Cleocin (Clindamycin) Indications and Dosage
- acne rosacea †
- acne vulgaris
- Actinomyces sp.
- Babesia microti
- Bacillus anthracis †
- bacteremia
- bacterial vaginosis
- Bacteroides fragilis
- Bacteroides sp.
- bone and joint infections
- Clostridium perfringens
- Clostridium sp.
- Clostridium tetani
- Corynebacterium diphtheriae
- Corynebacterium sp.
- diabetic foot ulcer
- empyema
- endocarditis prophylaxis
- endometritis
- erythrasma †
- Eubacterium sp.
- folliculitis †
- Fusobacterium sp.
- Gardnerella vaginalis
- gynecologic infections
- intraabdominal abscess
- intraabdominal infections
- lower respiratory tract infections
- lung abscess
- malaria †
- Mobiluncus sp.
- Mycoplasma sp.
- osteomyelitis
- pelvic cellulitis
- pelvic inflammatory disease (PID)
- pemphigus †
- Peptococcus sp.
- Peptostreptococcus sp.
- peritonitis
- Plasmodium falciparum
- Pneumocystis carinii
- Pneumocystis carinii pneumonia (PCP) †
- pneumonia
- Porphyromonas sp.
- Prevotella melaninogenica
- Prevotella sp.
- Propionibacterium sp.
- septicemia
- skin and skin structure infections
- Staphylococcus aureus (MSSA)
- Staphylococcus epidermidis
- Streptococcus pneumoniae
- Streptococcus pyogenes (group A beta-hemolytic streptococci)
- Streptococcus sp.
- Toxoplasma gondii
- toxoplasmic encephalitis †
- toxoplasmosis †
- toxoplasmosis prophylaxis †
- tubo-ovarian abscess
- Veillonella sp.
† non-FDA-approved indication
Cleocin Indications...Dosage
The following organisms are generally considered susceptible to clindamycin in vitro: Actinomyces sp.; Babesia microti; Bacillus anthracis † ; Bacteroides fragilis; Prevotella melaninogenica; Bacteroides sp.; Clostridium perfringens; Clostridium sp.; Clostridium tetani; Corynebacterium diphtheriae; Corynebacterium sp.; Cryptosporidium parvum; Eubacterium sp.; Fusobacterium sp.; Gardnerella vaginalis; Mobiluncus sp.; Mycoplasma sp.; Peptococcus sp.; Peptostreptococcus sp.; Plasmodium falciparum; Pneumocystis carinii pneumonia (PCP) † ; Pneumocystis carinii; Porphyromonas sp.; Prevotella sp.; Propionibacterium sp.; Staphylococcus aureus (MSSA); Staphylococcus epidermidis; Streptococcus pneumoniae; Streptococcus pyogenes (group A beta-hemolytic streptococci); Streptococcus sp.; Toxoplasma gondii; Veillonella sp.
For the treatment of lower respiratory tract infections (e.g. empyema, anaerobic pneumonia, and lung abscess); skin and skin structure infections (e.g. diabetic foot ulcer); intraabdominal infections (e.g. peritonitis, intraabdominal abscess); gynecologic infections (e.g. endometritis, pelvic cellulitis and postsurgical vaginal cuff infection); bone and joint infections (e.g. osteomyelitis); septicemia and bacteremia; and other anaerobic infections due to susceptible organisms:
Oral dosage (clindamycin hydrochloride capsules):
Adults: 150-450 mg PO every 6 hours, taken with a full glass of water.
Children > 10 kg: 8-20 mg/kg/day PO in equally divided doses every 6 or 8 hours. The dosage given is dependent on the severity of the infection.
Oral dosage (clindamycin palmitate hydrochloride oral granules):
Children > 10 kg: 8-25 mg/kg/day PO in equally divided doses every 6 or 8 hours. The dosage given is dependent on the severity of the infection.
Children <= 10 kg: 37.5 mg PO three times per day should be considered the minimum dose.
Intravenous or Intramuscular dosage (clindamycin phosphate):
Adults: 300 mg IV or IM every 6, 8 or 12 hours. Up to 2700 mg per day IV or IM, divided every 6, 8 or 12 hours may be used for severe infection. Daily doses up to 4800 mg IV have been given. IM doses above 600 mg are not recommended.
Children and infants >= 1 month: 20-40 mg/kg/day IM or IV, in equally divided doses every 6 or 8 hours. Or 350-450 mg/m2/day.
Neonates, postnatal age > 7 days weighing > 2000 g: 20 mg/kg/day IV or IM in equally divided doses every 6-8 hours.
