat for 7 to 14 days as an alternative option for S. aureus bacteremia.

    Neonates older than 40 weeks postmenstrual age

    9 mg/kg/dose IV every 8 hours. The FDA-approved dosage is 15 to 20 mg/kg/day IV divided every 6 to 8 hours. Treat for 14 days as an alternative option for S. aureus bacteremia.

    Neonates 33 to 40 weeks postmenstrual age

    7 mg/kg/dose IV every 8 hours. Treat for 14 days as an alternative option for S. aureus bacteremia.

    Neonates 32 weeks postmenstrual age and younger

    5 mg/kg/dose IV every 8 hours. Treat for 14 days as an alternative option for S. aureus bacteremia.

    Oral dosage
    Adults

    150 to 450 mg PO every 6 hours.

    Infants, Children, and Adolescents

    10 to 25 mg/kg/day (Max: 1,800 mg/day) PO divided every 8 hours. The FDA-approved dosage is 8 to 20 mg/kg/day PO for the capsule and 8 to 25 mg/kg/day PO for the solution divided every 6 to 8 hours (Max: 450 mg/dose).

    Neonates older than 40 weeks postmenstrual age

    9 mg/kg/dose PO every 8 hours. The FDA-approved dosage for all pediatric patients, including neonates, is 8 to 25 mg/kg/day PO divided every 6 to 8 hours depending on the severity of infection.[44983]

    Neonates 33 to 40 weeks postmenstrual age

    7 mg/kg/dose PO every 8 hours. The FDA-approved dosage for all pediatric patients, including neonates, is 8 to 25 mg/kg/day PO divided every 6 to 8 hours depending on the severity of infection.

    Neonates 32 weeks postmenstrual age and younger

    5 mg/kg/dose PO every 8 hours. The FDA-approved dosage for all pediatric patients, including neonates, is 8 to 25 mg/kg/day PO divided every 6 to 8 hours depending on the severity of infection.

    For the treatment of sepsis.
    Intravenous dosage
    Adults

    600 to 900 mg IV every 8 hours. For life-threatening infections, doses up to 4,800 mg/day IV have been used. Start within 1 hour for septic shock or within 3 hours for possible sepsis without shock. Duration of therapy is not well-defined and dependent on patient- and infection-specific factors. Assess patient daily for deescalation of antimicrobial therapy based on pathogen identification and/or adequate clinical response.

    Adolescents 17 years

    600 to 900 mg IV every 8 hours. For life-threatening infections, doses up to 4,800 mg/day IV have been used in adults. Start within 1 hour for septic shock or within 3 hours for sepsis-associated organ dysfunction without shock. Duration of therapy is not well-defined and dependent on patient- and infection-specific factors. Assess patient daily for deescalation of antimicrobial therapy based on pathogen identification and/or adequate clinical response.

    Infants, Children, and Adolescents 1 month to 16 years

    40 mg/kg/day (Max: 2,700 mg/day) IV divided every 6 to 8 hours. Start within 1 hour for septic shock or within 3 hours for sepsis-associated organ dysfunction without shock. Duration of therapy is not well-defined and dependent on patient- and infection-specific factors. Assess patient daily for deescalation of antimicrobial therapy based on pathogen identification and/or adequate clinical response.

    Neonates older than 40 weeks postmenstrual age

    9 mg/kg/dose IV every 8 hours. The FDA-approved dosage is 15 to 20 mg/kg/day IV divided every 6 to 8 hours. Start within 1 hour for septic shock or within 3 hours for sepsis-associated organ dysfunction without shock. Duration of therapy is not well-defined and dependent on patient- and infection-specific factors. Assess patient daily for deescalation of antimicrobial therapy based on pathogen identification and/or adequate clinical response. Neonates younger than 37 weeks gestational age were excluded from guideline scope.

    Neonates 33 to 40 weeks postmenstrual age

    7 mg/kg/dose IV every 8 hours. Start within 1 hour for septic shock or within 3 hours for sepsis-associated organ dysfunction without shock. Duration of therapy is not well-defined and dependent on patient- and infection-specific factors. Assess patient daily for deescalation of antimicrobial therapy based on pathogen identification and/or adequate clinical response. Neonates younger than 37 weeks gestational age were excluded from guideline scope.

    Neonates 32 weeks postmenstrual age and younger

    5 mg/kg/dose IV every 8 hours.

    For the treatment of lower respiratory tract infections (LRTIs), including anaerobic pneumonia, aspiration pneumonia, community-acquired pneumonia (CAP), lung abscess, and pleural empyema.
    For the treatment of nonspecific lower respiratory tract infections (LRTIs), anaerobic pneumonia, aspiration pneumonia, lung abscess, and pleural empyema.
    Oral dosage
    Adults

    150 to 450 mg PO every 6 hours.[44982] Guidelines recommend clindamycin in combination with a second- or third-generation cephalosporin an alternative therapy for community-acquired empyema. Treat for at least 2 weeks after drainage and defervescence.[61949]

    Infants, Children, and Adolescents

    10 to 40 mg/kg/day PO divided every 6 to 8 hours (Max: 1,800 mg/day) is recommended by the American Academy of Pediatrics (AAP).[63245] The FDA-approved dose is 8 to 25 mg/kg/day divided every 6 to 8 hours (Max: 450 mg/dose).[44982] [44983]

    Neonates older than 40 weeks postmenstrual age

    9 mg/kg/dose PO every 8 hours is recommended by the American Academy of Pediatrics (AAP).[63245] The FDA-approved dose is 8 to 25 mg/kg/day PO divided every 6 to 8 hours.[44983]

    Neonates 33 to 40 weeks postmenstrual age

    7 mg/kg/dose PO every 8 hours is recommended by the American Academy of Pediatrics (AAP). The FDA-approved dose is 8 to 25 mg/kg/day PO divided every 6 to 8 hours.

    Neonates 32 weeks postmenstrual age and younger

    5 mg/kg/dose PO every 8 hours is recommended by the American Academy of Pediatrics (AAP). The FDA-approved dose is 8 to 25 mg/kg/day PO divided every 6 to 8 hours.

    Intravenous or Intramuscular dosage
    Adults

    300 mg IV or IM every 6 to 12 hours for less severe infections and 600 mg IV or IM every 6 to 12 hours to 900 mg IV every 8 to 12 hours for severe infections. May further increase dose for life-threatening infections; doses up to 4,800 mg/day IV have been used.[29120] Guidelines recommend clindamycin in combination with a second- or third-generation cephalosporin an alternative therapy for community-acquired empyema. Treat for at least 2 weeks after drainage and defervescence.[61949]

    Adolescents 17 years

    300 mg IV or IM every 6 to 12 hours for less severe infections and 600 mg IV or IM every 6 to 12 hours to 900 mg IV every 8 to 12 hours for severe infections. May further increase dose for life-threatening infections; doses up to 4,800 mg/day IV have been used.

    Infants, Children, and Adolescents 13 to 16 years

    20 to 40 mg/kg/day IV or IM divided every 6 to 8 hours (Max: 2,700 mg/day).[29120] [63245]

    Neonates older than 40 weeks postmenstrual age

    9 mg/kg/dose IV every 8 hours is recommended by the American Academy of Pediatrics (AAP).[63245] The FDA-approved dose is 15 to 20 mg/kg/day IV or IM divided every 6 to 8 hours noting that the lower dose may be adequate for premature neonates of low birth weight.[29120]

    Neonates 33 to 40 weeks postmenstrual age

    7 mg/kg/dose IV every 8 hours is recommended by the American Academy of Pediatrics (AAP).[63245] The FDA-approved dose is 15 to 20 mg/kg/day IV or IM divided every 6 to 8 hours noting that the lower dose may be adequate for premature neonates of low birth weight.[29120]

    Neonates 32 weeks postmenstrual age and younger

    5 mg/kg/dose IV every 8 hours is recommended by the American Academy of Pediatrics (AAP). The FDA-approved dose is 15 to 20 mg/kg/day IV or IM divided every 6 to 8 hours noting that the lower dose may be adequate for premature neonates of low birth weight.

    For the treatment of methicillin-resistant S. aureus pneumonia.
    Oral dosage
    Adults

    600 mg PO every 8 hours for 7 to 21 days.[46693]

    Infants, Children, and Adolescents

    30 to 40 mg/kg/day PO divided every 6 to 8 hours (Max: 1,800 mg/day) for 7 to 21 days.[46693] [63245] Guidelines recommend clindamycin as empirical therapy if the patient is stable without ongoing bacteremia and local clindamycin resistance rates are low (less than 10%).[46693]

    Intravenous dosage
    Adults

    600 mg IV every 8 hours for 7 to 21 days.[46693]

    Infants, Children, and Adolescents

    30 to 40 mg/kg/day IV divided every 6 to 8 hours (Max: 1,800 mg/day) for 7 to 21 days.[46693] [63245] Guidelines recommend clindamycin as empirical therapy if the patient is stable without ongoing bacteremia and local clindamycin resistance rates are low (less than 10%).[46693]

    For the treatment of community-acquired pneumonia (CAP).
    Oral dosage
    Adults

    600 mg PO every 8 hours for at least 5 days. [46693] Guidelines recommend clindamycin as part of combination therapy in addition to vancomycin for hospitalized HIV-infected patients at risk for MRSA who have severe necrotizing disease. This therapy is not routinely recommended.

    Adolescents

    40 mg/kg/day PO divided every 6 to 8 hours (Max: 1,800 mg/day) for at least 5 days. [46963] [63245] Guidelines recommend clindamycin for susceptible strains of MRSA, as an alternative for MSSA, penicillin-resistant S. pneumoniae, and S. pyogenes (group A beta-hemolytic streptococci), and although not routinely recommended, as part of combination therapy in addition to vancomycin for hospitalized HIV-infected patients at risk for MRSA who have severe necrotizing disease. [46963]

    Infants 4 to 11 months and Children

    40 mg/kg/day PO divided every 6 to 8 hours (Max: 1,800 mg/day) for 10 days. Guidelines recommend clindamycin for susceptible strains of MRSA, as an alternative for MSSA, penicillin-resistant S. pneumoniae, and S. pyogenes (group A beta-hemolytic streptococci).[46963]

    Intravenous dosage
    Adults

    600 mg IV every 8 hours for at least 5 days. [46693] Guidelines recommend clindamycin as part of combination therapy in addition to vancomycin for hospitalized HIV-infected patients at risk for MRSA who have severe necrotizing disease. This therapy is not routinely recommended.

    Adolescents

    40 mg/kg/day IV divided every 6 to 8 hours (Max: 1,800 mg/day) for 10 days. [46963] [63245] Guidelines recommend clindamycin for susceptible strains of MRSA, as an alternative for MSSA, penicillin-resistant S. pneumoniae, and S. pyogenes (group A beta-hemolytic streptococci), and although not routinely recommended, as part of combination therapy in addition to vancomycin for hospitalized HIV-infected patients at risk for MRSA who have severe necrotizing disease. [46963]

    Infants 4 to 11 months and Children

    40 mg/kg/day IV divided every 6 to 8 hours (Max: 1,800 mg/day) for 10 days. Guidelines recommend clindamycin for susceptible strains of MRSA, as an alternative for MSSA, penicillin-resistant S. pneumoniae, and S. pyogenes (group A beta-hemolytic streptococci).[46963]

    For the treatment of skin and skin structure infections, including impetigo, cellulitis, erysipelas, skin abscesses, furunculosis, carbuncle, necrotizing infections such as gas gangrene, animal bite wounds, diabetic foot ulcer, and infectious neonatal pustulosis.
    For the treatment of impetigo.
    Oral dosage
    Adults

    300 to 450 mg PO every 6 hours for 5 to 7 days.

    Infants, Children, and Adolescents

    20 mg/kg/day PO divided every 8 hours (Max: 1,800 mg/day) for 5 to 7 days.

    Neonates older than 40 weeks postmenstrual age

    9 mg/kg/dose PO every 8 hours for 5 to 7 days. The FDA-approved dose is 8 to 25 mg/kg/day PO divided every 6 to 8 hours depending on the severity of infection.

    Neonates 33 to 40 weeks postmenstrual age

    7 mg/kg/dose PO every 8 hours for 5 to 7 days.

    Neonates 32 weeks postmenstrual age and younger

    5 mg/kg/dose PO every 8 hours for 5 to 7 days.

    For the treatment of necrotizing infections of the skin, fascia, and muscle (i.e., gas gangrene).
    Intravenous dosage
    Adults

    600 to 900 mg IV every 8 hours until further debridement is not necessary, the patient has improved clinically, and fever has been absent for 48 to 72 hours. Clindamycin is used as a single agent for S. aureus and in combination with penicillin for streptococcal infections (including toxic shock) or clostridial infections (including gas gangrene). Clindamycin may also be considered empirically as part of combination broad spectrum therapy for mixed infections.

    Infants, Children, and Adolescents

    30 to 40 mg/kg/day IV divided every 8 hours (Max: 2,700 mg/day) until further debridement is not necessary, the patient has improved clinically, and fever has been absent for 48 to 72 hours. Clindamycin is used as a single agent for S. aureus and in combination with penicillin for streptococcal infections (including toxic shock) or clostridial infections (including gas gangrene). Clindamycin may also be considered empirically as part of combination broad spectrum therapy for mixed infections.

    Neonates older than 40 weeks postmenstrual age

    9 mg/kg/dose IV every 8 hours until further debridement is not necessary, the patient has improved clinically, and fever has been absent for 48 to 72 hours. Clindamycin is used as a single agent for S. aureus and in combination with penicillin for streptococcal infections (including toxic shock) or clostridial infections (including gas gangrene). Clindamycin may also be considered empirically as part of combination broad spectrum therapy for mixed infections.

    Neonates 33 to 40 weeks postmenstrual age

    7 mg/kg/dose IV every 8 hours until further debridement is not necessary, the patient has improved clinically, and fever has been absent for 48 to 72 hours. Clindamycin is used as a single agent for S. aureus and in combination with penicillin for streptococcal infections (including toxic shock) or clostridial infections (including gas gangrene). Clindamycin may also be considered empirically as part of combination broad spectrum therapy for mixed infections.

    Neonates 32 weeks postmenstrual age and younger

    5 mg/kg/dose IV every 8 hours until further debridement is not necessary, the patient has improved clinically, and fever has been absent for 48 to 72 hours. Clindamycin is used as a single agent for S. aureus and in combination with penicillin for streptococcal infections (including toxic shock) or clostridial infections (including gas gangrene). Clindamycin may also be considered empirically as part of combination broad spectrum therapy for mixed infections.

    For the treatment of animal bite wounds.
    Oral dosage
    Adults

    300 mg PO every 8 hours. In setting of a cat or dog bite, preemptive early antimicrobial therapy for 3 to 5 days is recommended for patients who are immunocompromised, asplenic, have advanced liver disease, have edema of the bite area, have moderate to severe injuries, particularly of the hand or face, or have penetrating injuries to the periosteum or joint capsule.

    Intravenous dosage
    Adults

    600 mg IV every 6 to 8 hours. In setting of a cat or dog bite, preemptive early antimicrobial therapy for 3 to 5 days is recommended for patients who are immunocompromised, asplenic, have advanced liver disease, have edema of the bite area, have moderate to severe injuries, particularly of the hand or face, or have penetrating injuries to the periosteum or joint capsule.

    For the treatment of diabetic foot ulcer.
    Oral dosage
    Adults

    150 to 450 mg PO every 6 hours for 7 to 14 days for mild infections due to methicillin-resistant S. aureus or other staphylococci in patients allergic or intolerant to beta-lactams or moderate or severe infections including ischemic limb/necrosis/gas forming. Continue treatment for up to 28 days if infection is improving but is extensive and resolving slower than expected or if patient has severe peripheral artery disease.

    Intravenous or Intramuscular dosage
    Adults

    600 mg IV or IM every 8 hours to 900 mg IV every 8 hours for 7 to 14 days for mild infections due to methicillin-resistant S. aureus or other staphylococci in patients allergic or intolerant to beta-lactams or moderate or severe infections including ischemic limb/necrosis/gas forming. Continue treatment for up to 28 days if infection is improving but is extensive and resolving slower than expected or if patient has severe peripheral artery disease.

