Clindamycin (systemic): Pediatric drug information

For additional information see "Clindamycin (systemic): Drug information" and "Clindamycin (systemic): Patient drug information"

For abbreviations, symbols, and age group definitions show table

ALERT: US Boxed Warning

Colitis:

Clostridioides difficile-associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including clindamycin, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon, leading to overgrowth of C. difficile.

Because clindamycin therapy has been associated with severe colitis, which may end fatally, reserve it for serious infections for which less toxic antimicrobial agents are inappropriate. Do not use clindamycin in patients with nonbacterial infections, such as most upper respiratory tract infections.

C. difficile produces toxins A and B, which contribute to the development of CDAD. Hypertoxin-producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary because CDAD has been reported to occur more than 2 months after the administration of antibacterial agents.

If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued. Institute appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation as clinically indicated.

Brand Names: US

Cleocin;
Cleocin Phosphate

Brand Names: Canada

AG-Clindamycin;
APO-Clindamycin [DSC];
Auro-Clindamycin;
Dalacin C;
Dalacin C Palmitate;
Dalacin C Phosphate;
JAMP Clindamycin;
M-Clindamycin;
MED-Clindamycin;
NRA-Clindamycin;
RIVA-Clindamycin;
TEVA-Clindamycin

Therapeutic Category

Antibiotic, Anaerobic;
Antibiotic, Miscellaneous

Dosing: Neonatal

General dosing, susceptible infection:

Age-directed dosing (Ref): IV, Oral:

PMA	Dose
≤32 weeks	5 mg/kg/dose every 8 hours
>32 to 40 weeks	7 mg/kg/dose every 8 hours
>40 weeks	9 mg/kg/dose every 8 hours

Weight-directed dosing (Ref): IV, IM, Oral:

Body Weight	PNA	Dose
≤2 kg	≤28 days	5 mg/kg/dose every 8 hours
≤2 kg	29 to 60 days	10 mg/kg/dose every 8 hours
>2 kg	≤7 days	7 mg/kg/dose every 8 hours
	8 to 28 days	9 mg/kg/dose every 8 hours
	29 to 60 days	10 mg/kg/dose every 8 hours

Manufacturer's labeling: IM, IV: 15 to 20 mg/kg/day divided every 6 to 8 hours.

Anthrax, treatment

Anthrax, treatment : Note: Consult public health officials for event-specific recommendations. Treatment must be followed by prophylaxis for a total antibiotic course of 60 days (Ref).

Severe anthrax (eg, anthrax meningitis, inhalational anthrax, head or neck lesions, cutaneous anthrax with systemic involvement), initial parenteral therapy: Note: Administer as part of an appropriate combination regimen for ≥2 to 3 weeks and until patient is clinically stable. Linezolid is preferred over clindamycin if meningitis cannot be ruled out.

IV:

GA	PNA	Dose
32 to 34 weeks	≤7 days	5 mg/kg/dose every 12 hours
32 to 34 weeks	8 to 28 days	5 mg/kg/dose every 8 hours
>34 weeks	≤7 days	5 mg/kg/dose every 8 hours
>34 weeks	8 to 28 days	5 mg/kg/dose every 6 hours

Postexposure prophylaxis (inhalational exposure); cutaneous anthrax without systemic involvement; oral step-down therapy for severe anthrax: Note: Treat for 7 to 10 days for naturally acquired cutaneous anthrax without systemic involvement; treat for ≥14 days and until patient is clinically stable for oral step-down therapy (as part of a combination regimen) for severe anthrax; and treat for 60 days for postexposure prophylaxis.

Oral:

GA	PNA	Dose
32 to 34 weeks	≤7 days	5 mg/kg/dose every 12 hours
32 to 34 weeks	8 to 28 days	5 mg/kg/dose every 8 hours
>34 weeks	≤7 days	5 mg/kg/dose every 8 hours
>34 weeks	8 to 28 days	5 mg/kg/dose every 6 hours

Dosing: Pediatric

Dosage guidance:

Dosing: Dosing presented in mg/kg/dose and mg/kg/day; use caution. Dosage should be based on total body weight for children ≥2 years of age and adolescents with and without obesity (Ref).

General dosing, susceptible infection:

Infants, Children, and Adolescents:

IM, IV: 20 to 40 mg/kg/day divided every 6 to 8 hours; maximum daily dose: 2,700 mg/day (Ref).

Oral: 10 to 25 mg/kg/day divided every 8 hours (Ref); higher doses of 30 to 40 mg/kg/day divided every 6 to 8 hours recommended for some infections; maximum daily dose: 1,800 mg/day (Ref).

Anthrax

Anthrax: Note: Consult public health officials for event-specific recommendations. After completion of therapy, initiate antimicrobial prophylaxis to complete an antimicrobial course of 60 days from onset of illness.

Infants, Children, and Adolescents: Limited data available:

Postexposure prophylaxis (inhalational exposure): Oral: 30 mg/kg/day divided every 8 hours for 60 days; maximum dose: 900 mg/dose.

Cutaneous, without systemic involvement: Oral: 30 mg/kg/day divided every 8 hours for 7 to 10 days for a naturally acquired infection or 60 days for a biological weapon-related event; maximum dose: 600 mg/dose.

Systemic involvement (including severe disease): IV: 40 mg/kg/day divided every 8 hours as part of an appropriate combination regimen for ≥14 days if meningitis is excluded or ≥14 to 21 days if meningitis cannot be excluded, and until patient clinically stable; maximum dose: 900 mg/dose.

Step-down therapy for severe infection: Oral: 30 mg/kg/day divided every 8 hours as part of an appropriate combination regimen to complete ≥14 days total therapy following appropriate initial treatment; maximum dose: 600 mg/dose.

Babesiosis

Babesiosis (alternative agent):

Infants, Children, and Adolescents: Limited data available:

Mild to moderate disease or oral step-down therapy following initial parenteral treatment: Oral: 7 to 10 mg/kg/dose every 6 to 8 hours in combination with quinine for a total of 7 to 10 days; maximum dose: 600 mg/dose. A longer duration of ≥6 weeks, including 2 weeks after resolution of parasitemia, may be necessary in highly immunocompromised patients (Ref).