Neonates, postnatal age > 7 days weighing 1200-2000 g: 15 mg/kg/day IV or IM in equally divided doses every 8 hours.
Neonates, postnatal age > 7 days weighing < 1200 g: 10 mg/kg/day IV or IM in equally divided doses every 12 hours.
Neonates, postnatal age <= 7 days weighing > 2000 g: 15 mg/kg/day IV or IM in equally divided doses every 8 hours.
Neonates, postnatal age <= 7 days weighing <= 2000 g: 10 mg/kg/day IV or IM in equally divided doses every 12 hours.
- for the treatment of Pneumocystis carinii pneumonia (PCP) † in combination with primaquine:
Intravenous followed by oral dosage:
Adults weighing > 60 kg: In a pilot study, clindamycin 600 mg IV every 6 hours for 10 days then 450 mg PO every 6 hours for the first 11 days in combination with primaquine base for the full 21 days was successful. In a larger, double-blind study, clindamycin was dosed at 600 mg PO tid for 21 days when administered in combination with primaquine and this regimen was as efficacious as TMP-SMX however hematologic toxicity was more frequent in the clindamycin-primaquine group.
Adults weighing < 60 kg: 450 mg IV every 6 hours for 10 days then 300 mg PO every 6 hours for the first 11 days in combination with primaquine base 15 mg PO for the full 21 days.
For the treatment of acute pelvic inflammatory disease (PID) with or without associated tubo-ovarian abscess:
Intravenous and oral dosage:
Adults and adolescents: The CDC recommends 900 mg IV every 8 hours in combination with gentamicin. Parenteral therapy may be discontinued 24 hours after a patient improves clinically, and therapy should be continued with oral clindamycin 450 mg PO four times per day or oral doxycycline to complete a total of 14 days of therapy. Alternatively, a regimen of clindamycin 900 mg IV every 8 hours in combination with gentamicin IV and ampicillin IV ( i.e., triple therapy) has been recommended, particularly when PID is complicated by tubo-ovarian abscess.
For the treatment of acne vulgaris:
Topical dosage (gel, lotion, or solution):
Adults and adolescents: 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 8-12 weeks of topical application.
Topical dosage (foam):
Adults and adolescents: Apply 1% topical foam to affected areas once daily. Improvement is usually seen after 6 weeks, but may require 8-12 weeks of topical application.
For the treatment of bacterial vaginosis:
Intravaginal dosage (vaginal creams except Clindesse™):
Nonpregnant adult and adolescent females: The CDC recommends one applicatorful (100 mg clindamycin/5 g cream) intravaginally at bedtime for 7 days. The FDA approved regimen is one applicatorful (100 mg clindamycin/5 g cream) intravaginally at bedtime for 3 or 7 consecutive days.
Pregnant adult and adolescent females (second or third trimester): One applicatorful (100 mg clindamycin/5 g cream) intravaginally once daily, preferably at bedtime, for 7 days. According to the CDC, use of clindamycin vaginal cream is not recommended during pregnancy because data from two randomized trials indicate an increase in the number of preterm deliveries with this medication. However, in a placebo-controlled, randomized, double-blind study, 409 pregnant women between 13 and 20 weeks’ gestation with asymptomatic bacterial vaginosis self-administered 5 g 2% clindamycin cream intravaginally or placebo nightly for 3 consecutive nights. Compared to placebo, clindamycin reduced the incidence of preterm births by 60%.
Intravaginal dosage (Clindesse™ vaginal cream ONLY):
Nonpregnant adult and adolescent females: One applicatorful (100 mg clindamycin/5 g cream) intravaginally as a single dose at any time of the day.
Intravaginal dosage (ovules/suppositories):
Nonpregnant adult and adolescent females: As an alternative to first-line therapies, the CDC recommends one ovule (100 mg clindamycin) inserted intravaginally at bedtime for 3 days.
Oral dosage (capsules):
Nonpregnant adult and adolescent females: The CDC recommends clindamycin 300 mg PO twice daily for 7 days.
Pregnant adult and adolescent females: As an alternative to oral metronidazole, the CDC recommends clindamycin 300 mg PO twice daily for 7 days for either high-risk (i.e., those who have previously delivered a premature infant) or low-risk (i.e., those who previously have not had a premature delivery) pregnant women. One study reported marked antibiotic resistance after treatment of bacterial vaginosis with clindamycin; resistance persisted for up to 90 days after treatment.
