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clindamycin
generic
Black Box Warnings .
C. difficile-assoc. Diarrhea
rxns ranging in severity from mild diarrhea to fatal colitis reported during tx and even >2mo after D/C; reserve clindamycin for serious infections where less toxic abx inappropriate; do not use in nonbacterial infections incl. most URI; abx alter colon flora, leading to C. difficile overgrowth; C. difficile produces toxins A and B, which contribute to C. difficile-assoc. diarrhea; hypertoxin-producing strains cause incr. morbidity and mortality since infections can be refractory to abx tx and may require colectomy; consider C. difficile-assoc. diarrhea in all pts presenting w/ diarrhea after abx tx; consider D/C clindamycin if C. difficile-assoc. diarrhea suspected or confirmed; provide appropriate fluids, electrolytes, protein supplementation, abx, and surgical eval. as clinically indicated
Adult Dosing .
Dosage forms: CAP: 75 mg, 150 mg, 300 mg; INJ: various
infections, bacterial
- [150-450 mg PO q6h]
- Max: 600 mg/dose IM; 4800 mg/day IV; Alt: 600-2700 mg/day IM/IV divided q6-12h; Info: use IV for severe infections
pharyngitis, streptococcal
- [300 mg PO q8h x10 days]
bacterial vaginosis
- [300 mg PO q12h x7 days]
- Info: not 1st-line agent
PID, severe
- [900 mg IV q8h x14 days]
- Info: give w/ gentamicin; not 1st-line agent; switch to PO regimen ASAP to complete course
pneumonia, community-acquired
- [600-900 mg IM/IV q6-8h for at least 5 days]
- Info: for inpatient tx; may be part of multi-drug regimen
babesiosis (off-label)
- [mild-moderate infection, immunocompetent pts]
- Dose: 600 mg PO q8h x7-10 days; Info: give w/ quinine sulfate; not 1st-line regimen
- [severe infection, immunocompetent pts]
- Dose: 600 mg IV q6h x7-10 days; Info: give w/ quinine sulfate; not 1st-line regimen; switch to clindamycin 600 mg PO q8h for step-down tx
- [immunocompromised pts]
- Dose: 600 mg IV q6h for at least 6wk; Info: give w/ quinine sulfate; not 1st-line regimen; switch to clindamycin 600 mg PO q8h for step-down tx
infection prophylaxis, surgical (off-label)
- [900 mg IV x1]
- Start: w/in 60min preop; Info: may repeat dose q6h intraop
anthrax (off-label)
- [systemic]
- Dose: 900 mg IV q8h for at least 2wk; Info: part of multi-drug regimen; switch to PO abx for post-exposure prophylaxis if inhalational exposure
- [cutaneous]
- Dose: 600 mg PO q8h x7-10 days; Info: for non-systemic infection; not 1st-line agent; use extended duration for post-exposure prophylaxis if bioterrorism suspected
- [post-exposure prophylaxis]
- Dose: 600 mg PO q8h x60 days; Info: not 1st-line agent; give in combo w/ anthrax vaccine; may give x42 days or x14 days after last vaccine dose in immunocompetent pts 18-65 yo if anthrax vaccine regimen completed
PCP (off-label)
- [mild-moderate infection]
- Dose: 600 mg PO q8h x21 days; Alt: 450 mg PO q6h x21 days; Info: not 1st-line agent; give w/ primaquine
- [severe infection]
- Dose: 900 mg IV q8h x21 days or 600 mg PO q8h x21 days; Alt: 600 mg IV q6h x21 days; 450 mg PO q6h x21 days; Info: not 1st-line agent; give w/ primaquine
malaria, uncomplicated (off-label)
- [20 mg/kg/day PO divided q8h x7 days]
- Info: give w/ quinine sulfate; to avoid relapse in acute P. vivax or P. ovale infection, follow up tx w/ primaquine; refer to CDC guidelines
toxoplasmosis (off-label)
- [treatment]
- Dose: 600 mg PO/IV q6h for at least 6wk; Info: not 1st-line agent; give w/ pyrimethamine, leucovorin
- [maintenance tx]
- Dose: 600 mg PO q8h; Info: not 1st-line agent; give w/ pyrimethamine, leucovorin
endophthalmitis, bacterial (off-label)
- [1 mg in 0.1 ml sterile water or saline intravitreally x1]
- Info: part of multi-drug regimen; refer to institution protocol; may repeat q48h x1
renal dosing
- [no adjustment]
- renal impairment: no adjustment
- HD/PD: no adjustment; no supplement
hepatic dosing
- [no adjustment]
Peds Dosing .
