Clindamycin Dosing in Adults ≥ 18 years
Key messages
- Clindamycin is associated with increased risk of Clostridioides difficile (C. diff) which can be fatal. It should only be prescribed as per the Infection Management Guidelines/Adult Therapeutics Handbook or on the advice of Microbiology/Infectious Diseases (ID)
- Oral clindamycin has high bioavailability and can be given 8 hourly to improve compliance
- Monitor LFTs, FBC and renal function for courses longer than 10 days
Clindamycin overview
Clindamycin is a lincosamide antibiotic that is active against most Gram-positive aerobic bacteria, many anaerobes, and protozoa. GGC antibiotic guidelines recommend different clindamycin dosing regimens depending on route of administration and indication. This information is summarised in the table below and in the Clindamycin Dosing in Adults guideline.
Please note that in view of oral clindamycin’s pharmacokinetic and pharmacodynamic properties, it has been agreed between Microbiology and ID that oral clindamycin can be given 8 hourly to improve compliance. This dosing regimen is unlicensed.
(If viewing table on a mobile device switch to landscape)
|
Infection indication |
Clindamycin dosing |
|
Mild/Moderate Cellulitis (on advice of Microbiology/ID) |
*Oral – 600 mg 8 hourly ≥70 kg *Oral – 450 mg 8 hourly <70 kg |
|
Bone and Joint Infection (on advice of Microbiology/ID) |
*Oral – 600 mg 8 hourly |
|
†Moderate/Severe Cellulitis (if rapidly progressive) †Tonsillitis/Pharyngitis (severe sepsis) †Peri-anal infection (severe, penicillin allergy) |
‡IV – 600 mg 6 hourly |
|
†Suspected Necrotising Fasciitis |
‡IV – 1.2 g 6 hourly |
*Please note these are unlicensed doses (see above).
†Clindamycin given with other agents, refer to Infection Management Guidelines/Adult Therapeutics Handbook for antibiotic regimen advice.
‡Bioavailability of oral clindamycin is 90%, consider switching to oral at the earliest appropriate point in care. Eight hourly dosing may also be used when switching from 6 hourly IV therapy.
Dose adjustments
In severe renal/hepatic impairment and obesity, seek advice from the Antimicrobial Pharmacy team for further information.
Monitoring and toxicity
As per key messages, monitor LFTs, FBC and renal function for courses longer than 10 days. Avoid if previous C.diff or discuss with Microbiology/ID. Patient should stop if diarrhoea occurs and discuss urgently with clinical team.
Interactions
There are a number of important clindamycin interactions to be aware of including interactions with neuromuscular blocking agents, vitamin K antagonists (e.g. warfarin), and inhibitors of CYP3A4 and CYP3A5. For a full list, please refer to the BNF or SPC via eMC.
For full prescribing information on clindamycin, please refer to the BNF or SPC via eMC. Note: the 8 hourly oral dosing regimen is unlicensed.
Published 10/08/2021. Links updated 09/03/2022.
Medicines Update blogs are correct at the time of publication.