    For the treatment of nonpurulent skin infections, such as cellulitis and erysipelas.
    Oral dosage
    Adults

    300 to 450 mg PO every 6 hours for 5 to 14 days.

    Infants, Children, and Adolescents

    25 to 40 mg/kg/day PO divided every 6 to 8 hours (Max: 1,800 mg/day) for 5 to 14 days.

    Neonates older than 40 weeks postmenstrual age

    9 mg/kg/dose PO every 8 hours for 5 to 14 days. The FDA-approved dose is 8 to 25 mg/kg/day PO divided every 6 to 8 hours depending on the severity of infection.

    Neonates 33 to 40 weeks postmenstrual age

    7 mg/kg/dose PO every 8 hours for 5 to 14 days.

    Neonates 32 weeks postmenstrual age and younger

    5 mg/kg/dose PO every 8 hours for 5 to 14 days.

    Intravenous or Intramuscular dosage
    Adults

    600 mg IV or IM every 8 hours to 900 mg IV every 8 hours for 5 to 14 days.

    Infants, Children, and Adolescents

    20 to 40 mg/kg/day IV or IM divided every 6 to 8 hours (Max: 2,700 mg/day) for 5 to 14 days.

    Neonates older than 40 weeks postmenstrual age

    9 mg/kg/dose IV every 8 hours for 5 to 14 days. The FDA-approved dose is 15 to 20 mg/kg/day IV or IM divided every 6 to 8 hours.

    Neonates 33 to 40 weeks postmenstrual age

    7 mg/kg/dose IV every 8 hours for 5 to 14 days.

    Neonates 32 weeks postmenstrual age and younger

    5 mg/kg/dose IV every 8 hours for 5 to 14 days.

    For the treatment of purulent skin infections, such as furunculosis, carbuncle, and skin abscesses.
    Oral dosage
    Adults

    300 to 450 mg PO every 6 hours for 5 to 10 days plus incision and drainage.

    Infants, Children, and Adolescents

    25 to 40 mg/kg/day PO divided every 6 to 8 hours (Max: 1,800 mg/day) for 5 to 10 days plus incision and drainage.

    Neonates older than 40 weeks postmenstrual age

    9 mg/kg/dose PO every 8 hours for 5 to 10 days plus incision and drainage. The FDA-approved dose is 8 to 25 mg/kg/day PO divided every 6 to 8 hours depending on the severity of infection.

    Neonates 33 to 40 weeks postmenstrual age

    7 mg/kg/dose PO every 8 hours for 5 to 10 days plus incision and drainage.

    Neonates 32 weeks postmenstrual age and younger

    5 mg/kg/dose PO every 8 hours for 5 to 10 days plus incision and drainage.

    Intravenous or Intramuscular dosage
    Adults

    600 mg IV or IM every 8 hours to 900 mg IV every 8 hours for 5 to 10 days plus incision and drainage.

    Infants, Children, and Adolescents

    20 to 40 mg/kg/day IV or IM divided every 6 to 8 hours (Max: 2,700 mg/day) for 5 to 10 days plus incision and drainage.

    Neonates older than 40 weeks postmenstrual age

    9 mg/kg/dose IV every 8 hours for 5 to 10 days plus incision and drainage. The FDA-approved dose is 15 to 20 mg/kg/day IV or IM divided every 6 to 8 hours.

    Neonates 33 to 40 weeks postmenstrual age

    7 mg/kg/dose IV every 8 hours for 5 to 10 days plus incision and drainage.

    Neonates 32 weeks postmenstrual age and younger

    5 mg/kg/dose IV every 8 hours for 5 to 10 days plus incision and drainage.

    For the treatment of infectious neonatal pustulosis.
    Intravenous dosage
    Neonates older than 40 weeks postmenstrual age

    9 mg/kg/dose IV every 8 hours. Initial treatment with clindamycin is recommended as a treatment option for premature or very low birthweight neonates or for more extensive disease involving multiple sites in term neonates until bacteremia is excluded.

    Neonates 33 to 40 weeks postmenstrual age

    7 mg/kg/dose IV every 8 hours. Initial treatment with clindamycin is recommended as a treatment option for premature or very low birthweight neonates or for more extensive disease involving multiple sites in term neonates until bacteremia is excluded.

    Neonates 32 weeks postmenstrual age and younger

    5 mg/kg/dose IV every 8 hours. Initial treatment with clindamycin is recommended as a treatment option for premature or very low birthweight neonates until bacteremia is excluded.

    For the treatment of gynecologic infections, including endometritis, pelvic cellulitis, postsurgical vaginal cuff infections, and pelvic inflammatory disease (PID), with or without associated tubo-ovarian abscess.
    For the treatment of acute PID, with or without associated tubo-ovarian abscess.
    Intravenous dosage
    Adults

    900 mg IV every 8 hours in combination with gentamicin as an alternative. IV therapy should be continued for at least 24 to 48 hours after clinical improvement, and then stepdown to oral clindamycin or doxycycline for total of 14 days of therapy. When tubo-ovarian abscess is present, oral clindamycin or metronidazole plus doxycycline should be used for a total of 14 days of therapy.

    Adolescents

    900 mg IV every 8 hours in combination with gentamicin as an alternative. IV therapy should be continued for at least 24 to 48 hours after clinical improvement, and then stepdown to oral clindamycin or doxycycline for total of 14 days of therapy. When tubo-ovarian abscess is present, oral clindamycin or metronidazole plus doxycycline should be used for a total of 14 days of therapy.

    Oral dosage
    Adults

    450 mg PO 4 times daily to complete a total of 14 days after IV therapy. When tubo-ovarian abscess is present, add doxycycline.

    Adolescents

    450 mg PO 4 times daily to complete a total of 14 days after IV therapy. When tubo-ovarian abscess is present, add doxycycline.

    For the general treatment of gynecologic infections.
    Intravenous or Intramuscular dosage
    Adults

    600 mg IV or IM every 6 to 8 hours up to 900 mg IV every 8 hours. The FDA-approved dosage is 300 mg IV or IM every 6 to 12 hours for less severe infections and 600 mg IV or IM every 6 to 12 hours to 900 mg IV every 8 to 12 hours for severe infections. For life-threatening infections, doses may be increased; doses up to 4,800 mg/day IV have been used.

    Adolescents 17 years

    600 mg IV or IM every 6 to 8 hours up to 900 mg IV every 8 hours. The FDA-approved dosage is 300 mg IV or IM every 6 to 12 hours for less severe infections and 600 mg IV or IM every 6 to 12 hours to 900 mg IV every 8 to 12 hours for severe infections. For life-threatening infections, doses may be increased; doses up to 4,800 mg/day IV have been used.

    Adolescents 13 to 16 years

    20 to 40 mg/kg/day (Max: 2,700 mg/day) IV or IM divided every 6 to 8 hours.

    Oral dosage
    Adults

    150 to 450 mg PO every 6 hours.

    Adolescents

    8 to 25 mg/kg/day PO divided every 6 to 8 hours (Max: 450 mg/dose).

    For the treatment of bacterial vaginosis.
    Intravaginal dosage (cream - Clindesse)
    Adults

    1 applicatorful (100 mg clindamycin/5 g cream) intravaginally as a single dose at any time of the day.

    Adolescents (post-menarchal)

    1 applicatorful (100 mg clindamycin/5 g cream) intravaginally as a single dose at any time of the day.

    Intravaginal dosage (cream - standard formulations)
    Adults

    1 applicatorful (100 mg clindamycin/5 g cream) intravaginally at bedtime for 7 days. The FDA-approved dosage for most products is 1 applicatorful (100 mg clindamycin/5 g cream) intravaginally at bedtime for 3 or 7 consecutive days in nonpregnant patients and for 7 days in pregnant patients.

    Adolescents†

    1 applicatorful (100 mg clindamycin/5 g cream) intravaginally at bedtime for 7 days.

    Intravaginal dosage (ovules/suppositories)
    Adults

    1 ovule (100 mg clindamycin) inserted intravaginally at bedtime for 3 days as an alternative.

    Adolescents (post-menarchal)

    1 ovule (100 mg clindamycin) inserted intravaginally at bedtime for 3 days as an alternative.

    Intravaginal dosage (gel)
    Adults

    1 applicatorful (100 mg clindamycin/5 g gel) intravaginally as a single dose at any time of the day.

    Children and Adolescents 12 to 17 years

    1 applicatorful (100 mg clindamycin/5 g cream) intravaginally as a single dose at any time of the day.

    Oral dosage†
    Adults

    300 mg PO twice daily for 7 days as an alternative.

    Adolescents

    300 mg PO twice daily for 7 days as an alternative.

    For the treatment of acne vulgaris.
    Topical dosage (gel, lotion, or solution)
    Adults

    Apply a thin film of 1% topical gel, lotion, or solution to affected areas twice daily.

    Children and Adolescents 12 to 17 years

    Apply a thin film of 1% topical gel, lotion, or solution to affected areas twice daily. Improvement is usually seen after 6 weeks, but may require 8 to 12 weeks of topical application. Due to a slow onset of action and the increased risk of the development of bacterial resistance, topical antibiotic monotherapy is not recommended. If topical antibiotic therapy is continued longer than a few weeks, the addition of topical benzoyl peroxide is recommended.

    Topical dosage (foam)
    Adults

    Apply 1% topical foam to affected areas once daily. If there is no improvement after 6 to 8 weeks, or if the condition worsens, discontinue treatment.

    Children and Adolescents 12 to 17 years

    Apply 1% topical foam to affected areas once daily. If there is no improvement after 6 to 8 weeks, or if the condition worsens, discontinue treatment. Due to a slow onset of action and the increased risk of the development of bacterial resistance, topical antibiotic monotherapy is not recommended. If topical antibiotic therapy is continued longer than a few weeks, the addition of topical benzoyl peroxide is recommended.

    Topical dosage (medicated pledgets)
    Adults

    Use a pledget to apply a thin film to the affected area twice daily. More than 1 pledget may be used; however, each pledget should be used only once then discarded.

    Children and Adolescents 12 to 17 years

    Use a pledget to apply a thin film to the affected area twice daily. More than 1 pledget may be used; however, each pledget should be used only once then discarded. Due to a slow onset of action and the increased risk of the development of bacterial resistance, topical antibiotic monotherapy is not recommended. If topical antibiotic therapy is continued longer than a few weeks, the addition of topical benzoyl peroxide is recommended.

    For the treatment of mastitis.
    Oral dosage
    Adults

    300 to 450 mg PO every 6 hours for 10 to 14 days.

    For the treatment of intraabdominal infections, including peritonitis, appendicitis, intraabdominal abscess, neonatal necrotizing enterocolitis, peritoneal dialysis-related peritonitis†, and peritoneal dialysis catheter-related infection†.
    For the treatment of peritoneal dialysis-related peritonitis†.
    Continuous Intraperitoneal dosage†
    Adults

    600 mg/L in each dialysate exchange. Treat for 21 days.

    Infants, Children, and Adolescents

    300 mg/L intraperitoneal loading dose, followed by 150 mg/L in each dialysate exchange. Treat for 14 to 21 days.

    For the general treatment of intraabdominal infections.
    Oral dosage
    Adults

    150 to 450 mg PO every 6 hours.

    Infants, Children, and Adolescents

    8 to 25 mg/kg/day (Max: 1,800 mg/day) PO divided every 6 to 8 hours.

    Neonates older than 40 weeks postmenstrual age

    9 mg/kg/dose PO every 8 hours. The FDA-approved dosage for all pediatric patients, including neonates, is 8 to 25 mg/kg/day PO divided every 6 to 8 hours depending on the severity of infection.[44983]

    Neonates 33 to 40 weeks postmenstrual age

    7 mg/kg/dose PO every 8 hours. The FDA-approved dosage for all pediatric patients, including neonates, is 8 to 25 mg/kg/day PO divided every 6 to 8 hours depending on the severity of infection.[44983]

    Neonates 32 weeks postmenstrual age and younger

    5 mg/kg/dose PO every 8 hours. The FDA-approved dosage for all pediatric patients, including neonates, is 8 to 25 mg/kg/day PO divided every 6 to 8 hours depending on the severity of infection.[44983]

    Intravenous or Intramuscular dosage
    Adults

    300 mg IV or IM every 6 to 12 hours for less severe infections and 600 mg IV or IM every 6 to 12 hours to 900 mg IV every 8 to 12 hours for severe infections. For life-threatening infections, doses may be increased; doses up to 4,800 mg/day IV have been used.[29120]

    Adolescents 17 years

    300 mg IV or IM every 6 to 12 hours for less severe infections and 600 mg IV or IM every 6 to 12 hours to 900 mg IV every 8 to 12 hours for severe infections. For life-threatening infections, doses may be increased; doses up to 4,800 mg/day IV have been used in adults.[29120] Dosing intervals of every 6 or 8 hours are most commonly used in pediatric practice.

    Infants, Children, and Adolescents 1 month to 16 years

    20 to 40 mg/kg/day (Max: 2,700 mg/day) IV or IM divided every 6 to 8 hours.

    Neonates older than 40 weeks postmenstrual age

    9 mg/kg/dose IV every 8 hours. The FDA-approved dosage is 15 to 20 mg/kg/day IV or IM divided every 6 to 8 hours.

    Neonates 33 to 40 weeks postmenstrual age

    7 mg/kg/dose IV every 8 hours.

    Neonates 32 weeks postmenstrual age and younger

    5 mg/kg/dose IV every 8 hours.

    For the treatment of complicated intraabdominal infections with adequate source control.
    Intravenous dosage
    Adults

    600 to 900 mg IV every 6 to 12 hours as part of combination therapy for 3 to 7 days. Complicated infections include peritonitis and appendicitis complicated by rupture, and intraabdominal abscess.

    Infants, Children, and Adolescents

    20 to 40 mg/kg/day (Max: 2,700 mg/day) IV divided every 6 to 8 hours as part of combination therapy for 3 to 7 days. Complicated infections include peritonitis and appendicitis complicated by rupture, and intraabdominal abscess.

    Neonates older than 40 weeks postmenstrual age

    9 mg/kg/dose IV every 8 hours as part of combination therapy for 7 to 10 days. Clindamycin is an option for necrotizing enterocolitis.

    Neonates 33 to 40 weeks postmenstrual age

    7 mg/kg/dose IV every 8 hours as part of combination therapy for 7 to 10 day. Clindamycin is an option for necrotizing enterocolitis.

    Neonates 32 weeks postmenstrual age and younger

    5 mg/kg/dose IV every 8 hours as part of combination therapy for 7 to 10 day. Clindamycin is an option for necrotizing enterocolitis.

    For the treatment of peritoneal dialysis catheter-related infection†.
    Oral dosage
    Adults

    300 to 450 mg PO every 8 hours for at least 14 days.

    Infants, Children, and Adolescents

    30 mg/kg/day (Max: 1,800 mg/day) PO divided every 8 hours for at least 14 to 28 days.

    For the treatment of bone and joint infections, including osteomyelitis and septic/infectious arthritis, or an orthopedic device-related infection†.
    For the treatment of methicillin-resistant Staphylococcus aureus-associated prosthetic joint infections†.
    Intravenous dosage
    Adults

    600 mg IV every 8 hours plus rifampin for 2 weeks in patients with early-onset (less than 2 months after surgery) or acute hematogenous prosthetic joint infections involving a stable implant with short duration (3 weeks or less) of symptoms and debridement (but device retention). Continue with oral combination therapy after the completion of IV therapy for 3 months for hip infections or for 6 months for knee infections.

    Oral dosage
    Adults

    600 mg PO every 8 hours plus rifampin starting after the completion of IV therapy and continuing for 3 months for hip infections or for 6 months for knee infections.

    For the treatment of methicillin-resistant Staphylococcus aureus-associated spinal implant infections†.
    Intravenous dosage
    Adults

    600 mg IV every 8 hours plus rifampin in patients with early-onset spinal implant infections (30 days or less after surgery) or for implants in an actively infected site. Follow IV therapy with prolonged oral therapy; however, the optimal duration of therapy is unclear.