- Dosage forms: CAP: 75 mg, 150 mg, 300 mg; SOL: 75 mg per 5 mL; INJ: various
infections, mild-mod. bacterial
- [infants/children]
- Dose: 10-25 mg/kg/day PO divided q6-8h; Max: 1.8 g/day PO; 4.8 g/day IM/IV; Alt: 15-25 mg/kg/day IM/IV divided q6-8h; 350 mg/m^2/day IM/IV divided q6-8h; 30-40 mg/kg/day PO divided q6-8h for susceptible Staph aureus skin/soft tissue infections
- [adolescents]
- Dose: 150-300 mg PO q6h; Max: 1.8 g/day PO; 4.8 g/day IM/IV; Alt: 15-25 mg/kg/day IM/IV divided q6-8h; 350 mg/m^2/day IM/IV divided q6-8h; 30-40 mg/kg/day PO divided q6-8h for susceptible Staph aureus skin/soft tissue infections
infections, severe bacterial
- [<1 mo, postmenstrual age <32 wk]
- Dose: 15 mg/kg/day IM/IV divided q8h
- [<1 mo, postmenstrual age 33-40 wk]
- Dose: 21 mg/kg/day IM/IV divided q8h
- [infants/children]
- Dose: 25-40 mg/kg/day IM/IV divided q6-8h; Max: 4.8 g/day IM/IV; 1.8 g/day PO; Alt: 450 mg/m^2/day IM/IV divided q6-8h; 20-30 mg/kg/day PO divided q6-8h
- [adolescents]
- Dose: 25-40 mg/kg/day IM/IV divided q6-8h; Max: 4.8 g/day IM/IV; 1.8 g/day PO; Alt: 450 mg/m^2/day IM/IV divided q6-8h; 300-450 mg PO q6h
otitis media, acute
- [6 mo-1 yo]
- Dose: 30-40 mg/kg/day PO divided q8h x10 days
- [mild-moderate infection, 2-5 yo]
- Dose: 30-40 mg/kg/day PO divided q8h x7 days
- [mild-moderate infection, 6-12 yo]
- Dose: 30-40 mg/kg/day PO divided q8h x5-7 days
- [severe infection, 2-12 yo]
- Dose: 30-40 mg/kg/day PO divided q8h x10 days
sinusitis, acute bacterial
- [children]
- Dose: 30-40 mg/kg/day PO divided q8h x10-14 days; Info: use w/ cefixime or cefpodoxime
pharyngitis, streptococcal
- [7 mg/kg/dose PO q8h x10 days]
- Max: 300 mg/dose
community-acquired pneumonia, bacterial
- [mild infection, >3 mo]
- Dose: 30-40 mg/kg/day PO divided q6-8h x7-10 days
- [moderate-severe infection, >3 mo]
- Dose: 40 mg/kg/day IV divided q6-8h x10-14 days; Info: may switch to PO regimen when possible to complete course
bacterial vaginosis
- [adolescents]
- Dose: 300 mg PO q12h x7 days; Info: not 1st-line agent
PID, severe
- [adolescents]
- Dose: 900 mg IV q8h x14 days; Info: give w/ gentamicin; not 1st-line agent; switch to PO regimen ASAP to complete course
toxoplasmosis (off-label)
- [treatment, congenital infection]
- Dose: 20-30 mg/kg/day PO/IV divided q6h x12mo; Max: 600 mg/dose; Info: not 1st-line agent; give w/ pyrimethamine, leucovorin
- [treatment, acquired infection]
- Dose: 20-30 mg/kg/day PO/IV divided q6h for at least 6wk; Max: 600 mg/dose; Info: not 1st-line agent; give w/ pyrimethamine, leucovorin
- [suppressive therapy]
- Dose: 21-30 mg/kg/day PO divided q8h; Info: not 1st-line agent; give w/ pyrimethamine, leucovorin
babesiosis (off-label)
- [mild-moderate infection, immunocompetent pts]
- Dose: 7-10 mg/kg/dose PO q8h x7-10 days; Max: 600 mg/dose; Info: give w/ quinine sulfate; not 1st-line regimen
- [severe infection, immunocompetent pts]
- Dose: 7-10 mg/kg/dose IV q6-8h x7-10 days; Max: 600 mg/dose; Info: give w/ quinine sulfate; not 1st-line regimen; switch to clindamycin 7-10 mg/kg/dose PO q8h for step-down tx
- [immunocompromised pts]
- Dose: 7-10 mg/kg/dose IV q6-8h for at least 6wk; Max: 600 mg/dose; Info: give w/ quinine sulfate; not 1st-line regimen; switch to clindamycin 7-10 mg/kg/dose PO q8h for step-down tx
infection prophylaxis, surgical (off-label)
- [1 yo and older]
- Dose: 10 mg/kg/dose IV x1; Start: w/in 60min preop; Max: 900 mg/dose; Info: may repeat dose q6h intraop
anthrax, systemic (off-label)
- [neonates >32 wk gestation]
- Dose: 10-20 mg/kg/day IV divided q6-12h for at least 2wk; Info: part of multi-drug regimen; dose, frequency depend on gestational and post-natal age; switch to PO abx x60 days total if inhalational exposure