Severe disease, initial therapy: IV: 7 to 10 mg/kg/dose every 6 to 8 hours in combination with quinine; maximum dose: 600 mg/dose; change to oral clindamycin once symptoms improve (Ref).

Endocarditis, prophylaxis before invasive dental or respiratory tract procedures

Endocarditis, prophylaxis before invasive dental or respiratory tract procedures:

Note: Clindamycin is NOT recommended for prevention of endocarditis in penicillin-allergic patients at high risk due to C. difficile risk; preferred options include cephalexin, azithromycin, clarithromycin, and doxycycline. Recommended only in patients who are at highest risk for infective endocarditis (IE) or adverse outcomes (Ref).

Infants, Children, and Adolescents: Limited data available: Oral, IV, IM: 20 mg/kg administered 30 to 60 minutes prior to procedure; maximum dose: 600 mg/dose (Ref).

Exit-site or tunnel infection, peritoneal dialysis catheter

Exit-site or tunnel infection, peritoneal dialysis catheter: Infant, Children, and Adolescents: Oral: 10 mg/kg/dose 3 times daily; maximum dose: 600 mg/dose (Ref).

Intra-abdominal infection, complicated

Intra-abdominal infection, complicated: Note: Not routinely recommended due to Bacteroides fragilis resistance.

Infants, Children, and Adolescents: IV: 30 to 40 mg/kg/day divided every 6 to 8 hours in combination with other antibiotics; maximum daily dose: 2,700 mg/day (Ref).

Malaria, uncomplicated, treatment

Malaria, uncomplicated, treatment (alternative agent): Infants, Children, and Adolescents: Oral: 20 mg/kg/day divided every 8 hours for 7 days in combination with quinine (Ref).

Osteoarticular infection, acute

Osteoarticular infection, acute (eg, septic [bacterial] arthritis, osteomyelitis): Infants, Children, and Adolescents: IV, Oral: 30 to 40 mg/kg/day divided every 6 to 8 hours; maximum dose: IV: 900 mg/dose; Oral: 600 mg/dose. Duration should be individualized based on several factors including causative pathogen, response to therapy, and normalization of inflammatory markers. Minimum total duration is ≥2 to 3 weeks for septic arthritis and ≥3 to 4 weeks for osteomyelitis; longer duration commonly necessary, particularly for infections caused by methicillin-resistant Staphylococcus aureus (MRSA) (Ref).

Otitis media, acute

Otitis media, acute (alternative agent): Note: Typically reserved for patients who cannot tolerate beta-lactam antibiotics or as an alternative in patients in whom initial therapy for acute otitis media (AOM) fails. In some instances, it may be necessary to use as part of a combination regimen (eg, when activity is desired against Haemophilus influenzae or Moraxella catarrhalis) (Ref).

Infants ≥6 months, Children, and Adolescents: Oral: 30 to 40 mg/kg/day divided every 6 to 8 hours; maximum daily dose: 1,800 mg/day (Ref). For patients with severe or recurrent AOM, tympanic membrane perforation, or who are <2 years of age, treat for 10 days; for patients ≥2 years of age with mild to moderate, non-recurrent disease without tympanic membrane perforation, shorter durations of 5 to 7 days may be sufficient (Ref).

Peritonitis

Peritonitis (peritoneal dialysis):

Infants, Children, and Adolescents:

Prophylaxis in patients receiving peritoneal dialysis (Ref):

Invasive dental procedures: Oral: 20 mg/kg administered 30 to 60 minutes before procedure; maximum dose: 600 mg.

GI or genitourinary procedures: IV: 10 mg/kg administered 30 to 60 minutes before procedure; maximum dose: 600 mg.

Treatment: Intraperitoneal, continuous: Loading dose: 300 mg per liter of dialysate; maintenance dose: 125 to 150 mg per liter of dialysate (Ref).

Pneumocystis jirovecii pneumonia, treatment

Pneumocystis jirovecii pneumonia (PCP), treatment (alternative agent):

HIV-exposed/-infected: Note: Patients with moderate or severe infection (PaO₂ <70 mm Hg at room air or alveolar-arterial oxygen gradient ≥35 mm Hg) should receive adjunctive glucocorticoids (Ref).

Infants and Children: Limited data available: IV, Oral: 10 mg/kg/dose every 6 hours in combination with primaquine for 21 days; maximum IV dose: 600 mg/dose; maximum oral dose: 300 to 450 mg/dose (Ref).

Adolescents (Ref):

Oral: Mild to severe disease: 450 mg every 6 hours or 600 mg every 8 hours in combination with primaquine for 21 days.

IV: Moderate to severe disease: 600 mg every 6 hours or 900 mg every 8 hours in combination with primaquine for 21 days.

Pneumonia, community-acquired

Pneumonia, community-acquired: Note: Duration dependent upon pathogen and clinical course. Typical duration for uncomplicated infections is 5 to 10 days; however, infections caused by MRSA may require longer treatment (Ref).

Infants ≥3 months, Children, and Adolescents (Ref):

Moderate to severe infection: IV: 40 mg/kg/day divided every 6 to 8 hours; maximum daily dose: 2,700 mg/day.

Mild infection or oral step-down therapy: Oral: 30 to 40 mg/kg/day divided every 6 to 8 hours; maximum daily dose: 1,800 mg/day.

Rhinosinusitis, acute bacterial

Rhinosinusitis, acute bacterial (alternative agent): Children and Adolescents: Oral: 30 to 40 mg/kg/day divided every 8 hours for 10 to 14 days (Ref). Note: Use as part of appropriate combination therapy if activity against H. influenzae or M. catarrhalis is desired (Ref).

Skin and soft tissue infection

Skin and soft tissue infection (SSTI):

Infants, Children, and Adolescents:

Impetigo, ecthyma (if MRSA is suspected or confirmed): Oral: 20 mg/kg/day in divided doses every 8 hours for 7 days; maximum dose: 400 mg/dose (Ref).