    Oral dosage
    Adults

    600 mg PO every 8 hours with or without rifampin as prolonged oral therapy starting after the completion of IV therapy; the optimal duration of therapy is unclear. Continue oral therapy until spine fusion has occurred. Long term oral suppressive therapy (including clindamycin) may be considered in select cases, especially if device removal is not possible.

    Intravenous or Intramuscular dosage
    Adults

    300 mg IV or IM every 6 to 12 hours for less severe infections and 600 mg IV or IM every 6 to 12 hours to 900 mg IV every 8 to 12 hours for severe infections. For life-threatening infections, doses may be increased; doses up to 4,800 mg/day IV have been used. For MRSA infections, the Infectious Diseases Society of America (IDSA) recommends 600 mg IV every 8 hours. Treat for 3 to 4 weeks for septic arthritis. For osteomyelitis, rifampin may be added; however, in patients with concurrent bacteremia, add rifampin after the clearance of the bacteremia. Treat for at least 8 weeks for osteomyelitis; an additional 1 to 3 months (or longer for chronic infection or if no debridement performed) of oral combination therapy may be necessary.

    Adolescents 17 years

    300 mg IV or IM every 6 to 12 hours for less severe infections and 600 mg IV or IM every 6 to 12 hours to 900 mg IV every 8 to 12 hours for severe infections. For life-threatening infections, doses may be increased; doses up to 4,800 mg/day IV have been used in adults. Dosing intervals of every 6 or 8 hours are most commonly used in pediatric practice. As an alternative to vancomycin for MRSA infections, the Infectious Diseases Society of America (IDSA) recommends 600 mg IV every 8 hours for 3 to 4 weeks for septic arthritis and for 4 to 6 weeks for osteomyelitis.

    Infants, Children, and Adolescents 13 to 16 years

    20 to 40 mg/kg/day IV or IM divided every 6 to 8 hours (Max: 2,700 mg/day); use the upper end of the dosage range for more severe infections.[29120] [63245] As an alternative to vancomycin for MRSA infections, the Infectious Diseases Society of America (IDSA) recommends 30 to 40 mg/kg/day IV (10 to 13 mg/kg/dose every 6 to 8 hours; Max: 1,800 mg/day) for 3 to 4 weeks for septic arthritis and for 4 to 6 weeks for osteomyelitis.[46693]

    Neonates older than 40 weeks postmenstrual age

    9 mg/kg/dose IV every 8 hours is recommended by the American Academy of Pediatrics (AAP).The FDA-approved labeling recommends 15 to 20 mg/kg/dose IV or IM divided every 6 to 8 hours. Duration of therapy must be individualized; the minimum duration recommended for pediatric patients with MRSA infections is 3 to 4 weeks for septic arthritis and 4 to 6 weeks for osteomyelitis.

    Neonates 33 to 40 weeks postmenstrual age

    7 mg/kg/dose IV every 8 hours is recommended by the American Academy of Pediatrics (AAP).The FDA-approved labeling recommends 15 to 20 mg/kg/dose IV or IM divided every 6 to 8 hours and states that the lower dose may be adequate for premature neonates of low birthweight. Duration of therapy must be individualized; the minimum duration recommended for pediatric patients with MRSA infections is 3 to 4 weeks for septic arthritis and 4 to 6 weeks for osteomyelitis.

    Neonates 32 weeks postmenstrual age and younger

    5 mg/kg/dose IV every 8 hours is recommended by the American Academy of Pediatrics (AAP).The FDA-approved labeling recommends 15 to 20 mg/kg/dose IV or IM divided every 6 to 8 hours and states that the lower dose may be adequate for premature neonates of low birthweight. Duration of therapy must be individualized; the minimum duration recommended for pediatric patients with MRSA infections is 3 to 4 weeks for septic arthritis and 4 to 6 weeks for osteomyelitis.

    Oral dosage†
    Adults

    600 mg PO every 8 hours is recommended for MRSA infections by the Infectious Diseases Society of America (IDSA). Treat for 3 to 4 weeks for septic arthritis. For osteomyelitis, rifampin may be added; however, in patients with concurrent bacteremia, add rifampin after the clearance of the bacteremia. Treat for at least 8 weeks for osteomyelitis; an additional 1 to 3 months (or longer for chronic infection or if no debridement performed) of oral combination therapy may be necessary.

    Adolescents 17 years

    600 mg PO every 8 hours is recommended as an alternative to vancomycin for MRSA infections by the Infectious Diseases Society of America (IDSA). Treat for 3 to 4 weeks for septic arthritis and for 4 to 6 weeks for osteomyelitis.

    Infants, Children, and Adolescents 13 to 16 years

    30 to 40 mg/kg/day PO (10 to 13 mg/kg/dose every 6 to 8 hours; Max: 1,800 mg/day) is recommended as an alternative to vancomycin for MRSA infections by the Infectious Diseases Society of America (IDSA). Treat for 3 to 4 weeks for septic arthritis and for 4 to 6 weeks for osteomyelitis.

    Neonates older than 40 weeks postmenstrual age

    9 mg/kg/dose PO every 8 hours. Duration of therapy must be individualized; the minimum duration recommended for pediatric patients with MRSA infections is 3 to 4 weeks for septic arthritis and 4 to 6 weeks for osteomyelitis.

    Neonates 33 to 40 weeks postmenstrual age

    7 mg/kg/dose PO every 8 hours. Duration of therapy must be individualized; the minimum duration recommended for pediatric patients with MRSA infections is 3 to 4 weeks for septic arthritis and 4 to 6 weeks for osteomyelitis.

    Neonates 32 weeks postmenstrual age and younger

    5 mg/kg/dose PO every 8 hours. Duration of therapy must be individualized; the minimum duration recommended for pediatric patients with MRSA infections is 3 to 4 weeks for septic arthritis and 4 to 6 weeks for osteomyelitis.

    For the treatment of acute otitis media†.
    Oral dosage
    Infants and Children 6 months and older

    30 to 40 mg/kg/day PO divided every 8 hours (Max: 1,800 mg/day) with or without a third-generation cephalosporin for 10 days as an alternative in patients who have failed initial antibiotic therapy. Use in combination with a third-generation cephalosporin after failure of a second antibiotic.

    For the treatment of acute bacterial sinusitis†.
    Oral dosage
    Adults

    300 mg PO 3 times daily plus cefixime or cefpodoxime for 5 to 10 days. Combination therapy with clindamycin and a third-generation cephalosporin is recommended as second-line therapy for patients with penicillin allergy or those from areas with high endemic rates of penicillin-sensitive S. pneumoniae. However, increased resistance has been reported among S. pneumoniae serotype 19A isolates, in which case a fluoroquinolone is recommended as an alternative. 

    Infants, Children, and Adolescents

    30 to 40 mg/kg/day PO divided every 8 hours (Max: 1,800 mg/day) plus cefixime or cefpodoxime for 10 to 14 days. Combination therapy with clindamycin and a third-generation cephalosporin is recommended as second-line therapy for patients with penicillin allergy or those from areas with high endemic rates of penicillin-sensitive S. pneumoniae. However, increased resistance has been reported among S. pneumoniae serotype 19A isolates, in which case a fluoroquinolone is recommended as an alternative.

    For the treatment of acute dental infection†, dentoalveolar infection†, or endodontic infection† including periodontitis† in combination with conventional treatment (e.g., scaling and root planing) as well as acute dental abscess (apical)† and/or dental abscess (periapical)†.
    For acute dental abscess (apical)† and/or dental abscess (periapical)† in combination with surgical incision and drainage in patients with beta-lactam allergy.
    Oral dosage
    Adults

    600 mg PO as a loading dose on day 1, followed by 300 mg PO 4 times daily for 3 days.

    Oral dosage
    Adults

    150 to 300 mg PO 4 times daily for 7 to 10 days or 300 mg PO 3 times daily for 8 days.

    Children and Adolescents

    8 to 12 mg/kg/day PO divided every 6 to 8 hours (Max: 300 mg/dose) for 10 days.

    For the treatment of group A beta-hemolytic streptococcal (GAS) pharyngitis† (primary rheumatic fever prophylaxis†) and tonsillitis†.
    Oral dosage
    Adults

    300 mg PO every 8 hours, or alternatively, 20 mg/kg/day PO divided every 8 hours (Max: 600 mg/dose) for 10 days as an alternative in patients allergic to penicillin.

    Infants, Children, and Adolescents

    7 mg/kg/dose (Max: 600 mg/dose) PO every 8 hours for 10 days as an alternative in patients allergic to penicillin.

    For surgical infection prophylaxis†.
    For general surgical infection prophylaxis†.
    Intravenous dosage
    Adults

    900 mg IV as a single dose within 60 minutes prior to the surgical incision; consider intraoperative redosing 6 hours from the first preoperative dose. May continue 900 mg IV every 8 hours for no more than 24 hours post-operatively if necessary. Guidelines recommend clindamycin as an alternative monotherapy in patients with beta-lactam allergy for multiple types of surgical procedures, including hernia repair, neurosurgical, orthopedic, vascular, plastic surgery, clean urologic, and clean and clean-contaminated head and neck procedures. Clindamycin is generally recommended as alternate therapy in combination with other anti-infectives for gastrointestinal, biliary tract, and urology procedures as well as liver, pancreas, and pancreas-kidney transplantation.

    Infants, Children, and Adolescents

    10 mg/kg (Max: 900 mg/dose) IV as a single dose within 60 minutes prior to the surgical incision; consider intraoperative redosing 6 hours from the first preoperative dose. May continue 10 mg/kg (Max: 900 mg/dose) every 8 hours for no more than 24 hours post-operatively if necessary. Guidelines recommend clindamycin as an alternative monotherapy in patients with beta-lactam allergy for multiple types of surgical procedures, including hernia repair, neurosurgical, orthopedic, vascular, plastic surgery, clean urologic, and clean and clean-contaminated head and neck procedures. Clindamycin is generally recommended as alternate therapy in combination with other anti-infectives for gastrointestinal, biliary tract, and urology procedures as well as liver, pancreas, and pancreas-kidney transplantation.

    For surgical infection prophylaxis for gynelogical procedures†.
    Intravenous dosage
    Adults

    600 to 900 mg IV as a single dose within 60 minutes prior to the surgical incision; consider intraoperative redosing 6 hours from the first preoperative dose. May continue 600 to 900 mg IV every 8 hours for no more than 24 hours post-operatively if necessary. Guidelines recommend clindamycin as an alternative therapy in combination with other anti-infectives for gynecology procedures.

    For surgical infection prophylaxis for cardiothoracic procedures†.
    Intravenous dosage
    Adults

    900 mg IV as a single dose within 60 minutes prior to the surgical incision; consider intraoperative redosing 6 hours from the first preoperative dose. May continue 900 mg IV every 8 hours for no more than 24 hours post-operatively if necessary. A longer prophylaxis duration of 48 hours for certain cardiothoracic procedures is controversial. Guidelines recommend clindamycin as an alternative monotherapy in patients with beta-lactam allergy for multiple types of surgical procedures, including cardiothoracic and heart and/or lung transplantations.

    Infants, Children, and Adolescents

    10 mg/kg (Max: 900 mg/dose) IV as a single dose within 60 minutes prior to the surgical incision; consider intraoperative redosing 6 hours from the first preoperative dose. May continue 10 mg/kg (Max: 900 mg/dose) every 8 hours for no more than 24 hours post-operatively if necessary. A longer prophylaxis duration of 48 hours for certain cardiothoracic procedures is controversial. Guidelines recommend clindamycin as an alternative monotherapy in patients with beta-lactam allergy for multiple types of surgical procedures, including cardiothoracic and heart and/or lung transplantations.

    For the treatment of anthrax†.
    For the treatment of cutaneous anthrax infection.
    Oral dosage
    Adults

    600 mg PO every 8 hours. Clindamycin is recommended as an alternative therapy for cutaneous anthrax infection. Treat for 7 to 10 days for naturally acquired infection and for up to 60 days for a bioterrorism-related event.

    Infants, Children, and Adolescents

    30 mg/kg/day PO divided every 8 hours (Max: 600 mg/dose). Clindamycin is recommended as an alternative therapy for cutaneous anthrax infection. Treat for 7 to 10 days for naturally acquired infection and for up to 60 days for a bioterrorism-related event.

    Premature Neonates 34 to 37 weeks gestational age and Term Neonates older than 7 days

    5 mg/kg/dose PO every 6 hours. Clindamycin is recommended as an alternative therapy for cutaneous anthrax infection. Treat for 7 to 10 days for naturally acquired infection and for up to 60 days for a bioterrorism-related event.

    Premature Neonates 34 to 37 weeks gestational age and Term Neonates 0 to 7 days

    5 mg/kg/dose PO every 8 hours. Clindamycin is recommended as an alternative therapy for cutaneous anthrax infection. Treat for 7 to 10 days for naturally acquired infection and for up to 60 days for a bioterrorism-related event.

    Premature Neonates 32 to 34 weeks gestational age and older than 7 days

    5 mg/kg/dose PO every 8 hours. Clindamycin is recommended as an alternative therapy for cutaneous anthrax infection. Treat for 7 to 10 days for naturally acquired infection and for up to 60 days for a bioterrorism-related event.

    Premature Neonates 32 to 34 weeks gestational age and 0 to 7 days

    5 mg/kg/dose PO every 12 hours. Clindamycin is recommended as an alternative therapy for cutaneous anthrax infection. Treat for 7 to 10 days for naturally acquired infection and for up to 60 days for a bioterrorism-related event.

    For the treatment of systemic anthrax infection.
    Intravenous dosage
    Adults

    900 mg IV every 8 hours in combination with appropriate antimicrobial therapy. Clindamycin in combination with a bactericidal antimicrobial (i.e., ciprofloxacin) is the preferred therapy for the treatment of systemic anthrax without CNS involvement. Clindamycin in combination with a fluoroquinolone and beta-lactam is an alternative therapy for systemic anthrax infection in which meningitis cannot be excluded. For systemic infection without CNS involvement, treatment should continue for at least 14 days or until clinical criteria for improvement are met. For systemic infection in which meningitis cannot be excluded, treatment should continue for at least 2 to 3 weeks or until clinical criteria for improvement are met. Prophylaxis to complete an antimicrobial course of up to 60 days will be required in both cases.

    Infants, Children, and Adolescents

    40 mg/kg/day IV divided every 8 hours (Max: 900 mg/dose) in combination with appropriate antimicrobial therapy. Clindamycin in combination with a bactericidal antimicrobial (i.e., ciprofloxacin) is the preferred therapy for the treatment of systemic anthrax without CNS involvement. Clindamycin in combination with a fluoroquinolone and beta-lactam/glycopeptide is an alternative therapy for systemic anthrax infection in which meningitis cannot be excluded. For systemic infection without CNS involvement, treatment should continue for at least 14 days or until clinical criteria for improvement are met. For systemic infection in which meningitis cannot be excluded, treatment should continue for at least 2 to 3 weeks or until clinical criteria for improvement are met. Prophylaxis to complete an antimicrobial course of up to 60 days will be required in both cases.

    Premature Neonates 34 to 37 weeks gestational age and Term Neonates older than 7 days

    5 mg/kg/dose IV every 6 hours in combination with appropriate antimicrobial therapy. Clindamycin in combination with a bactericidal antimicrobial (i.e., ciprofloxacin) is the preferred therapy for the treatment of systemic anthrax without CNS involvement. Clindamycin in combination with a fluoroquinolone and beta-lactam is an alternative therapy for systemic anthrax infection in which meningitis cannot be excluded. Treat for at least 2 to 3 weeks or until clinical criteria for improvement are met. Prophylaxis to complete an antimicrobial course of up to 60 days is required.

    Premature Neonates 34 to 37 weeks gestational age and Term Neonates 0 to 7 days

    5 mg/kg/dose IV every 8 hours in combination with appropriate antimicrobial therapy. Clindamycin in combination with a bactericidal antimicrobial (i.e., ciprofloxacin) is the preferred therapy for the treatment of systemic anthrax without CNS involvement. Clindamycin in combination with a fluoroquinolone and beta-lactam is an alternative therapy for systemic anthrax infection in which meningitis cannot be excluded. Treat for at least 2 to 3 weeks or until clinical criteria for improvement are met. Prophylaxis to complete an antimicrobial course of up to 60 days is required.