For the treatment of infection due to Gardnerella † , specifically, Gardnerella vaginalis vaginitis † :
Oral dosage:
Adults: 300 mg PO twice daily for 7 days.
For toxoplasmic encephalitis † (toxoplasmosis † ) in combination with pyrimethamine:
Oral dosage:
Adults: In an open label stud, 49 patients who were either HIV-positive or at high risk for HIV infection were treated with pyrimethamine-leucovorin-clindamycin for 6 weeks. Clindamycin was administered as 600 mg PO every 6 hours throughout the study. After 6 weeks of combination therapy, 71% of patients demonstrated a response and 24% had no response (2 patients could not be evaluated).
Intravenous followed by oral dosage:
Adults: In a randomized trial published in 1992, 59 patients with AIDS and presumptive TE were treated for 6 weeks with pyrimethamine-leucovorin-clindamycin or pyrimethamine-leucovorin-sulfadiazine. Although there was a trend towards greater efficacy at 42 days for the sulfadiazine group, this trend was not statistically significant. Clindamycin dosing was 1200 mg IV every 6 hours for the first 3 weeks, then either 300 mg PO every 6 hours or 450 mg PO every 8 hours for the second 3 weeks.
For secondary toxoplasmosis prophylaxis † of in HIV-infected patients after treatment for an acute episode of toxoplasmic encephalitis in patients who cannot tolerate sulfa drugs:
Oral dosage:
Adults and adolescents: The CDC recommends clindamycin 300-450 mg PO every 6-8 hours in combination with pyrimethamine plus leucovorin. Unlike the preferred regimen containing sulfadiazine and pyrimethamine, this regimen does not provide adequate prophylaxis against Pneumocystis carinii. Secondary prophylaxis may be discontinued in asymptomatic patients who have a sustained increase in their CD4+ counts > 200 cells/mm3 following highly active antiretroviral therapy for >= 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 < 200 cells/mm3.
Children and infants: The CDC recommends clindamycin 20-30 mg/kg/day PO in 4 divided doses, in combination with pyrimethamine (1 mg/kg PO once daily) and leucovorin (5 mg PO every 3 days). Unlike the preferred regimen containing sulfadiazine and pyrimethamine, this regimen does not provide adequate prophylaxis against Pneumocystis carinii. Children with a history of toxoplasmosis should be given lifelong prophylaxis to prevent recurrence.
For bacterial endocarditis prophylaxis in at risk patients who are undergoing dental, oral, respiratory tract, or esophageal procedures and who are allergic to amoxicillin, ampicillin, and penicillin:
Oral dosage:
Adults: The recommended dose is 600 mg PO 1 hour before procedure.
Children: The recommended dose is 20 mg/kg PO 1 hour before procedure. Maximum dose 600 mg.
Intravenous dosage:
Adults unable to take oral medications: The recommended dose is 600 mg IV within 30 minutes before procedure.
Children unable to take oral medications: The recommended dose is 20 mg/kg IV within 30 minutes before procedure. Maximum dose 600 mg.
For the treatment of minor skin infection such as erythrasma † , folliculitis † , pemphigus † , or acne rosacea † :
Topical dosage:
Adults: Apply a thin film of 1% solution to affected areas twice daily.
For the treatment of malaria † due to chloroquine-resistant Plasmodium falciparum in combination with quinine sulfate:
Oral dosage:
Adults: 900 mg PO three times per day for 3 days.
Children: 20-40 mg/kg/day PO divided in 3 doses for 3 days.
Maximum Dosage Limits:
- Adults: 4800 mg/day IV has been given for severe infection; 2700 mg/day PO.
- Elderly: 4800 mg/day IV has been given for severe infection; 2700 mg/day PO.
- Adolescents <= 16 years: 40 mg/kg/day IV; 20 mg/kg/day PO.
- Children: 40 mg/kg/day IV; 20 mg/kg/day PO.
- Infants >= 1 month: 40 mg/kg/day IV; 20 mg/kg/day PO.
- Neonates: 20 mg/kg/day IV.
- Premature Neonates: 20 mg/kg/day IV.
- Premature neonates of low birth weight: 15 mg/kg/day IV.
Patients with hepatic impairment:
The manufacturer states that dosage reduction may not be necessary when the drug is given at 8 hour intervals; however, liver function monitoring is recommended in the patient with severe liver disease.
Patients with renal impairment:
The manufacturer states that dosage adjustment of clindamycin may not be necessary in patients with renal impairment. Other experts have also recommended against dosage adjustment. Only 10% of clindamycin is eliminated renally.
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 CAPD.
† non-FDA-approved indication
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