Cellulitis, erysipelas, purulent/fluctuant SSTI: Note: Typical duration is 5 days for uncomplicated infection but may be extended if clinical response is inadequate (Ref).

IV: 25 to 40 mg/kg/day in divided doses every 8 hours; maximum dose: 600 mg/dose (Ref).

Oral:

Methicillin-susceptible Staphylococcus aureus (MSSA) infection: Oral: 25 to 30 mg/kg/day in divided doses every 8 hours; maximum dose: 450 mg/dose (Ref).

MRSA infection: Oral: 30 to 40 mg/kg/day in divided doses every 6 to 8 hours; maximum dose: 450 mg/dose (Ref).

Necrotizing soft tissue infections: IV: 10 to 13 mg/kg/dose every 8 hours as part of an appropriate combination regimen in addition to surgical intervention; maximum dose: 900 mg/dose. Continue until further debridement is not necessary, patient has clinically improved, and patient is afebrile for 48 to 72 hours (Ref).

Streptococcus, group A

Streptococcus, group A:

Pharyngitis/tonsillitis (alternative agent for severe penicillin allergy): Children and Adolescents: Oral: 21 mg/kg/day in divided doses every 8 hours for 10 days; maximum dose: 300 mg/dose (Ref).

Chronic carriage: Note: Most individuals with chronic carriage do not require antibiotic treatment (Ref).

Children and Adolescents: Oral: 20 to 30 mg/kg/day in divided doses every 8 hours for 10 days; maximum dose: 300 mg/dose (Ref).

Surgical prophylaxis

Surgical prophylaxis: Children and Adolescents: IV: 10 mg/kg within 30 to 60 minutes prior to procedure; may repeat dose in 6 hours for prolonged procedure or excessive blood loss; maximum dose: 900 mg/dose (Ref).

Toxic shock syndrome, toxin production suppression

Toxic shock syndrome, toxin production suppression (empiric therapy): Infants, Children, and Adolescents: IV: 40 mg/kg/day in divided doses every 6 to 8 hours; maximum dose: 900 mg/dose (Ref).

Toxoplasmosis

Toxoplasmosis (alternative agent):

HIV-exposed/-infected: Infants, Children, and Adolescents:

Initial treatment: IV, Oral: 5 to 7.5 mg/kg/dose every 6 hours in combination with pyrimethamine and leucovorin; maximum dose: 600 mg/dose. For congenital toxoplasmosis, continue therapy for 12 months. For acquired toxoplasmosis, continue for ≥6 weeks followed by chronic maintenance therapy; longer duration may be required if incomplete response or extensive disease (Ref).

Chronic maintenance therapy (secondary prophylaxis): Oral: 7 to 10 mg/kg/dose every 8 hours in combination with pyrimethamine and leucovorin; maximum dose: 600 mg/dose. May consider discontinuation when asymptomatic, CD4 percentage is ≥15% (or CD4 count is >200 cells/mm³ for ages ≥6 years), and the patient has an undetectable HIV viral load in response to antiretroviral therapy for ≥6 months (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Pediatric

Altered kidney function: Infants, Children, and Adolescents: IV, Oral:

Mild to severe impairment: No dosage adjustment necessary.

Hemodialysis, intermittent (thrice weekly): Poorly dialyzed; based on adult information, no supplemental dose or dosage adjustment necessary (Ref).

Peritoneal dialysis: Poorly dialyzed; based on adult information, no dosage adjustment necessary (Ref).

Continuous renal replacement therapy (CRRT): Based on adult information, no dosage adjustment necessary (Ref).

Dosing: Hepatic Impairment: Pediatric

No adjustment required. Use caution with severe hepatic impairment.

Dosing: Adult

(For additional information see "Clindamycin (systemic): Drug information")

Usual dose:

Oral: 600 mg to 1.8 g/day in 2 to 4 divided doses.

IM, IV: 600 mg to 2.7 g/day in 2 to 4 divided doses; according to the manufacturer, up to 4.8 g/day IV (in divided doses) has been used in life-threatening infections; however, data supporting this dose are lacking; maximum: 600 mg/dose IM.

Anthrax

Anthrax (off-label use): Note: Consult public health officials for event-specific recommendations.

Inhalational (postexposure prophylaxis) (alternative agent): Oral: 600 mg every 8 hours for 42 to 60 days; duration depends on anthrax vaccine status and series completion, age, immune status, and pregnancy/breastfeeding status. For those who have not previously received an anthrax vaccine, duration ranges from 42 to 60 days (Ref). Some experts favor longer durations of prophylaxis (eg, total of 3 to 4 months) for patients who are immunocompromised or remain unvaccinated (Ref).

Note: Anthrax vaccine should also be administered to exposed individuals (Ref).

Cutaneous, without systemic involvement, empiric therapy (alternative agent): Oral: 600 mg every 8 hours for 60 days following biological weapon-related event; duration is 7 to 10 days after naturally acquired infection. Note: Treat patients with extensive edema or cutaneous lesions of the head or neck with a parenteral regimen recommended for systemic involvement (Ref).

Systemic (with or without meningitis): IV: 900 mg every 8 hours in combination with other appropriate agents for ≥2 to 3 weeks or until clinically stable, whichever is longer (Ref).

Note: Antitoxin should also be administered for systemic anthrax. Following the course of IV combination therapy for systemic anthrax infection (including meningitis), patients exposed to aerosolized spores require oral monotherapy to complete a total antimicrobial course of 60 days (Ref).

Babesiosis

Babesiosis (alternative agent) (off-label use):

Mild to moderate disease or oral step-down therapy following initial parenteral treatment: Oral: 600 mg every 8 hours in combination with quinine for a total of 7 to 10 days; a longer duration of ≥6 weeks, including 2 weeks after resolution of parasitemia, may be necessary for patients at high risk of relapse (eg, highly immunocompromised patients) (Ref).

Severe disease, initial therapy: IV: 600 mg every 6 hours in combination with quinine; may switch to oral clindamycin once symptoms improve (Ref).