    Premature Neonates 32 to 34 weeks gestational age and older than 7 days

    5 mg/kg/dose IV every 8 hours in combination with appropriate antimicrobial therapy. Clindamycin in combination with a bactericidal antimicrobial (i.e., ciprofloxacin) is the preferred therapy for the treatment of systemic anthrax without CNS involvement. Clindamycin in combination with a fluoroquinolone and beta-lactam is an alternative therapy for systemic anthrax infection in which meningitis cannot be excluded. Treat for at least 2 to 3 weeks or until clinical criteria for improvement are met. Prophylaxis to complete an antimicrobial course of up to 60 days is required.

    Premature Neonates 32 to 34 weeks gestational age and 0 to 7 days

    5 mg/kg/dose IV every 12 hours in combination with appropriate antimicrobial therapy. Clindamycin in combination with a bactericidal antimicrobial (i.e., ciprofloxacin) is the preferred therapy for the treatment of systemic anthrax without CNS involvement. Clindamycin in combination with a fluoroquinolone and beta-lactam is an alternative therapy for systemic anthrax infection in which meningitis cannot be excluded. Treat for at least 2 to 3 weeks or until clinical criteria for improvement are met. Prophylaxis to complete an antimicrobial course of up to 60 days is required.

    Oral dosage
    Infants, Children, and Adolescents

    30 mg/kg/day PO divided every 8 hours (Max: 600 mg/dose). Clindamycin in combination with a fluoroquinolone is recommended as the preferred oral follow-up combination therapy for severe anthrax (non-CNS infection). Treatment should continue to complete a treatment course of at least 14 days. Prophylaxis to complete an antimicrobial course of up to 60 days may be required.

    Premature Neonates 34 to 37 weeks gestational age and Term Neonates older than 7 days

    5 mg/kg/dose PO every 6 hours. Clindamycin in combination with a fluoroquinolone is recommended as the preferred oral follow-up combination therapy for severe anthrax. Treatment should continue to complete a treatment course of 10 to 14 days or more. Prophylaxis to complete an antimicrobial course of up to 60 days may be required.

    Premature Neonates 34 to 37 weeks gestational age and Term Neonates 0 to 7 days

    5 mg/kg/dose PO every 8 hours. Clindamycin in combination with a fluoroquinolone is recommended as the preferred oral follow-up combination therapy for severe anthrax. Treatment should continue to complete a treatment course of 10 to 14 days or more. Prophylaxis to complete an antimicrobial course of up to 60 days may be required.

    Premature Neonates 32 to 34 weeks gestational age and older than 7 days

    5 mg/kg/dose PO every 8 hours. Clindamycin in combination with a fluoroquinolone is recommended as the preferred oral follow-up combination therapy for severe anthrax. Treatment should continue to complete a treatment course of 10 to 14 days or more. Prophylaxis to complete an antimicrobial course of up to 60 days may be required.

    Premature Neonates 32 to 34 weeks gestational age and 0 to 7 days

    5 mg/kg/dose PO every 12 hours. Clindamycin in combination with a fluoroquinolone is recommended as the preferred oral follow-up combination therapy for severe anthrax. Treatment should continue to complete a treatment course of 10 to 14 days or more. Prophylaxis to complete an antimicrobial course of up to 60 days may be required.

    For anthrax prophylaxis† after exposure to Bacillus anthracis (postexposure prophylaxis, PEP).
    Oral dosage
    Adults

    600 mg PO every 8 hours. Clindamycin is recommended as an alternative therapy to ciprofloxacin or doxycycline for postexposure prophylaxis. Treat for 60 days after exposure.

    Infants, Children, and Adolescents

    10 mg/kg/dose PO every 8 hours (Max: 900 mg/dose). Clindamycin is recommended as an alternative therapy to ciprofloxacin or doxycycline for postexposure prophylaxis. Treat for 60 days after exposure.

    Premature Neonates 34 to 37 weeks gestational age and Term Neonates older than 7 days

    5 mg/kg/dose PO every 6 hours. Clindamycin is recommended as an alternative therapy to ciprofloxacin or doxycycline (term neonates and older) for postexposure prophylaxis. Treat for 60 days after exposure.

    Premature Neonates 34 to 37 weeks gestational age and Term Neonates 0 to 7 days

    5 mg/kg/dose PO every 8 hours. Clindamycin is recommended as an alternative therapy to ciprofloxacin or doxycycline (term neonates and older) for postexposure prophylaxis. Treat for 60 days after exposure.

    Premature neonates 32 to 34 weeks gestational age and older than 7 days

    5 mg/kg/dose PO every 8 hours. Clindamycin is recommended as an alternative therapy to ciprofloxacin for postexposure prophylaxis. Treat for 60 days after exposure.

    Premature Neonates 32 to 34 weeks gestational age and 0 to 7 days

    5 mg/kg/dose PO every 12 hours. Clindamycin is recommended as an alternative therapy to ciprofloxacin for postexposure prophylaxis. Treat for 60 days after exposure.

    For the treatment of toxoplasmosis†, including toxoplasmic encephalitis†.
    Intravenous dosage
    Adults

    600 mg IV every 6 hours plus pyrimethamine and leucovorin is recommended by the HIV guidelines as an alternative therapy in sulfonamide-intolerant patients. Treatment duration should be at least 6 weeks; however, a longer duration may be necessary if clinical or radiologic disease is extensive or if the response is incomplete at 6 weeks. Chronic maintenance therapy should start after acute treatment. Adjunctive corticosteroids may be administered when clinically indicated for the treatment of mass effect attributed to focal lesions or associated edema; however discontinue as soon as possible. Anticonvulsants may be administered to patients with a seizure history during the acute treatment phase; however they should not be used prophylactically.

    Adolescents

    600 mg IV every 6 hours plus pyrimethamine and leucovorin is recommended by the HIV guidelines as an alternative therapy in sulfonamide-intolerant patients. Treatment duration should be at least 6 weeks; however, a longer duration may be necessary if clinical or radiologic disease is extensive or if the response is incomplete at 6 weeks. Chronic maintenance therapy should start after acute treatment. Adjunctive corticosteroids may be administered when clinically indicated for the treatment of mass effect attributed to focal lesions or associated edema; however, discontinue as soon as possible. Anticonvulsants may be administered to patients with a seizure history during the acute treatment phase; however, they should not be used prophylactically.

    Infants and Children

    5 to 7.5 mg/kg/dose IV every 6 hours (Max: 600 mg/dose) in combination with pyrimethamine and leucovorin is recommended by the HIV guidelines as an alternative therapy in sulfonamide-intolerant patients. For acquired toxoplasmosis, treatment duration should be at least 6 weeks; however, a longer duration may be necessary if clinical or radiologic disease is extensive or if the response is incomplete at 6 weeks. For congenital toxoplasmosis, treatment duration is for 12 months. Adjunctive corticosteroids may be administered when clinically indicated for the treatment of mass effect attributed to focal lesions or associated edema; however, discontinue as soon as possible. Anticonvulsants may be administered to patients with a seizure history during the acute treatment phase; however, they should not be used prophylactically.

    Oral dosage
    Adults

    600 mg PO every 6 hours plus pyrimethamine and leucovorin is recommended by the HIV guidelines as an alternative therapy in sulfonamide-intolerant patients. Treatment duration should be at least 6 weeks; however, a longer duration may be necessary if clinical or radiologic disease is extensive or if the response is incomplete at 6 weeks. Chronic maintenance therapy should start after acute treatment. Adjunctive corticosteroids may be administered when clinically indicated for the treatment of mass effect attributed to focal lesions or associated edema; however discontinue as soon as possible. Anticonvulsants may be administered to patients with a seizure history during the acute treatment phase; however they should not be used prophylactically.

    Adolescents

    600 mg PO every 6 hours plus pyrimethamine and leucovorin is recommended by the HIV guidelines as an alternative therapy in sulfonamide-intolerant patients. Treatment duration should be at least 6 weeks; however, a longer duration may be necessary if clinical or radiologic disease is extensive or if the response is incomplete at 6 weeks. Chronic maintenance therapy should start after acute treatment. Adjunctive corticosteroids may be administered when clinically indicated for the treatment of mass effect attributed to focal lesions or associated edema; however, discontinue as soon as possible. Anticonvulsants may be administered to patients with a seizure history during the acute treatment phase; however, they should not be used prophylactically.

    Infants and Children

    5 to 7.5 mg/kg/dose PO every 6 hours (Max: 600 mg/dose) in combination with pyrimethamine and leucovorin is recommended by the HIV guidelines as an alternative therapy in sulfonamide-intolerant patients. For acquired toxoplasmosis, treatment duration should be at least 6 weeks; however, a longer duration may be necessary if clinical or radiologic disease is extensive or if the response is incomplete at 6 weeks. For congenital toxoplasmosis, treatment duration is for 12 months. Adjunctive corticosteroids may be administered when clinically indicated for the treatment of mass effect attributed to focal lesions or associated edema; however, discontinue as soon as possible. Anticonvulsants may be administered to patients with a seizure history during the acute treatment phase; however, they should not be used prophylactically.

    For secondary toxoplasmosis prophylaxis† in HIV-infected patients intolerant of sulfa drugs.
    Oral dosage
    Adults

    600 mg PO every 8 hours in combination with pyrimethamine plus leucovorin. Unlike the preferred regimen containing sulfadiazine and pyrimethamine, this regimen does not provide adequate prophylaxis against Pneumocystis pneumonia. Consideration may be given to discontinuing secondary prophylaxis in asymptomatic patients who have a sustained increase in their CD4 counts greater than 200 cells/mm3 after receiving antiretroviral therapy for at least 6 months; however, limited number of patients have been evaluated and recurrences have been observed. Secondary prophylaxis should be reintroduced if the CD4 count decreases to less than 200 cells/mm3.

    Adolescents

    600 mg PO every 8 hours in combination with pyrimethamine plus leucovorin. Unlike the preferred regimen containing sulfadiazine and pyrimethamine, this regimen does not provide adequate prophylaxis against Pneumocystis pneumonia. Consideration may be given to discontinuing secondary prophylaxis in asymptomatic patients who have a sustained increase in their CD4 counts more than 200 cells/mm3 after receiving antiretroviral therapy for at least 6 months; however, a limited number of patients have been evaluated and recurrences have been observed. Secondary prophylaxis should be reintroduced if the CD4 count decreases to less than 200 cells/mm3.

    Infants and Children

    7 to 10 mg/kg/dose PO every 8 hours (Max: 600 mg/dose) in combination with pyrimethamine and leucovorin. Unlike the preferred regimen containing sulfadiazine and pyrimethamine, this regimen does not provide adequate prophylaxis against Pneumocystis pneumonia. Discontinuation of secondary prophylaxis may be considered for patients who have completed at least 6 months of stable antiretroviral therapy, remain asymptomatic, and have a CD4 percentage of at least 15% (children 1 to 5 years of age) or CD4 count more than 200 cells/mm3 (children 6 years and older) for more than 6 consecutive months. Prophylaxis should not be discontinued in children younger than 1 year of age. Secondary prophylaxis should be reintroduced if the CD4 percentage is less than 15% (children 1 to 5 years of age) or CD4 count decreases to less than 200 cells/mm3 (children 6 years and older).

    For the treatment of Pneumocystis pneumonia (PCP)†.
    For the treatment of PCP in HIV-infected patients†.
    Oral dosage
    Adults

    450 mg PO every 6 hours or 600 mg PO every 8 hours in combination with primaquine for 21 days as alternative therapy then chronic suppressive therapy.

    Adolescents

    450 mg PO every 6 hours or 600 mg PO every 8 hours in combination with primaquine for 21 days as alternative therapy then chronic suppressive therapy.

    Infants and Children

    10 mg/kg/dose (Max: 450 mg/dose) PO every 6 hours in combination with primaquine for 21 days as alternative therapy then chronic suppressive therapy.

    Intravenous dosage
    Adults

    600 mg IV every 6 hours or 900 mg IV every 8 hours in combination with primaquine for 21 days as alternative therapy for moderate to severe infection then chronic suppressive therapy.

    Adolescents

    600 mg IV every 6 hours or 900 mg IV every 8 hours in combination with primaquine for 21 days as alternative therapy for moderate to severe infection then chronic suppressive therapy.[34362]

    Infants and Children

    10 mg/kg/dose (Max: 600 mg/dose) IV every 6 hours in combination with primaquine for 21 days as alternative therapy for moderate to severe infection then chronic suppressive therapy.[34361]

    For the treatment of PCP in solid organ transplant recipients†.
    Oral dosage
    Adults

    450 mg PO every 8 hours or 600 to 900 mg PO every 6 to 8 hours in combination with primaquine for 14 to 21 days as alternative therapy.

    Intravenous dosage
    Adults

    600 to 900 mg IV every 6 to 8 hours in combination with primaquine for 14 to 21 days as alternative therapy.

    For the treatment of PCP in hematology patients with hematological malignancies, cancer, or autoimmune/inflammatory disease†.
    Oral dosage
    Adults

    450 mg PO every 6 hours or 600 mg PO every 8 hours in combination with primaquine for 14 to 21 days as alternative therapy.

    Adolescents

    300 mg PO every 6 hours or 450 mg PO every 8 hours in combination with primaquine for 14 to 21 days as alternative therapy.

    Infants and Children

    10 mg/kg/dose (Max: 450 mg/dose) PO every 6 hours in combination with primaquine for 14 to 21 days as alternative therapy.

    Intravenous dosage
    Adults

    600 mg IV every 6 to 8 hours or 900 mg IV every 8 hours in combination with primaquine for 14 to 21 days as alternative therapy.

    Adolescents

    600 mg IV every 6 hours in combination with primaquine for 14 to 21 days as alternative therapy.

    Infants and Children

    10 mg/kg/dose (Max: 600 mg/dose) IV every 6 hours in combination with primaquine for 14 to 21 days as alternative therapy.

    For Pneumocystis pneumonia (PCP) prophylaxis in solid organ transplant recipients†.
    Oral dosage
    Adults

    300 mg PO once daily or 3 times weekly in combination with pyrimethamine for 3 to 6 months after kidney transplant, for at least 6 to 12 months after other transplants, as well as for at least 6 weeks during and after antirejection therapy in kidney transplant recipients, as alternative therapy. Lifelong prophylaxis is recommended for lung and small bowel transplant recipients, as well as patients with a history of prior PCP or chronic cytomegalovirus disease.

    For the treatment of malaria†.
    For the treatment of uncomplicated malaria† due to P. falciparum.
    Oral dosage
    Adults

    20 mg/kg/day PO divided 3 times daily for 7 days. Guidelines recommend clindamycin for chloroquine-resistant infections and for infections of unknown resistance in combination with quinine; may also use for chloroquine-sensitive infections if necessary.

    Infants, Children, and Adolescents

    20 mg/kg/day PO divided 3 times daily for 7 days. Guidelines recommend clindamycin for chloroquine-resistant infections and for infections of unknown resistance in combination with quinine; may also use for chloroquine-sensitive infections if necessary.

    For the treatment of severe malaria† after IV artesunate therapy is completed.
    Oral dosage
    Pregnant Female Adults

    20 mg/kg/day PO divided 3 times daily for 7 days as alternative to doxycycline.

    Pregnant Female Adolescents

    20 mg/kg/day PO divided 3 times daily for 7 days as alternative to doxycycline.

    Infants and Children younger than 8 years

    20 mg/kg/day PO divided 3 times daily for 7 days as alternative to doxycycline.

    Intravenous dosage
    Pregnant Female Adults

    10 mg/kg IV loading dose, then 5 mg/kg/dose IV every 8 hours in persons unable to tolerate oral medication as alternative to doxycyline. Switch to oral therapy as soon as possible for a total treatment duration of 7 days.

    Pregnant Female Adolescents

    10 mg/kg IV loading dose, then 5 mg/kg/dose IV every 8 hours in persons unable to tolerate oral medication as alternative to doxycycline. Switch to oral therapy as soon as possible for a total treatment duration of 7 days.