- [1 mo and older]
- Dose: 40 mg/kg/day IV divided q8h for at least 2wk; Alt: 30 mg/kg/day PO divided q8h for at least 2wk; Max: 900 mg/dose IV; 600 mg/dose PO; Info: part of multi-drug regimen; switch to PO abx x60 days total if inhalational exposure
anthrax, cutaneous (off-label)
- [neonates >32 wk gestation]
- Dose: 10-20 mg/kg/day PO divided q6-12h x7-10 days; Info: for pts w/ non-systemic infection; not 1st-line agent; dose, frequency depend on gestational and post-natal age; give abx x60 days total if bioterrorism suspected
- [1 mo and older]
- Dose: 30 mg/kg/day PO divided q8h x7-10 days; Max: 600 mg/dose; Info: for pts w/ non-systemic infection; not 1st-line agent; give abx x60 days total if bioterrorism suspected
anthrax, post-exposure prophylaxis (off-label)
- [neonates >32 wk gestation]
- Dose: 10-20 mg/kg/day PO divided q6-12h x60 days; Info: not 1st-line agent; dose, frequency depend on gestational and post-natal age
- [1 mo and older]
- Dose: 30 mg/kg/day PO divided q8h x60 days; Max: 900 mg/dose; Info: not 1st-line agent
malaria, uncomplicated (off-label)
- [20 mg/kg/day PO divided q8h x7 days]
- Info: give w/ quinine sulfate; to avoid relapse in acute P. vivax or P. ovale infection, follow up tx w/ primaquine; refer to CDC guidelines
renal dosing
- [no adjustment]
- renal impairment: no adjustment
- HD/PD: no adjustment; no supplement
hepatic dosing
- [no adjustment]
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- hypersensitivity to lincosamides
- neonates (benzyl alcohol-containing INJ form)
- ulcerative colitis
- caution: abx-associated colitis hx, recent
- caution: GI disorder hx
- caution: elderly pts
- caution: atopy
- caution: hepatic impairment
- caution: botulism
Drug Interactions .
Overview
clindamycin
lincosamide
- CYP3A4 substrate
- affected by altered gastrointestinal motility
- alters GI flora
- impairs immunomodulatory bacterial infective agent
- nephrotoxicity
- neuromuscular blocking effects
Contraindicated
- cidofovir
Avoid/Use Alternative
- aldesleukin
- amikacin
- amikacin inhaled
- BCG live intravesical
- bremelanotide
- bumetanide
- clofarabine
- fecal microbiota, live
- foscarnet
- ganciclovir
- gentamicin
- mannitol
- methotrexate
- pentamidine
- polymyxin B
- streptomycin
- streptozocin
- tenofovir disoproxil
- tobramycin
- tobramycin inhaled
- valganciclovir
Monitor/Modify Tx
- acyclovir
- adefovir dipivoxil
- alectinib
- aliskiren
- amiloride
- amphotericin
- anthrax immune globulin
- aspirin
- atracurium
- auranofin
- axitinib
- azilsartan medoxomil
- balsalazide
- benazepril
- bevacizumab
- bleomycin
- botulism immune globulin
- cabozantinib
- candesartan cilexetil
- capecitabine
- captopril
- carboplatin
- carfilzomib
- celecoxib
- chlorothiazide
- chlorthalidone
- cisatracurium
- cisplatin
- colistimethate
- creatine
- cyclophosphamide
- cyclosporine
- cytomegalovirus immune globulin
- deferasirox
- deferoxamine
- diclofenac
- diclofenac topical
- diflunisal
- enalapril
- enalaprilat
- ethacrynic acid
- etodolac
- everolimus
- exenatide
- fenoprofen
- flucytosine
- flurbiprofen
- fosinopril
- furosemide
- hydrochlorothiazide
- ibuprofen
- ibuprofen lysine
- ifosfamide
- immune globulin
- indapamide
- indomethacin
- inotersen
- iobenguane I 131
- iohexol
- irbesartan
- ketoprofen
- ketorolac
- lenvatinib
- lifileucel
- liraglutide
- lisinopril
- lithium
- losartan
- lutetium Lu 177 vipivotide tetraxetan
- magnesium citrate
- magnesium salicylate
- meclofenamate
- mefenamic acid
- meloxicam
- mesalamine
- mesalamine rectal
- metolazone
- mitomycin
- moexipril
- nabumetone
- naproxen
- neomycin
- nusinersen