Bacterial vaginosis

Bacterial vaginosis (alternative agent) (off-label use):

Note: Treatment is generally not warranted for patients who are asymptomatic (Ref).

Oral: 300 mg twice daily for 7 days (Ref).

Bite wound infection, prophylaxis or treatment

Bite wound infection, prophylaxis or treatment (animal or human bite) (alternative agent) (off-label use): Note: For animal bite, use in combination with an appropriate agent for Pasteurella multocida. For human bite, use in combination with an appropriate agent for Eikenella corrodens (Ref).

Oral: 300 to 450 mg 3 times daily (Ref).

IV: 600 mg every 6 to 8 hours (Ref).

Duration: Duration is 3 to 5 days for prophylaxis; for established infection, continue for 1 to 2 days after resolution, typically 5 to 14 days total, although deep or complicated infection may require a longer course (Ref).

Diabetic foot infection, mild to moderate

Diabetic foot infection, mild to moderate (alternative agent) (off-label use): Oral: 300 to 450 mg every 6 to 8 hours (Ref). Note: May be used alone for empiric therapy of mild infections; if there are risk factors for gram-negative bacilli, must be used in combination with other appropriate agents. Duration of therapy should be tailored to individual clinical circumstances; most patients respond to 1 to 2 weeks of therapy (Ref).

Hidradenitis suppurativa

Hidradenitis suppurativa (off-label use): Oral: 300 mg twice daily in combination with rifampin for 10 to 12 weeks (Ref).

Malaria, treatment

Malaria, treatment (alternative agent) (off-label use): Oral: 20 mg/kg/day in divided doses every 8 hours for 7 days, as part of an appropriate combination regimen (Ref); oral doses generally do not exceed 1.8 g/day (Ref). Note: If used for severe malaria (after completion of IV therapy), use full 7-day schedule of clindamycin (Ref).

Mastitis, lactational

Mastitis, lactational (alternative agent):

Note: Reserve for patients unable to use first-line agents or for patients at risk for methicillin-resistant S. aureus (Ref).

Oral: 300 mg 4 times daily or 450 mg 3 times daily for 10 to 14 days; shorter courses (eg, 5 to 7 days) may be considered for patients with rapid clinical resolution (Ref).

Neutropenic fever, empiric therapy for low-risk patients with cancer

Neutropenic fever, empiric therapy for low-risk patients with cancer (alternative agent for penicillin-allergic patients) (off-label use): Oral: 600 mg every 8 hours (Ref); some experts recommend 300 mg every 6 hours (Ref) (data on appropriate dose are limited). Use in combination with oral ciprofloxacin; continue until afebrile and neutropenia has resolved. Note: Avoid in patients who have received fluoroquinolone prophylaxis. Administer first dose in the health care setting (after blood cultures are drawn); observe patient for ≥4 hours before discharge (Ref).

Osteomyelitis

Osteomyelitis :

Osteomyelitis due to methicillin-resistant Staphylococcus aureus (MRSA) (alternative agent): IV, Oral: 600 mg 3 times daily for a minimum of 8 weeks; some experts combine with rifampin (Ref).

Osteomyelitis, native vertebral due to staphylococci, methicillin-susceptible (alternative agent):

IV: 600 to 900 mg every 8 hours for 6 weeks (Ref).

Oral: 300 to 450 mg 4 times daily (Ref) or 600 mg 3 times daily (Ref) for 6 weeks (Ref). Note: Clindamycin may also be used as suppressive therapy in selected patients (Ref).

Osteomyelitis, native vertebral due to Cutibacterium acnes (alternative agent): IV: 600 to 900 mg every 8 hours for 6 weeks (Ref).

Pelvic inflammatory disease, severe

Pelvic inflammatory disease, severe (including tubo-ovarian abscess) (alternative agent):

IV: 900 mg every 8 hours in combination with gentamicin; after 24 to 48 hours of sustained clinical improvement, transition to an oral regimen to complete 14 days of treatment (Ref). Note: Some experts reserve this regimen for patients who cannot use preferred agents due to greater associated adverse effects (Ref).

Oral: 450 mg 4 times daily, beginning after 24 to 48 hours of sustained clinical improvement on an appropriate parenteral regimen, to complete 14 days of therapy. Note: If tubo-ovarian abscess is present, use as part of an appropriate combination regimen (Ref).

Pneumocystis jirovecii pneumonia, treatment

Pneumocystis jirovecii pneumonia (PCP), treatment (alternative agent) (off-label use):

Mild to moderate disease: Oral: 450 mg every 6 hours or 600 mg every 8 hours with primaquine for 21 days (Ref).

Severe disease: IV: 600 mg every 6 hours or 900 mg every 8 hours with primaquine for 21 days; following clinical improvement, clindamycin can be given orally at 450 mg every 6 hours or 600 mg every 8 hours (Ref).

Note: Patients with moderate or severe infection (PaO₂ <70 mm Hg at room air or alveolar-arterial oxygen gradient ≥35 mm Hg) should receive adjunctive glucocorticoids (Ref).

Pneumonia

Pneumonia

Aspiration pneumonia (alternative agent):

Note: Reserve for patients with penicillin allergy, as initial treatment for mild, community-acquired infection or as oral step-down therapy for patients requiring initial parenteral therapy (Ref).

Oral: 300 to 450 mg 3 times daily; duration of therapy is generally 5 to 7 days (Ref).

Pathogen-specific therapy for methicillin-resistant S. aureus pneumonia (alternative agent):

Note: Data in adults are limited (Ref).

Oral, IV: 600 mg 3 times daily; duration of therapy varies based on disease severity and response to therapy; treatment is typically given for 7 days (Ref).

Postpartum endometritis

Postpartum endometritis: IV: 900 mg every 8 hours in combination with gentamicin. Treat until the patient is clinically improved (no fundal tenderness) and afebrile for 24 to 48 hours (Ref). Note: For patients with group B Streptococcus colonization or sepsis, additional agents or other regimens are preferred (Ref).