    Infants and Children younger than 8 years

    10 mg/kg IV loading dose, then 5 mg/kg/dose IV every 8 hours in persons unable to tolerate oral medication as alternative to doxycycline. Switch to oral therapy as soon as possible for a total treatment duration of 7 days.

    For the treatment of babesiosis†.
    For the treatment of babesiosis† in immunocompetent ambulatory patients with mild to moderate disease in combination with quinine.
    Oral dosage
    Adults

    600 mg PO every 8 hours for 7 to 10 days as an alternative. Clindamycin plus quinine is preferred when parasitemia and symptoms have failed to abate after the initiation of atovaquone plus azithromycin.

    Infants, Children, and Adolescents

    7 to 10 mg/kg/dose (Max: 600 mg/dose) PO every 6 to 8 hours for 7 to 10 days as an alternative. Clindamycin plus quinine is preferred when parasitemia and symptoms have failed to abate after the initiation of atovaquone plus azithromycin.

    For the treatment of babesiosis† in immunocompromised ambulatory patients with mild to moderate disease in combination with quinine.
    Oral dosage
    Adults

    600 mg PO every 8 hours for at least 7 to 10 days as an alternative; duration may need to be extended in these patients. Clindamycin plus quinine is preferred when parasitemia and symptoms have failed to abate after the initiation of atovaquone plus azithromycin.

    Infants, Children, and Adolescents

    7 to 10 mg/kg/dose (Max: 600 mg/dose) PO every 6 to 8 hours for at least 7 to 10 days as an alternative; duration may need to be extended in these patients. Clindamycin plus quinine is preferred when parasitemia and symptoms have failed to abate after the initiation of atovaquone plus azithromycin.

    For the initial treatment of babesiosis† in immunocompetent hospitalized patients with acute, severe disease in combination with quinine.
    Intravenous dosage
    Adults

    300 to 600 mg IV every 6 hours until symptoms abate, followed by oral stepdown therapy for a total treatment duration of 7 to 10 days as an alternative. Clindamycin plus quinine is preferred when parasitemia and symptoms have failed to abate after the initiation of atovaquone plus azithromycin.

    Infants, Children, and Adolescents

    7 to 10 mg/kg/dose (Max: 600 mg/dose) IV every 6 to 8 hours until symptoms abate, followed by oral stepdown therapy for a total treatment duration of 7 to 10 days as an alternative. Clindamycin plus quinine is preferred when parasitemia and symptoms have failed to abate after the initiation of atovaquone plus azithromycin.

    For the initial treatment of babesiosis† in immunocompromised hospitalized patients with acute, severe disease in combination with quinine.
    Intravenous dosage
    Adults

    300 to 600 mg IV every 6 hours until symptoms abate, followed by oral stepdown therapy for a total treatment duration of at least 7 to 10 days as an alternative; duration may need to be extended in these patients. Clindamycin plus quinine is preferred when parasitemia and symptoms have failed to abate after the initiation of atovaquone plus azithromycin.

    Infants, Children, and Adolescents

    7 to 10 mg/kg/dose (Max: 600 mg/dose) IV every 6 to 8 hours until symptoms abate, followed by oral stepdown therapy for a total treatment duration of at least 7 to 10 days as an alternative; duration may need to be extended in these patients. Clindamycin plus quinine is preferred when parasitemia and symptoms have failed to abate after the initiation of atovaquone plus azithromycin.

    For oral stepdown treatment of babesiosis† in immunocompetent hospitalized patients in combination with quinine after initial IV therapy.
    Oral dosage
    Adults

    600 mg PO every 8 hours for a total treatment duration of 7 to 10 days as an alternative. Clindamycin plus quinine is preferred when parasitemia and symptoms have failed to abate after the initiation of atovaquone plus azithromycin.

    Infants, Children, and Adolescents

    7 to 10 mg/kg/dose (Max: 600 mg/dose) PO every 6 to 8 hours for a total treatment duration of 7 to 10 days as an alternative. Clindamycin plus quinine is preferred when parasitemia and symptoms have failed to abate after the initiation of atovaquone plus azithromycin.

    For oral stepdown treatment of babesiosis† in immunocompromised hospitalized patients in combination with quinine after initial IV therapy.
    Oral dosage
    Adults

    600 mg PO every 8 hours for a total treatment duration of at least 7 to 10 days as an alternative; duration may need to be extended in these patients. Clindamycin plus quinine is preferred when parasitemia and symptoms have failed to abate after the initiation of atovaquone plus azithromycin.

    Infants, Children, and Adolescents

    7 to 10 mg/kg/dose (Max: 600 mg/dose) PO every 6 to 8 hours for a total treatment duration of at least 7 to 10 days as an alternative; duration may need to be extended in these patients. Clindamycin plus quinine is preferred when parasitemia and symptoms have failed to abate after the initiation of atovaquone plus azithromycin.

    For the initial treatment of babesiosis† in highly immunocompromised patients in combination with quinine.
    Intravenous dosage
    Adults

    300 to 600 mg IV every 6 hours until symptoms abate, followed by oral stepdown therapy for a total duration of at least 6 weeks, including 2 final weeks during which parasites are no longer detected on peripheral blood smear as an alternative. Clindamycin plus quinine is preferred when parasitemia and symptoms have failed to abate after the initiation of atovaquone plus azithromycin.

    Infants, Children, and Adolescents

    7 to 10 mg/kg/dose (Max: 600 mg/dose) IV every 6 to 8 hours until symptoms abate, followed by oral stepdown therapy for a total duration of at least 6 weeks, including 2 final weeks during which parasites are no longer detected on peripheral blood smear as an alternative. Clindamycin plus quinine is preferred when parasitemia and symptoms have failed to abate after the initiation of atovaquone plus azithromycin.

    For oral stepdown treatment of babesiosis† in highly immunocompromised patients in combination with quinine after initial IV therapy.
    Oral dosage
    Adults

    600 mg PO every 8 hours for a total duration of at least 6 weeks, including 2 final weeks during which parasites are no longer detected on peripheral blood smear as an alternative. Clindamycin plus quinine is preferred when parasitemia and symptoms have failed to abate after the initiation of atovaquone plus azithromycin.

    Infants, Children, and Adolescents

    7 to 10 mg/kg/dose (Max: 600 mg/dose) PO every 6 to 8 hours for a total duration of at least 6 weeks, including 2 final weeks during which parasites are no longer detected on peripheral blood smear as an alternative. Clindamycin plus quinine is preferred when parasitemia and symptoms have failed to abate after the initiation of atovaquone plus azithromycin.

    For oral stepdown treatment of refractory or relapsed babesiosis† after initial IV therapy.
    Oral dosage
    Adults

    600 mg PO every 8 hours as part of combination therapy which may include atovaquone, atovaquone plus azithromycin, or atovaquone plus azithromycin plus quinine.

    Infants, Children, and Adolescents

    7 to 10 mg/kg/dose (Max: 600 mg/dose) PO every 6 to 8 hours as part of combination therapy which may include atovaquone, atovaquone plus azithromycin, or atovaquone plus azithromycin plus quinine.

    For the initial treatment of refractory or relapsed babesiosis† as part of combination therapy.
    Intravenous dosage
    Adults

    300 to 600 mg IV every 6 hours until symptoms abate, followed by oral stepdown therapy as part of combination therapy which may include atovaquone, atovaquone plus azithromycin, or atovaquone plus azithromycin plus quinine.

    Infants, Children, and Adolescents

    7 to 10 mg/kg/dose (Max: 600 mg/dose) IV every 6 to 8 hours until symptoms abate, followed by oral stepdown therapy as part of combination therapy which may include atovaquone, atovaquone plus azithromycin, or atovaquone plus azithromycin plus quinine.

    For perinatal Group B streptococcal infection prophylaxis† in patients allergic to penicillin and cephalosporins.
    Intravenous dosage
    Pregnant females

    900 mg IV every 8 hours initiated at the time of labor or rupture of membranes and continued until delivery. Clindamycin is recommended as an alternative for patients with a high-risk penicillin allergy infected with a clindamycin-susceptible GBS isolate.[64407]

    For group A streptococci chronic pharyngeal carriage eradication†.
    Oral dosage
    Adults

    300 mg PO every 8 hours for 10 days. Most chronic streptococcal carriers do not need antimicrobial therapy. Treatment may be considered during a community outbreak of acute rheumatic fever, acute poststreptococcal glomerulonephritis or invasive group A streptococcal (GAS) infection; during an outbreak of GAS pharyngitis in a closed or partially closed community; in the presence of a family or personal history of acute rheumatic fever; in a family with excessive anxiety about GAS infections; or when tonsillectomy is being considered only because of carriage.[52889]

    Infants, Children, and Adolescents

    20 to 30 mg/kg/day PO divided every 8 hours (Max: 300 mg/dose) for 10 days. Most chronic streptococcal carriers do not need antimicrobial therapy. Treatment may be considered during a community outbreak of acute rheumatic fever, acute poststreptococcal glomerulonephritis or invasive group A streptococcal (GAS) infection; during an outbreak of GAS pharyngitis in a closed or partially closed community; in the presence of a family or personal history of acute rheumatic fever; in a family with excessive anxiety about GAS infections; or when tonsillectomy is being considered only because of carriage.[52889]

    For the treatment of actinomycosis†.
    Intravenous dosage
    Adults

    900 mg IV every 8 hours for 2 to 6 weeks, followed by oral therapy for 6 to 12 months. Shorter courses may be appropriate for less extensive infections.

    Oral dosage
    Adults

    300 to 450 mg PO every 6 hours for 6 to 12 months after IV therapy. Shorter courses may be appropriate for less extensive infections.

    For bacterial infection prophylaxis† after penetrating trauma.
    For bacterial infection prophylaxis after penetrating extremity trauma (including skin, soft tissue, and bone with or without open fractures)†.
    Oral dosage
    Adults

    300 to 450 mg PO every 8 hours for 1 to 3 days as an alternative.

    Infants, Children, and Adolescents

    10 to 25 mg/kg/day (Max: 1.35 g/day) PO divided every 8 hours for 1 to 3 days as an alternative.

    Intravenous dosage
    Adults

    600 mg IV every 8 hours for 1 to 3 days as an alternative.

    Infants, Children, and Adolescents

    20 to 40 mg/kg/day (Max: 1.8 g/day) IV divided every 6 to 8 hours for 1 to 3 days as an alternative.

    For bacterial infection prophylaxis after penetrating chest trauma without esophageal disruption†.
    Oral dosage
    Adults

    300 to 450 mg PO every 8 hours for 1 day as an alternative.

    Infants, Children, and Adolescents

    10 to 25 mg/kg/day (Max: 1.35 g/day) PO divided every 8 hours for 1 day as an alternative.

    Intravenous dosage
    Adults

    600 mg IV every 8 hours for 1 day as an alternative.

    Infants, Children, and Adolescents

    20 to 40 mg/kg/day (Max: 1.8 g/day) IV divided every 6 to 8 hours for 1 day as an alternative.

    †Indicates off-label use

    MAXIMUM DOSAGE

    Adults

    2,700 mg/day IV; up to 4,800 mg/day IV has been used for life-threatening infections; 2,400 mg/day IM; 1,800 mg/day PO. Topical formulations: 2 applications/day topically for gel, solution, lotion, or pledget; 1 application/day topically for foam. Vaginal creams: 1 applicatorful (100 mg clindamycin/5 g cream)/day for most products; 1 applicatorful (100 mg clindamycin/5 g cream) once for Clindesse. Vaginal ovules/suppositories: 1 ovule (100 mg clindamycin)/day.

    Geriatric

    2,700 mg/day IV; up to 4,800 mg/day IV has been used for life-threatening infections; 2,400 mg/day IM; 1,800 mg/day PO. Topical formulations: 2 applications/day topically for gel, solution, lotion, or pledget; 1 application/day topically for foam. Vaginal creams: 1 applicatorful (100 mg clindamycin/5 g cream)/day for most products; 1 applicatorful (100 mg clindamycin/5 g cream) once for Clindesse. Vaginal ovules/suppositories: 1 ovule (100 mg clindamycin)/day.

    Adolescents

    17 years: 2,700 mg/day IV; 2,400 mg/day IM; 25 mg/kg/day PO is FDA-approved maximum dosage; however, doses up to 40 mg/kg/day PO (Max: 1,800 mg/day) are used off-label. Topical formulations: 2 applications/day topically for gel, solution, lotion, or pledget; 1 application/day topically for foam. Vaginal creams: 1 applicatorful (100 mg clindamycin/5 g cream)/day for most products; 1 applicatorful (100 mg clindamycin/5 g cream) once for Clindesse. Vaginal ovules/suppositories: 1 ovule (100 mg clindamycin)/day.
    13 to 16 years: 40 mg/kg/day IV/IM (Max: 2,700 mg/day IV; 2,400 mg/day IM); 25 mg/kg/day PO is FDA-approved maximum dosage; however, doses up to 40 mg/kg/day PO (Max: 1,800 mg/day) are used off-label. Topical formulations: 2 applications/day topically for gel, solution, lotion, or pledget; 1 application/day topically for foam. Vaginal creams: 1 applicatorful (100 mg clindamycin/5 g cream)/day for most products; 1 applicatorful (100 mg clindamycin/5 g cream) once for Clindesse. Vaginal ovules/suppositories: 1 ovule (100 mg clindamycin)/day.

    Children

    12 years: 40 mg/kg/day IV/IM (Max: 2,700 mg/day IV; 2,400 mg/day IM); 25 mg/kg/day PO is FDA-approved maximum dosage; however, doses up to 40 mg/kg/day PO (Max: 1,800 mg/day) are used off-label. Topical formulations: 2 applications/day topically for gel, solution, lotion, or pledget; 1 application/day topically for foam.
    1 to 11 years: 40 mg/kg/day IV/IM (Max: 2,700 mg/day IV; 2,400 mg/day IM); 25 mg/kg/day PO is FDA-approved maximum dosage; however, doses up to 40 mg/kg/day PO (Max: 1,800 mg/day) are used off-label.

    Infants

    40 mg/kg/day IV/IM; 25 mg/kg/day PO is FDA-approved maximum dosage; however, doses up to 40 mg/kg/day PO are used off-label.

    Neonates

    20 mg/kg/day IV/IM and 25 mg/kg/day PO are the FDA-approved maximum dosages; however, the following doses have been recommended based on postmenstrual age (PMA):
    Neonates older than 40 weeks PMA: 9 mg/kg/dose IV/IM/PO every 8 hours.
    Neonates 33 to 40 weeks PMA: 7 mg/kg/dose IV/IM/PO every 8 hours.
    Neonates 32 weeks PMA and younger: 5 mg/kg/dose IV/IM/PO every 8 hours.

    DOSING CONSIDERATIONS

    Hepatic Impairment

    The FDA-approved labeling states that no dosage adjustment is needed for hepatic disease. Guidelines suggest to decrease dosage by 50% in patients with Child-Pugh class C cirrhosis.

    Renal Impairment

    No dosage adjustment is needed.
     
    Intermittent hemodialysis
    Hemodialysis is not effective in removing clindamycin from the serum. A supplemental dosage is not recommended for hemodialysis.
     
    Peritoneal dialysis
    Peritoneal dialysis is not effective in removing clindamycin from the serum. A supplemental dosage is not recommended for peritoneal dialysis.
     
    Continuous renal replacement therapy (CRRT)†
    No dosage adjustment is needed.

    ADMINISTRATION

    Oral Administration

    Administration with food may help minimize gastrointestinal adverse effects.
    Administer with a full glass of water to avoid esophageal irritation.

    Oral Liquid Formulations

    Tap the bottle to loosen the powder. The water should be added in 2 portions; shake well after each aliquot.
    Review the reconstitution instructions for the particular product and package size, as the amount of water required for reconstitution may vary from manufacturer to manufacturer.
    Storage: Solution stable at room temperature for 2 weeks; do not refrigerate.
    Undesirable taste can be a challenge for many patients; the taste of the oral solution can be improved by adding a flavoring agent (e.g., FLAVORx).