- olmesartan medoxomil
- olsalazine
- oxaliplatin
- oxaprozin
- pamidronate
- pancuronium
- paromomycin
- pazopanib
- pemetrexed
- penicillamine
- pentostatin
- perindopril
- piroxicam
- plazomicin
- polyethylene glycol
- polyethylene glycol/electrolytes
- quinapril
- ramipril
- ramucirumab
- Rho(D) immune globulin
- rituximab
- rocuronium
- ropeginterferon alfa-2b
- salsalate
- sirolimus
- sitagliptin
- sodium phosphate (bowel prep)
- sparsentan
- spironolactone
- succinylcholine
- sulfate bowel prep
- sulindac
- sunitinib
- tacrolimus
- telavancin
- telmisartan
- temsirolimus
- tenofovir alafenamide
- tiopronin
- tivozanib
- tolmetin
- torsemide
- trandolapril
- triamterene
- vaccinia immune globulin
- valacyclovir
- valsartan
- vancomycin
- vecuronium
- voclosporin
- warfarin
- ziv-aflibercept
- zoledronic acid
- zonisamide
Caution Advised
- adagrasib
- apalutamide
- atazanavir
- bosentan
- butalbital
- carbamazepine
- cenobamate
- ceritinib
- chloramphenicol
- clarithromycin
- cobicistat
- dabrafenib
- efavirenz
- encorafenib
- enzalutamide
- etravirine
- fosphenytoin
- idelalisib
- itraconazole
- ivosidenib
- ketoconazole
- lactulose
- levoketoconazole
- lonafarnib
- lopinavir/ritonavir
- lorlatinib
- lumacaftor/ivacaftor
- mavacamten
- mifepristone
- mitapivat
- mitotane
- modafinil
- mycophenolate mofetil
- mycophenolic acid
- nafcillin
- nefazodone
- nelfinavir
- pentobarbital
- pexidartinib
- phenobarbital
- phenytoin
- posaconazole
- primidone
- repotrectinib
- ribociclib
- rifabutin
- rifampin
- rifapentine
- ritonavir
- saquinavir
- sodium picosulfate
- sotorasib
- St. John's wort
- tipranavir
- tirzepatide
- tucatinib
- voriconazole
Adverse Reactions .
Serious Reactions
- C. difficile-assoc. diarrhea
- hypersensitivity rxn
- anaphylaxis
- Stevens-Johnson syndrome
- toxic epidermal necrolysis
- exfoliative dermatitis
- acute generalized exanthematous pustulosis
- drug rxn w/ eosinophilia and systemic sx
- granulocytopenia
- thrombocytopenia
- nephrotoxicity
Common Reactions
- rash
- diarrhea
- nausea
- vomiting
- abdominal pain
- pruritus
- jaundice
- urticaria
- hypotension
- esophagitis
- thrombophlebitis (IV use)
- metallic taste
Safety/Monitoring .
Monitoring Parameters
LFTs if severe hepatic dz or prolonged tx; BUN/Cr if renal impairment or prolonged tx; CBC if prolonged tx
Benzyl Alcohol Content
avoid use in neonates; serious, potentially fatal gasping syndrome may occur (IM/IV form)
Look/Sound-Alike Drug Names
clindamycin confused with: clarithromycin; Clinoril; gentamicin; vancomycin
Pregnancy/Lactation .
Pregnancy
Clinical Summary
may use during pregnancy; possible risk of teratogenicity based on conflicting human data; no known risk of fetal harm based on animal data
Lactation
Clinical Summary
may use while breastfeeding; possible risk of infant diarrhea based on limited human data; no human data available to assess effects on milk production
Pharmacology .
Metabolism: liver; CYP450: 3A4 (primary), 3A5 substrate; Info: active metabolites
Excretion: urine, feces; Half-life: 2.4-3h
Subclass: Anthrax ; Lincosamides ; Malaria
Mechanism of Action
binds to 50S ribosomal subunit, inhibiting protein synthesis
Formulary .
No Formulary Selected
Manufacturer/Pricing .
Manufacturer: generic
DEA/FDA: Rx
Approximate Retail Price
from http://www.goodrx.com/clindamycin
oral capsule:
- 75 mg (28 ea): $14.00
- 150 mg (28 ea): $7.00
- 300 mg (30 ea): $17.00
oral powder for reconstitution:
- 75 mg/5 mL (3 bottle of oral solution, 100 mL): $44.00
injectable solution:
- 150 mg/mL (1 vial, 6 mL): $9.00
injectable solution:
- 150 mg/mL (25 vial, 4 mL): $44.00
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