Prosthetic joint infection

Prosthetic joint infection (off-label use):

Cutibacterium acnes, treatment (alternative agent for penicillin allergy):

IV: 600 to 900 mg every 8 hours for 4 to 6 weeks (Ref).

Oral: 300 to 450 mg every 6 hours (Ref), following at least 2 weeks of parenteral therapy (Ref).

Methicillin-resistant staphylococci, treatment (chronic suppression): Oral: 600 mg every 8 hours (Ref).

Rhinosinusitis, acute bacterial

Rhinosinusitis, acute bacterial (alternative agent for patients with penicillin allergy who are able to tolerate cephalosporins) (off-label use):

Note: In uncomplicated acute bacterial rhinosinusitis, initial observation and symptom management without antibiotic therapy is appropriate in most patients. Reserve antibiotic therapy for poor follow-up or lack of improvement over the observation period (Ref).

Oral: 300 mg every 6 to 8 hours in combination with an oral third-generation cephalosporin for 5 to 7 days (Ref).

Septic arthritis due to Staphylococcus aureus

Septic arthritis due to Staphylococcus aureus (including MRSA) (alternative agent): Oral, IV: 600 mg 3 times daily for 3 to 4 weeks (Ref). Note: A longer course of parenteral therapy (4 weeks) may be required for patients with concomitant bacteremia (in the absence of endocarditis) (Ref).

Skin and soft tissue infection

Skin and soft tissue infection (alternative agent):

Abscess:

Note: Systemic antibiotics may be reasonably withheld in healthy, immunocompetent patients with a single, small abscess that has been drained if they are clinically well and have no indwelling device, risk factors for endocarditis, or risk for MRSA transmission (Ref).

Oral: 300 mg 4 times daily or 450 mg 3 times daily for ≥5 days; may extend up to 14 days depending on severity and clinical response (Ref).

Cellulitis, purulent or with risk for methicillin-resistant S. aureus or erysipelas:

Oral: 300 mg 4 times daily or 450 mg 3 times daily for ≥5 days; may extend up to 14 days depending on severity and clinical response (Ref).

IV: 600 to 900 mg every 8 hours (Ref).

Duration: Treat for ≥5 days but may extend up to 14 days depending on severity and clinical response (Ref).

Cellulitis, long-term suppression of recurrent infection: Note: For patients with recurrent presumptive staphylococcal cellulitis at the same anatomical site despite addressing predisposing factors; reserve for patients who cannot use other options (Ref).

Oral: 150 mg once daily after completion of treatment (Ref).

Impetigo or ecthyma if methicillin-resistant S. aureus is suspected or confirmed: Note: For impetigo, reserve systemic therapy for patients with numerous lesions or in outbreak settings to decrease transmission (Ref).

Oral: 300 mg 4 times daily or 450 mg 3 times daily for 7 days (Ref).

Necrotizing soft tissue infection: IV: 600 to 900 mg every 8 hours as part of an appropriate combination regimen. Note: Antibiotic therapy must be used in conjunction with early and aggressive surgical exploration and debridement of necrotic tissue (Ref).

Streptococcus, group A

Streptococcus, group A:

Bloodstream infection: IV: 900 mg every 8 hours in combination with IV penicillin G; duration is individualized, but clindamycin may be discontinued within 48 hours for patients without septic shock, organ failure, or necrotizing infection. Continue an appropriate antistreptococcal agent to complete ≥14 days of therapy (Ref).

Pharyngitis (alternative agent for penicillin-allergic patients) (off-label use): Oral: 300 mg 3 times daily for 10 days (Ref).

Chronic carriage (off-label use): Oral: 300 mg 3 times daily for 10 days. Note: Most individuals with chronic carriage do not require antimicrobial treatment (Ref).

Streptococcus, group B, maternal prophylaxis for prevention of neonatal disease

Streptococcus, group B , maternal prophylaxis for prevention of neonatal disease (alternative agent) (off-label use):

IV: 900 mg at onset of labor or prelabor rupture of membranes, then every 8 hours until delivery. Note: Reserve use for patients with penicillin allergy that are at high risk for anaphylaxis and who have documented clindamycin-susceptible group B streptococci (Ref).

Surgical prophylaxis

Surgical prophylaxis (in combination with other appropriate agents when coverage for MRSA is indicated or for gram-positive coverage in patients unable to tolerate cephalosporins) (off-label use): IV: 900 mg started within 60 minutes prior to initial surgical incision. Clindamycin doses may be repeated intraoperatively at 6-hour intervals if procedure is lengthy or if there is excessive blood loss (Ref). In cases where an extension of prophylaxis is warranted postoperatively, total duration should be ≤24 hours (Ref). For clean and clean-contaminated procedures, continued prophylactic antibiotics beyond surgical incision closure is not recommended, even in the presence of a drain (Ref).

Toxic shock syndrome, toxin production suppression

Toxic shock syndrome, toxin production suppression (empiric therapy): IV: 900 mg every 8 hours as part of an appropriate combination regimen (Ref). Duration is until clinically and hemodynamically stable for ≥48 to 72 hours; then discontinue clindamycin and give monotherapy with an appropriate agent (Ref).

Toxoplasma gondii encephalitis and pneumonitis

Toxoplasma gondii encephalitis and pneumonitis (alternative agent) (off-label use):

Initial treatment: Oral, IV: 600 mg every 6 hours in combination with pyrimethamine and leucovorin. Continue therapy for at least 6 weeks; longer duration may be required if incomplete response or extensive disease; after completion of acute therapy, all patients should receive long-term maintenance therapy (Ref).

Chronic maintenance therapy: Oral: 600 mg every 8 hours in combination with pyrimethamine and leucovorin (Ref); in patients with HIV, may discontinue when asymptomatic with a CD4 count >200 cells/mm³ and an undetectable HIV viral load for >6 months in response to ART (Ref).

Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.

Dosing: Kidney Impairment: Adult

The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.

IV, Oral:

Mild to severe impairment: No dosage adjustment necessary (Ref).

Hemodialysis, intermittent (thrice weekly): Poorly dialyzed; no supplemental dose or dosage adjustment necessary (Ref).