    Injectable Administration

    Visually inspect parenteral products for particulate matter and discoloration prior to administration whenever solution and container permit.

    Intravenous Administration

    Dilution
    Vials
    Dilute 300 and 600 mg doses with 50 mL of a compatible diluent. Dilute 900 mg doses with 50 to 100 mL of a compatible diluent. Dilute 1200 mg doses with 100 mL of a compatible diluent.
    Final concentration should not exceed 18 mg/mL.
    ADD-Vantage vials
    Dilute 300 and 600 mg ADD-Vantage containers with 50 mL of 0.9% Sodium Chloride Injection or 5% Dextrose Injection. Dilute 900 mg ADD-Vantage containers with 100 mL of 0.9% Sodium Chloride Injection or 5% Dextrose Injection.
    Pre-mixed Galaxy IV solution
    Check for leaks by squeezing bag firmly.
    Do not add supplementary medication.
    Do not use plastic containers in series connections as this could result in an embolism due to residual air being drawn from the primary container before administration of the fluid from the secondary container is complete.
    Storage: Pharmacy bulk vials should be discarded within 24 hours of initial entry. When diluted in 5% Dextrose Injection, 0.9% Sodium Chloride Injection, or Lactated Ringer's Injection, solutions with concentrations of 6, 9, or 12 mg/mL are stable for 16 days at room temperature or 32 days under refrigeration when stored in glass bottles or minibags. When diluted in 5% Dextrose injection, solutions with a concentration of 18 mg/mL are stable for 16 days at room temperature.
     
    Intermittent IV Infusion
    Infuse over at least 10 to 60 minutes. Infusion rates should not exceed 30 mg/minute and no more than 1.2 g should be infused in a 1 hour period.
    Infuse 300 mg doses over 10 minutes; infuse 600 mg doses over 20 minutes, infuse 900 mg doses over 30 minutes, and infuse 1200 mg doses over 40 minutes.
     
    Continuous IV Infusion
    Administer first dose rapidly, then follow with continuous infusion.
    Rate is based on desired serum clindamycin levels:
    To maintain serum concentrations above 4 mcg/mL, use a rapid infusion rate of 10 mg/minute for 30 minutes and a maintenance rate of 0.75 mg/minute.
    To maintain serum concentrations above 5 mcg/mL, use a rapid infusion rate of 15 mg/minute for 30 minute and a maintenance rate of 1 mg/minute.
    To maintain serum concentrations above 6 mcg/mL, use a rapid infusion rate of 20 mg/minute for 30 minutes and a maintenance rate of 1.25 mg/minute.

    Intramuscular Administration

    Administer undiluted.
    Single doses should not exceed 600 mg.
    Inject deeply into a large muscle mass.

    Topical Administration

    Topical skin products are not for intravaginal therapy and are for external use only. Do not use skin products near the eyes, nose, or mouth.
    Wash hands before and after use. Wash affected area and gently pat dry.

    Cream/Ointment/Lotion Formulations

    For lotions, shake well before use.
    Apply a thin film to the cleansed affected area. Massage gently into affected areas.

    Other Topical Formulations

    Foam Formulations:
    Do not dispense foam directly onto hands or face; the warmth of the skin will cause the foam to melt. Instead, dispense desired amount directly into the cap or onto a cool surface. Make sure enough foam is dispensed to cover the affected area(s). If the can feels warm or the foam seems runny, run the can under cold water. To apply, pick up small amounts of the foam with the fingertips and gently massage into the affected areas until the foam disappears.
    Avoid application near eyes, mouth, lips, or broken skin; rinse well with water if contact occurs.
     
    Solution Formulations:
    Apply a thin film to the cleansed affected area. Massage gently into affected areas.
    If using a solution-soaked pledget; patient may use more than 1 pledget per application as needed to treat affected areas, but each pledget should be used only once and then discarded.

    Intravaginal Administration

    Only use those dosage formulations specified for intravaginal use. Intravaginal dosage forms are not for topical therapy; do not ingest.
    Instruct patient on proper administration of the vaginal cream, gel, or ovules/suppositories.
    Instruct patients of appropriate age to avoid vaginal intercourse or use of other vaginal products (tampons or douches) during treatment with these products. For the vaginal gel, avoid vaginal intercourse or use of other vaginal products for an additional 3 days after use.
     
    Suppository Formulations:
    Unwrap vaginal ovule (suppository) prior to insertion.
    Use applicator(s) supplied by the manufacturer.
    Ingredients contained in the suppository base may weaken latex or rubber products (i.e., condoms or vaginal contraceptive diaphragms). Patients of appropriate age should be cautioned that use of these products within 72 hours after treatment is not recommended and that these contraceptive methods may not be as effective during this time.
     
    Cream Formulations:
    Use applicator(s) supplied by the manufacturer.
     
    Gel Formulations:
    Use applicator(s) supplied by the manufacturer.
    Clindamycin vaginal gel is not compatible with and may weaken polyurethane condoms. Patients of appropriate age should be cautioned that use of polyurethane condoms within 7 days after treatment is not recommended and that these products may not be reliable for preventing pregnancy or for protecting against transmission of HIV or other sexually transmitted infections during this time. Latex or polyisoprene condoms can be used.

    STORAGE

    Generic:
    - Avoid exposure to heat
    - Avoid temperatures above 86 degrees F
    - Discard product if it contains particulate matter, is cloudy, or discolored
    - Discard unused portion. Do not store for later use.
    - Store at controlled room temperature (between 68 and 77 degrees F)
    Cleocin:
    - Store between 68 to 77 degrees F, excursions permitted 59 to 86 degrees F
    Cleocin Ovules:
    - Avoid excessive humidity
    - Avoid temperatures above 86 degrees F
    - Store at 77 degrees F; excursions permitted to 59-86 degrees F
    Cleocin Pediatric:
    - Do not refrigerate reconstituted product
    - Store at controlled room temperature (between 68 and 77 degrees F)
    Cleocin T:
    - Protect from freezing
    - Store at controlled room temperature (between 68 and 77 degrees F)
    CLIN:
    - Store at controlled room temperature (between 68 and 77 degrees F)
    Clindacin ETZ:
    - Protect from freezing
    - Store at controlled room temperature (between 68 and 77 degrees F)
    Clindacin PAC:
    - Protect from freezing
    - Store at controlled room temperature (between 68 and 77 degrees F)
    Clindacin-P:
    - Protect from freezing
    - Store at controlled room temperature (between 68 and 77 degrees F)
    Clinda-Derm :
    - Keep away from heat and flame
    - Protect from freezing
    - Store at controlled room temperature (between 68 and 77 degrees F)
    - Store upright
    Clindagel:
    - Protect from freezing
    - Store at controlled room temperature (between 68 and 77 degrees F)
    ClindaMax:
    - Protect from freezing
    - Store at controlled room temperature (between 68 and 77 degrees F)
    ClindaReach:
    - Protect from freezing
    - Store at controlled room temperature (between 68 and 77 degrees F)
    Clindesse:
    - Avoid temperatures above 86 degrees F
    - Store at controlled room temperature (between 68 and 77 degrees F)
    Clindets:
    - Protect from freezing
    - Store at controlled room temperature (between 68 and 77 degrees F)
    Evoclin:
    - Avoid exposure to heat
    - Avoid extreme temperatures
    - Do Not Store at Temperatures Above 120 degrees F (49 degrees C)
    - Flammable, keep away from heat and flame
    - Protect from direct sunlight
    - Store at controlled room temperature (between 68 and 77 degrees F)
    - Store in a cool, well ventilated, dry place
    PledgaClin:
    - Protect from freezing
    - Store at controlled room temperature (between 68 and 77 degrees F)
    XACIATO:
    - Discard unused portion. Do not store for later use.
    - Do not refrigerate
    - Protect from freezing
    - Store between 68 to 77 degrees F, excursions permitted 59 to 86 degrees F

    CONTRAINDICATIONS / PRECAUTIONS

    Asthma, atopy, clindamycin hypersensitivity, lincomycin hypersensitivity, serious rash, tartrazine dye hypersensitivity

    Clindamycin is contraindicated in patients with known clindamycin hypersensitivity. Because some cross-sensitivity may occur, lincomycin hypersensitivity is also a contraindication for clindamycin use. Use the drug with caution in patients with asthma or a significant history of allergy (atopy). Some oral capsule preparations contain tartrazine dye and can precipitate bronchial asthma or other allergic reactions in patients with tartrazine dye hypersensitivity. Serious rash events, including toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), and drug reaction with eosinophilia and systemic symptoms (DRESS), some with fatal outcomes, have been reported with systemic clindamycin therapy. Clindamycin should be permanently discontinued if severe skin or hypersensitivity reactions occur.

    Fungal infection

    Clindamycin can cause the overgrowth of nonsusceptible bacteria resulting in superinfection, particularly yeast and fungal infection. Should superinfection occur, take appropriate measures.

    C. difficile-associated diarrhea, Crohn's disease, diarrhea, pseudomembranous colitis, ulcerative colitis

    Clindamycin topical products (topical solution, gel, and lotion) and vaginal (cream, ovules) are contraindicated in patients with a history of regional enteritis (Crohn's disease) or ulcerative colitis, or a history of pseudomembranous colitis; other product preparations warn against use in patients with pseudomembranous colitis. Clindamycin has been associated with severe colitis, more so than some other antimicrobials. Consider pseudomembranous colitis in patients presenting with diarrhea after antibacterial use. Careful medical history is necessary as pseudomembranous colitis has been reported to occur over 2 months after the administration of antibacterial agents. Almost all antibacterial agents, including clindamycin, have been associated with pseudomembranous colitis or C. difficile-associated diarrhea (CDAD) which may range in severity from mild to life-threatening. Treatment with antibacterial agents alters the normal flora of the colon leading to overgrowth of C. difficile.

    Hepatic disease

    Systemic clindamycin should be used with caution in patients with hepatic disease. Studies indicate that the clindamycin half-life is prolonged in patients with moderate to severe liver disease. However, extrapolation from these studies indicates that when the drug is given every 8 hours, accumulation should not occur and dosage modification for liver disease may not be necessary. Liver function tests (LFTs) should be monitored regularly during therapy in patients with severe liver disease.

    Renal impairment

    Consider monitoring of renal function during clindamycin therapy, particularly in patients with pre-existing renal impairment or those taking concomitant nephrotoxic drugs. Clindamycin is potentially nephrotoxic and acute kidney injury has been reported with use.

    Ocular exposure

    Clindamycin topical solution contains an alcohol base that will cause burning and irritation of the eye; therefore, avoid ocular exposure. In the event of accidental contact with sensitive surfaces (eye, abraded skin, mucous membranes), bathe with water.

    Neonates

    Use parenteral clindamycin with caution in neonates; the injectable preparation contains benzyl alcohol, which has been associated with a fatal 'gasping syndrome' in premature infants.

    Geriatric

    Reported clinical experience indicates that antibiotic-associated colitis and diarrhea (due to C. difficile) seen in association with most systemic antibiotics, such as clindamycin, occur more frequently in the geriatric adult (60 years or older) and may be more severe. These patients should be carefully monitored for the development of diarrhea. The federal Omnibus Budget Reconciliation Act (OBRA) regulates medication use in residents (e.g., geriatric adults) of long-term care facilities (LTCFs). According to OBRA, use of antibiotics should be limited to confirmed or suspected bacterial infections. Antibiotics are non-selective and may result in the eradication of beneficial microorganisms while promoting the emergence of undesired ones, causing secondary infections such as oral thrush, colitis, or vaginitis. Any antibiotic may cause diarrhea, nausea, vomiting, anorexia, and hypersensitivity reactions.

    Pregnancy

    In clinical trials with pregnant women, no congenital abnormalities have been associated with systemic administration of clindamycin during the second or third trimester. However, in a large population-based cohort study (n = 139,938 live births) assessing antibiotic exposure during the first trimester of pregnancy (n = 15,469 exposures) and the risk of major birth defects, clindamycin was associated with an increased risk of major congenital malformations (adjusted odds ratio (aOR) 1.34; 95% CI: 1.02 to 1.77; 60 exposed cases). Clindamycin exposure increased the risk of musculoskeletal system malformations (aOR 1.67; 95% CI: 1.12 to 2.48; 29 exposed cases) and ventricular/atrial septal defect (aOR 1.81; 95% CI: 1.04 to 3.16; 13 exposed cases). Use clindamycin during the first trimester of pregnancy only if clearly needed and the benefits outweigh the risks. Placental concentrations are roughly 50% of maternal serum concentrations. Parenteral clindamycin also contains benzyl alcohol, which can cross the placenta; benzyl alcohol has been associated with a fatal 'gasping syndrome' in neonates. Clindamycin vaginal cream has been studied during pregnancy to reduce preterm birth and treat asymptomatic bacterial vaginosis. In 1 trial (n = 409), women who were treated with 2% clindamycin vaginal cream prior to 20 weeks gestation demonstrated a reduction in preterm birth compared to placebo (p less than 0.03). In 3 other trials, intravaginal clindamycin cream was administered at 16 to 32 weeks gestation, and an increase in adverse events, such as low birthweight, pre-term delivery, premature rupture of the membranes, and neonatal infections, was observed in newborns. Clindamycin vaginal gel has not been studied in pregnant women; however, based on low systemic absorption, maternal use is not likely to result in significant fetal exposure. There are no adequate, well-controlled studies of topical clindamycin in pregnant women.

    Breast-feeding

    Clindamycin is excreted into human breast milk after administration by the oral or parenteral routes in concentrations of less than 0.5 to 3.8 mcg/mL. Because of the potential for serious gastrointestinal adverse reactions in the breast-fed infant, an alternative drug to clindamycin may be preferred during breast-feeding. Consider the developmental and health benefits of breast-feeding along with the mother's clinical need for clindamycin and any potential adverse effects on the breast-fed infant from clindamycin or the underlying maternal condition. If clindamycin is used during breast-feeding, monitor the infant for possible adverse effects on the gastrointestinal flora such as diarrhea, candidiasis (thrush, diaper rash), or rarely, blood in the stool indicating possible antibiotic-associated colitis.[29120] [44982] Diarrhea and bloody stools were reported in a 5-day-old infant whose mother was receiving intravenous clindamycin and gentamicin for suspected endometriosis.[46304] Previous American Academy of Pediatrics recommendations considered clindamycin as usually compatible with breast-feeding.[27500] It is unknown if clindamycin is excreted into human breast milk after the use of vaginally or topically administered clindamycin.[31059] [44984] [42862] Systemic absorption after intravaginal administration is low; therefore, transfer of clindamycin into breast milk is likely to be low and adverse effects on the breast-fed infant are not expected. If clindamycin is topically applied to the chest, care should be taken to avoid accidental ingestion by the infant.[42862] There are no data on the effect of clindamycin on milk production.

    Contraceptive devices

    Patients of appropriate age should be cautioned that certain clindamycin vaginal products may interact with contraceptive devices. Ingredients contained in the vaginal suppository base may weaken latex or rubber products (i.e., condoms or vaginal contraceptive diaphragms). Use of these products within 72 hours after treatment is not recommended as these contraceptive methods may not be as effective during this time. Clindamycin vaginal gel is not compatible with and may weaken polyurethane condoms during treatment and within 7 days after treatment. These contraceptive products may not be reliable for preventing pregnancy or for protecting against transmission of HIV or other sexually transmitted infections during this time. Latex or polyisoprene condoms can be used with the vaginal gel.