Peritoneal dialysis: Poorly dialyzed; no dosage adjustment necessary (Ref).

CRRT: No dosage adjustment necessary (Ref).

PIRRT (eg, sustained, low-efficiency diafiltration): No dosage adjustment necessary (Ref).

Dosing: Hepatic Impairment: Adult

The liver dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Matt Harris, PharmD, MHS, BCPS, FAST, Jeong Park, PharmD, MS, BCTXP, FCCP, FAST, Arun Jesudian, MD, Sasan Sakiani, MD.

Liver impairment prior to treatment initiation:

Child-Turcotte-Pugh class A and B: No dosage adjustment necessary (Ref).

Child-Turcotte-Pugh class C: No dosage adjustment necessary. Use with caution; clindamycin accumulation may occur, especially if dosed more frequently than every 8 hours; however, the risk of underexposure generally outweighs the risk of accumulation (Ref).

Adverse Reactions (Significant): Considerations

Antibiotic-associated (non-Clostridioides difficile) diarrhea

GI effects range from antibiotic-associated [non-C. difficile] diarrhea (AAD), nausea, and vomiting. Most cases of AAD are mild and self-limiting. However, Clostridioides difficile may account for as many as >20% of cases in children, adolescents, and adults (discussed separately) and result in more severe AAD (Ref).

Mechanism: Dose- and time-related; antibiotic disruption of indigenous gut microbiota (Ref).

Onset: Varied; mean time to onset of AAD is 3 to 18 days for adult patients and 2 to 6 days for pediatric patients. The majority of AAD cases occur during (versus after) antibiotic therapy in pediatric patients (Ref).

Risk factors:

• Duration of therapy (Ref)

• Age (pediatric patients <2 years of age and older adults) (Ref)

• Length of hospitalization or ICU stay (Ref)

• Duration of proton pump inhibitor use (Ref)

• Parenteral nutrition (Ref)

• Combinations of antibiotics (Ref)

Clostridioides difficile infection

Clostridioides difficile infection (CDI) has occurred, including Clostridioides difficile associated diarrhea (CDAD) and Clostridioides difficile colitis. Clindamycin has been associated with a several fold increased risk of CDI (Ref). CDAD must be considered in all patients who present with diarrhea following antibiotic use. If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile should be discontinued if possible. Institute appropriate fluid and electrolyte management, antibiotic treatment of C. difficile, and surgical evaluation as clinically indicated.

Mechanism: Dose- and time-related; related to cumulative antibiotic exposure. Clindamycin causes disruption of the intestinal microbiota resulting in the overgrowth of pathogens, such as C. difficile (Ref). In addition, C. difficile is highly resistant to clindamycin (Ref).

Onset: Varied; may start on the first day of antibiotic therapy or up to 3 months postantibiotic (Ref).

Risk factors:

• Antibiotic exposure (highest risk factor) (Ref)

• Type of antibiotic (clindamycin among the highest risk) (Ref)

• Long durations in a hospital or other health care setting (recent or current) (Ref)

• Older adults (Ref)

• Immunocompromised conditions (Ref)

• A serious underlying condition (Ref)

• GI surgery/manipulation (Ref)

• Antiulcer medications (eg, proton pump inhibitors and H2 blockers) (Ref)

• Chemotherapy (Ref)

Hypersensitivity reactions (immediate and delayed)

Hypersensitivity reactions (immediate and delayed) range from maculopapular rash to rare cases of anaphylaxis (Ref). Severe cutaneous adverse reactions (SCARs), including drug reaction with eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis, Stevens-Johnson syndrome, and toxic epidermal necrolysis have been reported (Ref).

Mechanism: Non–dose-related; immunologic.

Immediate hypersensitivity reactions (eg, anaphylaxis): IgE-mediated (Ref).

Delayed hypersensitivity reactions (eg, maculopapular rash, SCARs), T-cell-mediated (Ref).

Onset:

Immediate hypersensitivity reactions (eg, anaphylaxis): Rapid; may occur within an hour of administration (Ref).

Delayed hypersensitivity reaction: Maculopapular rash: Intermediate; usually 7 to 10 days after initiation (Ref). Other reactions: Varied; may occur after days to weeks of therapy (Ref).

Adverse Reactions

The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.

Frequency not defined:

Dermatologic: Urticaria, vesiculobullous dermatitis

Gastrointestinal: Abdominal pain, nausea, vomiting

Postmarketing:

Cardiovascular: Hypotension (following rapid IV administration), thrombophlebitis (IV)

Dermatologic: Acute generalized exanthematous pustulosis (Aiempanakit 2020), erythema multiforme, exfoliative dermatitis, maculopapular rash (Dilley 2022), Stevens-Johnson syndrome, Sweet syndrome (Dilley 2022), toxic epidermal necrolysis (Paquet 1995)

Gastrointestinal: Clostridioides difficile-associated diarrhea (Slimings 2014), Clostridioides difficile colitis (Slimings 2014), diarrhea (Nasiri 2018), dysgeusia (de Groot 2007), esophageal ulcer (Bestari 2019), esophagitis (Bestari 2019)

Genitourinary: Vaginitis

Hematologic & oncologic: Agranulocytosis (Pisciotta 1993), eosinophilia (transient), neutropenia (transient) (Bubalo 2003), pancytopenia (Morales 2014), thrombocytopenia (Morales 2014)

Hepatic: Cholestatic hepatitis (Aygun 2007)

Hypersensitivity: Anaphylactic shock (Chiou 2006), anaphylaxis (Paradis 2020, Vilchez-Sánchez 2020), angioedema, drug reaction with eosinophilia and systemic symptoms (Miller Quidley 2012), hypersensitivity angiitis (Fransen 2021)

Local: Abscess at injection site (IM), induration at injection site (IM), irritation at injection site (IM), pain at injection site (IM)

Neuromuscular & skeletal: Inflammatory polyarthritis

Renal: Acute kidney injury (Subedi 2019)

Contraindications

Hypersensitivity to clindamycin, lincomycin, or any component of the formulation.

Canadian labeling: Additional contraindications (not in US labeling): Oral clindamycin: Infants <30 days of age.

Warnings/Precautions

Concerns related to adverse effects:

• Renal toxicity: Acute kidney injury has been reported; discontinue treatment if clindamycin-induced acute kidney injury is suspected and no other etiology is identified.

• Superinfection: Use may result in overgrowth of nonsusceptible organisms, particularly yeast. Should superinfection occur, appropriate measures should be taken as indicated by the clinical situation.

Disease-related concerns:

• GI disease: Use with caution in patients with a history of GI disease, particularly colitis.

• Liver impairment: Use with caution in patients with moderate to severe liver disease; however, when administered at every-8-hour intervals, drug accumulation is rare.

• Renal impairment: Use with caution in patients with renal impairment; acute kidney injury may occur, especially if patient is taking other nephrotoxins concurrently.

Special populations:

• Atopic patients: Use with caution in atopic patients.

• Older adult: A subgroup of older patients with associated severe illness may tolerate diarrhea less well. Monitor carefully for changes in bowel frequency.

Dosage form specific issues:

• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer's labeling.

• Tartrazine: Some products may contain tartrazine (FD&C yellow no. 5), which may cause allergic reactions in certain individuals. Allergy is frequently seen in patients who also have an aspirin hypersensitivity.

Other warnings/precautions:

• Administration (IV): Do not inject IV undiluted as a bolus. Product should be diluted in compatible fluid and infused over 10 to 60 minutes.

• Appropriate use: Not appropriate for use in the treatment of meningitis due to inadequate penetration into the CSF.

Dosage Forms: US

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule, Oral, as hydrochloride [strength expressed as base]:

Cleocin: 75 mg, 150 mg [contains fd&c blue #1 (brilliant blue), fd&c yellow #5 (tartrazine)]

Cleocin: 300 mg [contains fd&c blue #1 (brilliant blue)]

Generic: 75 mg, 150 mg, 300 mg

Solution, Injection, as phosphate [strength expressed as base]:

Cleocin Phosphate: 300 mg/2 mL (2 mL); 600 mg/4 mL (4 mL); 900 mg/6 mL (6 mL); 9 g/60 mL (60 mL) [contains benzyl alcohol, edetate (edta) disodium]

Generic: 300 mg/2 mL (2 mL [DSC]); 600 mg/4 mL (4 mL [DSC]); 900 mg/6 mL (6 mL); 9000 mg/60 mL (60 mL); 9 g/60 mL (60 mL [DSC])

Solution, Intravenous, as phosphate [strength expressed as base]:

Cleocin Phosphate: 300 mg/2 mL (2 mL [DSC]); 600 mg/4 mL (4 mL [DSC]); 900 mg/6 mL (6 mL [DSC]) [contains benzyl alcohol, edetate (edta) disodium]

Generic: 600 mg/50 mL (50 mL); 900 mg/50 mL (50 mL)

Solution, Intravenous, as phosphate [strength expressed as base, preservative free]:

Generic: 300 mg/50 mL (50 mL); 600 mg/50 mL (50 mL); 900 mg/50 mL (50 mL); 300 mg/50 mL in NaCl 0.9% (50 mL); 600 mg/50 mL in NaCl 0.9% (50 mL); 900 mg/50 mL in NaCl 0.9% (50 mL)

Solution Reconstituted, Oral, as palmitate hydrochloride [strength expressed as base]:

Cleocin: 75 mg/5 mL (100 mL) [contains ethylparaben]

Generic: 75 mg/5 mL (100 mL)

Generic Equivalent Available: US

Yes

Pricing: US

Capsules (Cleocin Oral)

75 mg (per each): $0.27

150 mg (per each): $0.17

300 mg (per each): $0.34

Capsules (Clindamycin HCl Oral)

75 mg (per each): $0.72 - $3.60

150 mg (per each): $0.18 - $4.20

300 mg (per each): $0.54 - $4.80

Solution (Cleocin Phosphate Injection)

9 g/60 mL (per mL): $0.47

300 mg/2 mL (per mL): $1.49

600 mg/4 mL (per mL): $0.88

900 mg/6 mL (per mL): $0.85

Solution (Clindamycin Phosphate in D5W Intravenous)

300 mg/50 mL (per mL): $0.17 - $0.20

600 mg/50 mL (per mL): $0.10 - $0.30

900 mg/50 mL (per mL): $0.12 - $0.36

Solution (Clindamycin Phosphate in NaCl Intravenous)

300 mg/50 mL 0.9% (per mL): $0.17

600 mg/50 mL 0.9% (per mL): $0.26

900 mg/50 mL 0.9% (per mL): $0.31

Solution (Clindamycin Phosphate Injection)

900 mg/6 mL (per mL): $0.95

Solution (reconstituted) (Cleocin Oral)

75 mg/5 mL (per mL): $0.37

Solution (reconstituted) (Clindamycin Palmitate HCl Oral)

75 mg/5 mL (per mL): $0.29 - $1.08

Disclaimer: A representative AWP (Average Wholesale Price) price or price range is provided as reference price only. A range is provided when more than one manufacturer's AWP price is available and uses the low and high price reported by the manufacturers to determine the range. The pricing data should be used for benchmarking purposes only, and as such should not be used alone to set or adjudicate any prices for reimbursement or purchasing functions or considered to be an exact price for a single product and/or manufacturer. Medi-Span expressly disclaims all warranties of any kind or nature, whether express or implied, and assumes no liability with respect to accuracy of price or price range data published in its solutions. In no event shall Medi-Span be liable for special, indirect, incidental, or consequential damages arising from use of price or price range data. Pricing data is updated monthly.