    ADVERSE REACTIONS

    Severe

    acute generalized exanthematous pustulosis (AGEP) / Delayed / 0-1.0
    Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) / Delayed / 0-1.0
    toxic epidermal necrolysis / Delayed / 0-1.0
    odynophagia / Delayed / Incidence not known
    agranulocytosis / Delayed / Incidence not known
    Stevens-Johnson syndrome / Delayed / Incidence not known
    exfoliative dermatitis / Delayed / Incidence not known
    angioedema / Rapid / Incidence not known
    erythema multiforme / Delayed / Incidence not known
    nephrotoxicity / Delayed / Incidence not known
    anaphylactoid reactions / Rapid / Incidence not known
    anaphylactic shock / Rapid / Incidence not known
    cardiac arrest / Early / Incidence not known
    C. difficile-associated diarrhea / Delayed / Incidence not known

    Moderate

    candidiasis / Delayed / 1.5-17.0
    erythema / Early / 7.0-16.0
    vaginitis / Delayed / 0-10.7
    constipation / Delayed / 0-2.0
    vaginal pain / Early / 0-1.9
    dysuria / Early / 0-1.0
    hyperthyroidism / Delayed / 0-1.0
    edema / Delayed / 0-1.0
    dysphagia / Delayed / Incidence not known
    esophagitis / Delayed / Incidence not known
    thrombocytopenia / Delayed / Incidence not known
    eosinophilia / Delayed / Incidence not known
    leukopenia / Delayed / Incidence not known
    neutropenia / Delayed / Incidence not known
    bullous rash / Early / Incidence not known
    contact dermatitis / Delayed / Incidence not known
    phlebitis / Rapid / Incidence not known
    vaginal bleeding / Delayed / Incidence not known
    jaundice / Delayed / Incidence not known
    elevated hepatic enzymes / Delayed / Incidence not known
    hypotension / Rapid / Incidence not known
    superinfection / Delayed / Incidence not known
    pseudomembranous colitis / Delayed / Incidence not known

    Mild

    xerosis / Delayed / 1.0-23.0
    diarrhea / Early / 0-20.0
    pruritus / Rapid / 0-11.0
    headache / Early / 0-7.0
    back pain / Delayed / 5.0-5.0
    infection / Delayed / 0-2.0
    flatulence / Early / 0-1.0
    abdominal pain / Early / 0-1.0
    dyspepsia / Early / 0-1.0
    nausea / Early / 0-1.0
    vomiting / Early / 0-1.0
    dysmenorrhea / Delayed / 0-1.0
    pelvic pain / Delayed / 0-1.0
    vaginal discharge / Delayed / 0-1.0
    vaginal irritation / Early / 0-1.0
    dizziness / Early / 0-1.0
    vertigo / Early / 0-1.0
    fever / Early / 0-1.0
    epistaxis / Delayed / 0-1.0
    fatigue / Early / 0-1.0
    halitosis / Early / Incidence not known
    dysgeusia / Early / Incidence not known
    maculopapular rash / Early / Incidence not known
    rash / Early / Incidence not known
    ocular irritation / Rapid / Incidence not known
    vesicular rash / Delayed / Incidence not known
    urticaria / Rapid / Incidence not known
    ocular pain / Early / Incidence not known
    folliculitis / Delayed / Incidence not known
    seborrhea / Delayed / Incidence not known
    injection site reaction / Rapid / Incidence not known

    DRUG INTERACTIONS

    Acyclovir: (Moderate) Concomitant use of acyclovir and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Adefovir: (Moderate) Concomitant use of adefovir dipivoxil and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Aldesleukin, IL-2: (Moderate) Concomitant use of aldesleukin and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Amikacin: (Moderate) Concomitant use of aminoglycosides and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Aminoglycosides: (Moderate) Concomitant use of aminoglycosides and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Amoxicillin; Clarithromycin; Omeprazole: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of clarithromycin as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; clarithromycin is a strong inhibitor of CYP3A4.
    Amphotericin B cholesteryl sulfate complex (ABCD): (Moderate) Concomitant use of amphotericin B and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Amphotericin B lipid complex (ABLC): (Moderate) Concomitant use of amphotericin B and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Amphotericin B liposomal (LAmB): (Moderate) Concomitant use of amphotericin B and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Amphotericin B: (Moderate) Concomitant use of amphotericin B and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Apalutamide: (Moderate) Monitor for loss of clindamycin efficacy with coadministration of apalutamide as concurrent use may decrease clindamycin exposure. Clindamycin is a CYP3A4 substrate; apalutamide is a strong inducer of CYP3A4.
    Atazanavir: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of atazanavir as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; atazanavir is a strong inhibitor of CYP3A4.
    Atazanavir; Cobicistat: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of atazanavir as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; atazanavir is a strong inhibitor of CYP3A4. (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of cobicistat as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; cobicistat is a strong inhibitor of CYP3A4.
    Atracurium: (Moderate) Use neuromuscular blockers and lincosamides with caution. Concomitant use of neuromuscular blockers and lincosamides may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
    Bictegravir; Emtricitabine; Tenofovir Alafenamide: (Moderate) Concomitant use of tenofovir alafenamide and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Capreomycin: (Moderate) Partial neuromuscular blockade has been reported with capreomycin after the administration of large intravenous doses or rapid intravenous infusion. Clindamycin could potentiate the neuromuscular blocking effect of capreomycin by impairing transmission of impulses at the motor nerve terminals. If these drugs are used in combination, monitor patients for increased adverse effects.
    Carbamazepine: (Moderate) Monitor for loss of clindamycin efficacy with coadministration of carbamazepine as concurrent use may decrease clindamycin exposure. Clindamycin is a CYP3A4 substrate; carbamazepine is a strong inducer of CYP3A4.
    Carboplatin: (Moderate) Concomitant use of carboplatin and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Ceritinib: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of ceritinib as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; ceritinib is a strong inhibitor of CYP3A4.
    Chloramphenicol: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of chloramphenicol as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; chloramphenicol is a strong inhibitor of CYP3A4.
    Cidofovir: (Contraindicated) Concomitant use of cidofovir and clindamycin is contraindicated due to the increased risk of nephrotoxicity. Clindamycin must be discontinued at least 7 days prior to starting therapy with cidofovir.
    Cisatracurium: (Moderate) Use neuromuscular blockers and lincosamides with caution. Concomitant use of neuromuscular blockers and lincosamides may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
    Cisplatin: (Moderate) Concomitant use of cisplatin and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Clarithromycin: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of clarithromycin as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; clarithromycin is a strong inhibitor of CYP3A4.
    Clofarabine: (Moderate) Concomitant use of clofarabine and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Cobicistat: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of cobicistat as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; cobicistat is a strong inhibitor of CYP3A4.
    Colistin: (Moderate) Clindamycin can potentiate the neuromuscular blocking effect of colistimethate sodium by impairing transmission of impulses at the motor nerve terminals. If these drugs are used in combination, monitor patients for increased adverse effects. Neuromuscular blockade may be associated with colistimethate sodium, and is more likely to occur in patients with renal dysfunction.
    Cyclosporine: (Moderate) Concomitant use of cyclosporine and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Darunavir: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of darunavir as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; darunavir is a strong inhibitor of CYP3A4.
    Darunavir; Cobicistat: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of cobicistat as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; cobicistat is a strong inhibitor of CYP3A4. (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of darunavir as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; darunavir is a strong inhibitor of CYP3A4.
    Darunavir; Cobicistat; Emtricitabine; Tenofovir alafenamide: (Moderate) Concomitant use of tenofovir alafenamide and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required. (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of cobicistat as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; cobicistat is a strong inhibitor of CYP3A4. (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of darunavir as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; darunavir is a strong inhibitor of CYP3A4.
    Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of ritonavir as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; ritonavir is a strong inhibitor of CYP3A4.
    Deferasirox: (Moderate) Concomitant use of deferasirox and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required. Avoid use of clindamycin in pediatric patients (2 to 17 years) who develop decreases in renal function while receiving deferasirox.
    Delavirdine: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of delavirdine as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; delavirdine is a strong inhibitor of CYP3A4.
    Dienogest; Estradiol valerate: (Moderate) Anti-infectives that disrupt the normal GI flora, clindamycin, lincomycin, may potentially decrease the effectiveness of estrogen-containing oral contraceptives.
    Doravirine; Lamivudine; Tenofovir disoproxil fumarate: (Moderate) Concomitant use of tenofovir and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Doxacurium: (Moderate) Use neuromuscular blockers and lincosamides with caution. Concomitant use of neuromuscular blockers and lincosamides may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
    Efavirenz; Emtricitabine; Tenofovir Disoproxil Fumarate: (Moderate) Concomitant use of tenofovir and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Efavirenz; Lamivudine; Tenofovir Disoproxil Fumarate: (Moderate) Concomitant use of tenofovir and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Alafenamide: (Moderate) Concomitant use of tenofovir alafenamide and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required. (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of cobicistat as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; cobicistat is a strong inhibitor of CYP3A4.
    Elvitegravir; Cobicistat; Emtricitabine; Tenofovir Disoproxil Fumarate: (Moderate) Concomitant use of tenofovir and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required. (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of cobicistat as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; cobicistat is a strong inhibitor of CYP3A4.
    Emtricitabine; Rilpivirine; Tenofovir alafenamide: (Moderate) Concomitant use of tenofovir alafenamide and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Emtricitabine; Rilpivirine; Tenofovir Disoproxil Fumarate: (Moderate) Concomitant use of tenofovir and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Emtricitabine; Tenofovir alafenamide: (Moderate) Concomitant use of tenofovir alafenamide and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Emtricitabine; Tenofovir Disoproxil Fumarate: (Moderate) Concomitant use of tenofovir and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Enzalutamide: (Moderate) Monitor for loss of clindamycin efficacy with coadministration of enzalutamide as concurrent use may decrease clindamycin exposure. Clindamycin is a CYP3A4 substrate; enzalutamide is a strong inducer of CYP3A4.
    Estradiol Cypionate; Medroxyprogesterone: (Moderate) Anti-infectives which disrupt the normal GI flora, including lincomycin and clindamycin, may potentially decrease the effectiveness of estrogen containing oral contraceptives. Alternative or additional contraception may be advisable.
    Estradiol: (Moderate) Anti-infectives that disrupt the normal GI flora, clindamycin, lincomycin, may potentially decrease the effectiveness of estrogen-containing oral contraceptives. (Moderate) Anti-infectives which disrupt the normal GI flora, including lincomycin and clindamycin, may potentially decrease the effectiveness of estrogen containing oral contraceptives. Alternative or additional contraception may be advisable.
    Ethiodized Oil: (Moderate) Concomitant use of non-ionic contrast media and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Fosamprenavir: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of fosamprenavir as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; fosamprenavir is a strong inhibitor of CYP3A4.
    Foscarnet: (Major) Avoid concomitant use of foscarnet and clindamycin; coadministration may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Fosphenytoin: (Moderate) Monitor for loss of clindamycin efficacy with coadministration of fosphenytoin as concurrent use may decrease clindamycin exposure. Clindamycin is a CYP3A4 substrate; phenytoin is a strong inducer of CYP3A4.
    Ganciclovir: (Moderate) Concomitant use of ganciclovir and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Gentamicin: (Moderate) Concomitant use of aminoglycosides and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Grapefruit juice: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of grapefruit juice as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; grapefruit juice is a strong inhibitor of CYP3A4.
    Idelalisib: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of idelalisib as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; idelalisib is a strong inhibitor of CYP3A4.
    Indinavir: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of indinavir as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; indinavir is a strong inhibitor of CYP3A4.
    Iodipamide Meglumine: (Moderate) Concomitant use of ionic contrast media and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Iodixanol: (Moderate) Concomitant use of non-ionic contrast media and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Iohexol: (Moderate) Concomitant use of non-ionic contrast media and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Iomeprol: (Moderate) Concomitant use of non-ionic contrast media and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Ionic Contrast Media: (Moderate) Concomitant use of ionic contrast media and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Iopamidol: (Moderate) Concomitant use of non-ionic contrast media and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Iopromide: (Moderate) Concomitant use of non-ionic contrast media and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Ioversol: (Moderate) Concomitant use of non-ionic contrast media and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Ioxaglate Meglumine; Ioxaglate Sodium: (Moderate) Concomitant use of ionic contrast media and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Isoflurane: (Moderate) Concurrent use of isoflurane with systemic clindamycin can result in an additive neuromuscular blockade.
    Isoniazid, INH; Pyrazinamide, PZA; Rifampin: (Moderate) Monitor for loss of clindamycin efficacy with coadministration of rifampin as concurrent use may decrease clindamycin exposure. Clindamycin is a CYP3A4 substrate; rifampin is a strong inducer of CYP3A4.
    Isoniazid, INH; Rifampin: (Moderate) Monitor for loss of clindamycin efficacy with coadministration of rifampin as concurrent use may decrease clindamycin exposure. Clindamycin is a CYP3A4 substrate; rifampin is a strong inducer of CYP3A4.
    Isosulfan Blue: (Moderate) Concomitant use of non-ionic contrast media and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Itraconazole: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of itraconazole as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; itraconazole is a strong inhibitor of CYP3A4.
    Kanamycin: (Moderate) Concomitant use of aminoglycosides and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Ketoconazole: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of ketoconazole as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; ketoconazole is a strong inhibitor of CYP3A4.
    Lamivudine; Tenofovir Disoproxil Fumarate: (Moderate) Concomitant use of tenofovir and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Lansoprazole; Amoxicillin; Clarithromycin: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of clarithromycin as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; clarithromycin is a strong inhibitor of CYP3A4.
    Letermovir: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of letermovir as concurrent use may increase clindamycin exposure. In patients who are also receiving treatment with cyclosporine, the magnitude of this interaction may be amplified. Clindamycin is a CYP3A4 substrate. Letermovir is a moderate CYP3A4 inhibitor; however, when given with cyclosporine, the combined effect on CYP3A4 substrates may be similar to a strong CYP3A4 inhibitor.
    Levoketoconazole: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of ketoconazole as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; ketoconazole is a strong inhibitor of CYP3A4.
    Lithium: (Moderate) Moderate to significant dietary sodium changes, or changes in sodium and fluid intake, may affect lithium excretion. Systemic sodium chloride administration may result in increased lithium excretion and therefore, decreased serum lithium concentrations. In addition, high fluid intake may increase lithium excretion. For patients receiving sodium-containing intravenous fluids, symptom control and lithium concentrations should be carefully monitored. It is recommended that patients taking lithium maintain consistent dietary sodium consumption and adequate fluid intake during the initial stabilization period and throughout lithium treatment. Supplemental oral sodium and fluid should be only be administered under careful medical supervision.
    Lonafarnib: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of lonafarnib as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; lonafarnib is a strong inhibitor of CYP3A4.
    Lopinavir; Ritonavir: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of ritonavir as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; ritonavir is a strong inhibitor of CYP3A4.
    Lumacaftor; Ivacaftor: (Moderate) Monitor for loss of clindamycin efficacy with coadministration of lumacaftor as concurrent use may decrease clindamycin exposure. Clindamycin is a CYP3A4 substrate; lumacaftor is a strong inducer of CYP3A4.
    Lumacaftor; Ivacaftor: (Moderate) Monitor for loss of clindamycin efficacy with coadministration of lumacaftor as concurrent use may decrease clindamycin exposure. Clindamycin is a CYP3A4 substrate; lumacaftor is a strong inducer of CYP3A4.
    Mannitol: (Major) Avoid concomitant use of mannitol and clindamycin; coadministration may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Mesalamine, 5-ASA: (Moderate) Concomitant use of mesalamine and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Mifepristone: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of mifepristone as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; mifepristone is a strong inhibitor of CYP3A4.
    Mitotane: (Moderate) Monitor for loss of clindamycin efficacy with coadministration of mitotane as concurrent use may decrease clindamycin exposure. Clindamycin is a CYP3A4 substrate; mitotane is a strong inducer of CYP3A4.
    Mivacurium: (Moderate) Use neuromuscular blockers and lincosamides with caution. Concomitant use of neuromuscular blockers and lincosamides may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
    Nefazodone: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of nefazodone as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; nefazodone is a strong inhibitor of CYP3A4.
    Nelfinavir: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of nelfinavir as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; nelfinavir is a strong inhibitor of CYP3A4.
    Neomycin: (Moderate) Concomitant use of neomycin and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Neuromuscular blockers: (Moderate) Use neuromuscular blockers and lincosamides with caution. Concomitant use of neuromuscular blockers and lincosamides may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
    Nirmatrelvir; Ritonavir: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of ritonavir as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; ritonavir is a strong inhibitor of CYP3A4.
    Non-Ionic Contrast Media: (Moderate) Concomitant use of non-ionic contrast media and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Ombitasvir; Paritaprevir; Ritonavir: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of ritonavir as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; ritonavir is a strong inhibitor of CYP3A4.
    Oral Contraceptives: (Moderate) It would be prudent to recommend alternative or additional contraception when oral contraceptives (OCs) are used in conjunction with antibiotics. It was previously thought that antibiotics may decrease the effectiveness of OCs containing estrogens due to stimulation of metabolism or a reduction in enterohepatic circulation via changes in GI flora. One retrospective study reviewed the literature to determine the effects of oral antibiotics on the pharmacokinetics of contraceptive estrogens and progestins, and also examined clinical studies in which the incidence of pregnancy with OCs and antibiotics was reported. It was concluded that the antibiotics ampicillin, ciprofloxacin, clarithromycin, doxycycline, metronidazole, ofloxacin, roxithromycin, temafloxacin, and tetracycline did not alter plasma concentrations of OCs. Antituberculous drugs (e.g., rifampin) were the only agents associated with OC failure and pregnancy. Based on the study results, these authors recommended that back-up contraception may not be necessary if OCs are used reliably during oral antibiotic use. Another review concurred with these data, but noted that individual patients have been identified who experienced significant decreases in plasma concentrations of combined OC components and who appeared to ovulate; the agents most often associated with these changes were rifampin, tetracyclines, and penicillin derivatives. These authors concluded that because females most at risk for OC failure or noncompliance may not be easily identified and the true incidence of such events may be under-reported, and given the serious consequence of unwanted pregnancy, that recommending an additional method of contraception during short-term antibiotic use may be justified. During long-term antibiotic administration, the risk for drug interaction with OCs is less clear, but alternative or additional contraception may be advisable in selected circumstances. Data regarding progestin-only contraceptives or for newer combined contraceptive deliveries (e.g., patches, rings) are not available.
    Pamidronate: (Moderate) Concomitant use of pamidronate and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Pancuronium: (Moderate) Use neuromuscular blockers and lincosamides with caution. Concomitant use of neuromuscular blockers and lincosamides may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
    Paromomycin: (Moderate) Concomitant use of aminoglycosides and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Pentamidine: (Moderate) Concomitant use of pentamidine and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Phenobarbital: (Moderate) Monitor for loss of clindamycin efficacy with coadministration of phenobarbital as concurrent use may decrease clindamycin exposure. Clindamycin is a CYP3A4 substrate; phenobarbital is a strong inducer of CYP3A4.
    Phenobarbital; Hyoscyamine; Atropine; Scopolamine: (Moderate) Monitor for loss of clindamycin efficacy with coadministration of phenobarbital as concurrent use may decrease clindamycin exposure. Clindamycin is a CYP3A4 substrate; phenobarbital is a strong inducer of CYP3A4.
    Phenytoin: (Moderate) Monitor for loss of clindamycin efficacy with coadministration of phenytoin as concurrent use may decrease clindamycin exposure. Clindamycin is a CYP3A substrate; phenytoin is a strong inducer of CYP3A.
    Plazomicin: (Moderate) Concomitant use of aminoglycosides and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Posaconazole: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of posaconazole as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; posaconazole is a strong inhibitor of CYP3A4.
    Primidone: (Moderate) Monitor for loss of clindamycin efficacy with coadministration of primidone as concurrent use may decrease clindamycin exposure. Clindamycin is a CYP3A4 substrate; primidone is a strong inducer of CYP3A4.
    Rapacuronium: (Moderate) Use neuromuscular blockers and lincosamides with caution. Concomitant use of neuromuscular blockers and lincosamides may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
    Rifampin: (Moderate) Monitor for loss of clindamycin efficacy with coadministration of rifampin as concurrent use may decrease clindamycin exposure. Clindamycin is a CYP3A4 substrate; rifampin is a strong inducer of CYP3A4.
    Rifapentine: (Moderate) Monitor for loss of clindamycin efficacy with coadministration of rifapentine as concurrent use may decrease clindamycin exposure. Clindamycin is a CYP3A4 substrate; rifapentine is a strong inducer of CYP3A4.
    Ritonavir: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of ritonavir as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; ritonavir is a strong inhibitor of CYP3A4.
    Rocuronium: (Moderate) Use neuromuscular blockers and lincosamides with caution. Concomitant use of neuromuscular blockers and lincosamides may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
    Salicylic Acid: (Moderate) When concomitantly prescribed for acne therapy, apply salicylic acid and clindamycin topical solutions separately, at different times of the day to minimize skin irritation, unless directed otherwise by the prescriber. If skin irritation occurs, a decrease in dose or frequency of one or both agents may be necessary.
    Sevoflurane: (Moderate) Concurrent use of sevoflurane with systemic clindamycin can result in an additive neuromuscular blockade.
    Sodium picosulfate; Magnesium oxide; Anhydrous citric acid: (Major) Prior or concomitant use of antibiotics with sodium picosulfate; magnesium oxide; anhydrous citric acid may reduce efficacy of the bowel preparation as conversion of sodium picosulfate to its active metabolite bis-(p-hydroxy-phenyl)-pyridyl-2-methane (BHPM) is mediated by colonic bacteria. If possible, avoid coadministration. Certain antibiotics (i.e., tetracyclines and quinolones) may chelate with the magnesium in sodium picosulfate; magnesium oxide; anhydrous citric acid solution. Therefore, these antibiotics should be taken at least 2 hours before and not less than 6 hours after the administration of sodium picosulfate; magnesium oxide; anhydrous citric acid solution.
    Sodium Thiosulfate; Salicylic Acid: (Moderate) When concomitantly prescribed for acne therapy, apply salicylic acid and clindamycin topical solutions separately, at different times of the day to minimize skin irritation, unless directed otherwise by the prescriber. If skin irritation occurs, a decrease in dose or frequency of one or both agents may be necessary.
    St. John's Wort, Hypericum perforatum: (Moderate) Monitor for loss of clindamycin efficacy with coadministration of St. John's Wort as concurrent use may decrease clindamycin exposure. In the presence of strong CYP3A4 inducers, monitor for loss of clindamycin effectiveness. Clindamycin is a CYP3A4 substrate; St. John's Wort is a strong inducer of CYP3A4.
    Streptomycin: (Moderate) Concomitant use of aminoglycosides and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Streptozocin: (Moderate) Concomitant use of streptozocin and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Succinylcholine: (Moderate) Use neuromuscular blockers and lincosamides with caution. Concomitant use of neuromuscular blockers and lincosamides may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
    Tacrolimus: (Moderate) Concomitant use of tacrolimus and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Telavancin: (Moderate) Concomitant use of telavancin and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Telithromycin: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of telithromycin as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; telithromycin is a strong inhibitor of CYP3A4.
    Tenofovir Alafenamide: (Moderate) Concomitant use of tenofovir alafenamide and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Tenofovir Alafenamide: (Moderate) Concomitant use of tenofovir alafenamide and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Tenofovir Disoproxil Fumarate: (Moderate) Concomitant use of tenofovir and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Tobramycin: (Moderate) Concomitant use of aminoglycosides and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Tolvaptan: (Moderate) Coadministration of tolvaptan and hypertonic saline (e.g., 3% NaCl injection solution) is not recommended. The use of hypertonic sodium chloride in combination with tolvaptan may result in a too rapid correction of hyponatremia and increase the risk of osmotic demyelination (i.e., central pontine myelinolysis).
    Tucatinib: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of tucatinib as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; tucatinib is a strong inhibitor of CYP3A4.
    Valacyclovir: (Moderate) Concomitant use of valacyclovir and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Valganciclovir: (Moderate) Concomitant use of valganciclovir and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Vancomycin: (Moderate) Concomitant use of vancomycin and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Vecuronium: (Moderate) Use neuromuscular blockers and lincosamides with caution. Concomitant use of neuromuscular blockers and lincosamides may prolong neuromuscular blockade. The use of a peripheral nerve stimulator is strongly recommended to evaluate the level of neuromuscular blockade, to assess the need for additional doses of neuromuscular blocker, and to determine whether adjustments need to be made to the dose with subsequent administration.
    Voclosporin: (Moderate) Concomitant use of voclosporine and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.
    Vonoprazan; Amoxicillin; Clarithromycin: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of clarithromycin as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; clarithromycin is a strong inhibitor of CYP3A4.
    Voriconazole: (Moderate) Monitor for an increase in clindamycin-related adverse reactions with coadministration of voriconazole as concurrent use may increase clindamycin exposure. Clindamycin is a CYP3A4 substrate; voriconazole is a strong inhibitor of CYP3A4.
    Zoledronic Acid: (Moderate) Concomitant use of zoledronic acid and clindamycin may result in additive nephrotoxicity. Monitor for renal toxicity if concomitant use is required.

    PREGNANCY AND LACTATION

    Pregnancy

    In clinical trials with pregnant women, no congenital abnormalities have been associated with systemic administration of clindamycin during the second or third trimester. However, in a large population-based cohort study (n = 139,938 live births) assessing antibiotic exposure during the first trimester of pregnancy (n = 15,469 exposures) and the risk of major birth defects, clindamycin was associated with an increased risk of major congenital malformations (adjusted odds ratio (aOR) 1.34; 95% CI: 1.02 to 1.77; 60 exposed cases). Clindamycin exposure increased the risk of musculoskeletal system malformations (aOR 1.67; 95% CI: 1.12 to 2.48; 29 exposed cases) and ventricular/atrial septal defect (aOR 1.81; 95% CI: 1.04 to 3.16; 13 exposed cases). Use clindamycin during the first trimester of pregnancy only if clearly needed and the benefits outweigh the risks. Placental concentrations are roughly 50% of maternal serum concentrations. Parenteral clindamycin also contains benzyl alcohol, which can cross the placenta; benzyl alcohol has been associated with a fatal 'gasping syndrome' in neonates. Clindamycin vaginal cream has been studied during pregnancy to reduce preterm birth and treat asymptomatic bacterial vaginosis. In 1 trial (n = 409), women who were treated with 2% clindamycin vaginal cream prior to 20 weeks gestation demonstrated a reduction in preterm birth compared to placebo (p less than 0.03). In 3 other trials, intravaginal clindamycin cream was administered at 16 to 32 weeks gestation, and an increase in adverse events, such as low birthweight, pre-term delivery, premature rupture of the membranes, and neonatal infections, was observed in newborns. Clindamycin vaginal gel has not been studied in pregnant women; however, based on low systemic absorption, maternal use is not likely to result in significant fetal exposure. There are no adequate, well-controlled studies of topical clindamycin in pregnant women.

    Clindamycin is excreted into human breast milk after administration by the oral or parenteral routes in concentrations of less than 0.5 to 3.8 mcg/mL. Because of the potential for serious gastrointestinal adverse reactions in the breast-fed infant, an alternative drug to clindamycin may be preferred during breast-feeding. Consider the developmental and health benefits of breast-feeding along with the mother's clinical need for clindamycin and any potential adverse effects on the breast-fed infant from clindamycin or the underlying maternal condition. If clindamycin is used during breast-feeding, monitor the infant for possible adverse effects on the gastrointestinal flora such as diarrhea, candidiasis (thrush, diaper rash), or rarely, blood in the stool indicating possible antibiotic-associated colitis.[29120] [44982] Diarrhea and bloody stools were reported in a 5-day-old infant whose mother was receiving intravenous clindamycin and gentamicin for suspected endometriosis.[46304] Previous American Academy of Pediatrics recommendations considered clindamycin as usually compatible with breast-feeding.[27500] It is unknown if clindamycin is excreted into human breast milk after the use of vaginally or topically administered clindamycin.[31059] [44984] [42862] Systemic absorption after intravaginal administration is low; therefore, transfer of clindamycin into breast milk is likely to be low and adverse effects on the breast-fed infant are not expected. If clindamycin is topically applied to the chest, care should be taken to avoid accidental ingestion by the infant.[42862] There are no data on the effect of clindamycin on milk production.

    MECHANISM OF ACTION

    Clindamycin binds to the 23S RNA of the 50S ribosomal subunit of the bacteria, which inhibits protein synthesis. As with lincomycin, antibacterial activity results from inhibition of protein synthesis. Clindamycin is bacteriostatic. The mechanism of action of clindamycin in treating acne vulgaris is unknown.[29120] [31059]
     
    The susceptibility interpretive criteria for clindamycin are delineated by pathogen. The MICs are defined for beta-hemolytic streptococci, S. viridans group, and S. pneumoniae as susceptible at 0.25 mcg/mL or less, intermediate at 0.5 mcg/mL, and resistant at 1 mcg/mL or more. The MICs are defined for Staphylococcus sp. as susceptible at 0.5 mcg/mL or less, intermediate at 1 to 2 mcg/mL, and resistant at 4 mcg/mL or more. The MICs are defined for anaerobes as susceptible at 2 mcg/mL or less, intermediate at 4 mcg/mL, and resistant at 8 mcg/mL or more.[63320] [63321]
     
    Resistance to clindamycin is most often caused by modification of specific bases of the 23S ribosomal RNA. Cross-resistance between clindamycin and lincomycin is complete. Due to overlapping binding sites, cross-resistance is sometimes observed among lincosamides, macrolides, and streptogramin B. Clindamycin inducible resistance has been identified in macrolide-resistant organisms; therefore, macrolide-resistant and clindamycin-susceptible strains should be screened for inducible clindamycin resistance using the D-zone test.[29120] [31059] [44983] [46693] [63321]
     
    Clindamycin is a well-known cause of pseudomembranous colitis, possibly due to overgrowth of Clostridia difficile, and 10% to 20% of strains of Clostridia perfringens can be resistant to clindamycin.[29120] Increased resistance has also been seen in some strains of B. fragilis.[49877] One study reported marked antibiotic resistance after treatment of bacterial vaginosis with clindamycin; resistance persisted for up to 90 days after treatment.[30500]

    PHARMACOKINETICS

    Clindamycin is administered by the oral, parenteral, topical, and vaginal routes. Oral or parenteral doses are widely distributed into most body tissues, with high concentrations in bone, bile, and urine. Cerebrospinal fluid (CSF) concentrations are poor, and clindamycin is not indicated for the treatment of meningitis. It is, however, useful in treating toxoplasma encephalitis. It is highly protein bound (80% to 95%), primarily to alpha1-acid glycoprotein. Clindamycin is metabolized to 2 bioactive metabolites, clindamycin sulfoxide and N-desmethylclindamycin, and various inactive metabolites. After oral dosage, only about 10% is excreted in the urine as active drug and metabolites, and about 3.6% in the feces. The remainder is excreted as inactive metabolites. The plasma half-life in adults with normal renal function is 2 to 3 hours.
     
    Affected cytochrome P450 isoenzymes and drug transporters: CYP3A4, CYP3A5
    Clindamycin is metabolized primarily by CYP3A4, and to a lesser extent by CYP3A5. Drugs that are inhibitors or inducers of these enzymes may interact with clindamycin. In vitro studies have shown that clindamycin does not inhibit CYP1A2, CYP2C9, CYP2C19, CYP2E1, or CYP2D6, and only moderately inhibits CYP3A4.

    Oral Route

    About 90% of an oral dose of clindamycin is absorbed after oral administration. Absorption from the gut is rapid. The rate but not the extent of absorption can be delayed by food. Clindamycin palmitate and clindamycin phosphate require hydrolysis to form free clindamycin, which occurs readily in the bloodstream. In adults, peak serum concentrations are achieved within 45 to 60 minutes after oral administration. Peak serum concentrations are similar after oral administration of either the hydrochloride or the palmitate salt.

    Intravenous Route

    By the end of a short-term infusion (10 to 30 minutes), peak serum concentrations are reached.

    Intramuscular Route

    Peak concentrations are reached within 3 hours in adults and 1 hour in children after IM administration.

    Topical Route

    Some systemic absorption does occur after topical administration, depending on the surface area covered. Clindamycin phosphate appears to be less well absorbed through the skin than is the hydrochloride. Topical preparations are marketed as clindamycin phosphate.

    Other Route(s)

    Vaginal Route
    Clinicians should note that up to 30% of a vaginally applied clindamycin dosage (ovules) is systemically absorbed; systemic absorption with clindamycin vaginal cream is approximately 5%.