Dosage Forms: Canada

Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product

Capsule, Oral, as hydrochloride [strength expressed as base]:

Dalacin C: 150 mg, 300 mg

Generic: 150 mg, 300 mg

Solution, Injection:

Dalacin C Phosphate: 150 mg/mL (2 mL, 4 mL, 6 mL, 60 mL) [contains benzyl alcohol, edetate (edta) disodium]

Generic: 150 mg/mL (2 mL, 4 mL, 6 mL, 60 mL, 120 mL)

Solution, Intravenous, as phosphate [strength expressed as base]:

Generic: 300 mg/50 mL ([DSC]); 600 mg/50 mL (50 mL); 900 mg/50 mL (50 mL)

Solution Reconstituted, Oral, as palmitate hydrochloride [strength expressed as base]:

Dalacin C Palmitate: 75 mg/5 mL (100 mL) [contains ethylparaben]

Administration: Pediatric

Oral: Capsule should be taken with a full glass of water to avoid esophageal irritation. Shake oral solution well before use; solution should be administered using an accurate measuring device (eg, oral syringe). May administer with or without meals.

Parenteral:

IM: Administer undiluted deep IM; rotate sites. Do not exceed 600 mg in a single injection.

IV: Infuse over at least 10 to 60 minutes, at a rate not to exceed 30 mg/minute; hypotension and cardiopulmonary arrest have been reported following rapid IV administration.

Administration: Adult

IM: Administer undiluted deep IM; rotate sites. Do not exceed 600 mg in a single injection.

IV: Never administer undiluted as bolus; administer by IV intermittent infusion over at least 10 to 60 minutes, at a maximum rate of 30 mg/minute (do not exceed 1.2 g/hour).

Oral: Capsule should be taken with a full glass of water to avoid esophageal irritation; shake oral solution well before use; may administer with or without meals.

Storage/Stability

Oral: Store at 20°C to 25°C (68°F to 77°F). Do not refrigerate the reconstituted oral solution (it will thicken); the solution is stable for 2 weeks at room temperature.

IV: Store intact vials and premixed bags at 20°C to 25°C (68°F to 77°F). Infusion solution in NS or D5W solution is stable for 16 days at room temperature, 32 days refrigerated, or 8 weeks frozen. After initial use, discard any unused portion of vial after 24 hours.

Use

Treatment of infections involving the respiratory tract, skin and soft tissue, and female pelvis and genital tract; sepsis and intra-abdominal infections due to susceptible organisms (All indications: FDA approved in all ages); has also been used for endocarditis prophylaxis, preoperative prophylaxis, and prophylaxis of peritonitis in patients with peritoneal dialysis catheters undergoing invasive dental, GI, or genitourinary procedures; treatment of peritonitis, exit-site, and tunnel infections in patients with peritoneal dialysis catheters; treatment of osteoarticular infections; and treatment of anthrax, babesiosis, malaria, toxoplasmosis, and Pneumocystis jiroveci pneumonia.

Medication Safety Issues

Sound-alike/look-alike issues:

Cleocin may be confused with bleomycin, Clinoril, Cubicin, Lincocin

Clindamycin may be confused with clarithromycin, Claritin, vancomycin, lincomycin

High alert medication:

The Institute for Safe Medication Practices (ISMP) includes this medication among its list of drugs (pediatric liquid medications requiring measurement) which have a heightened risk of causing significant patient harm when used in error (High-Alert Medications in Community/Ambulatory Care Settings).

International issues:

Dynacin [Philippines] may be confused with Dynacirc brand name for isradipine [multiple international markets]

Metabolism/Transport Effects

Substrate of CYP3A4 (major); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential

Drug Interactions

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program by clicking on the “Launch drug interactions program” link above.

Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the drug interactions program

Bacillus clausii: Antibiotics may diminish the therapeutic effect of Bacillus clausii. Management: Bacillus clausii should be taken in between antibiotic doses during concomitant therapy. Risk D: Consider therapy modification

BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination

BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Risk C: Monitor therapy

Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Risk X: Avoid combination

Clofazimine: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk C: Monitor therapy

CYP3A4 Inducers (Moderate): May decrease the serum concentration of Clindamycin (Systemic). Risk C: Monitor therapy

CYP3A4 Inducers (Strong): May decrease the serum concentration of Clindamycin (Systemic). Risk C: Monitor therapy

CYP3A4 Inhibitors (Moderate): May increase the serum concentration of Clindamycin (Systemic). Risk C: Monitor therapy

CYP3A4 Inhibitors (Strong): May increase the serum concentration of Clindamycin (Systemic). Risk C: Monitor therapy

Fecal Microbiota (Live) (Oral): May diminish the therapeutic effect of Antibiotics. Risk X: Avoid combination

Fecal Microbiota (Live) (Rectal): Antibiotics may diminish the therapeutic effect of Fecal Microbiota (Live) (Rectal). Risk X: Avoid combination

Fexinidazole: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk X: Avoid combination

Fusidic Acid (Systemic): May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Management: Consider avoiding this combination if possible. If required, monitor patients closely for increased adverse effects of the CYP3A4 substrate. Risk D: Consider therapy modification

Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies): Antibiotics may diminish the therapeutic effect of Immune Checkpoint Inhibitors (Anti-PD-1, -PD-L1, and -CTLA4 Therapies). Risk C: Monitor therapy

Kaolin: May decrease the absorption of Lincosamide Antibiotics. Risk C: Monitor therapy

Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Risk C: Monitor therapy

Mecamylamine: Lincosamide Antibiotics may enhance the neuromuscular-blocking effect of Mecamylamine. Risk X: Avoid combination

Mycophenolate: Antibiotics may decrease serum concentrations of the active metabolite(s) of Mycophenolate. Specifically, concentrations of mycophenolic acid (MPA) may be reduced. Risk C: Monitor therapy

Neuromuscular-Blocking Agents: Lincosamide Antibiotics may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy

Pectin: May decrease the absorption of Lincosamide Antibiotics. Risk C: Monitor therapy

Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider therapy modification

Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents. Postpone vaccination until 3 days after cessation of antibiotics and avoid starting antibiotics within 3 days of last vaccine dose. Risk D: Consider therapy modification

Pregnancy Considerations

Clindamycin crosses the placenta and can be detected in the cord blood and fetal tissue (Philipson 1973; Weinstein 1976). Clindamycin injection contains benzyl alcohol, which may also cross the placenta.

Clindamycin pharmacokinetics are not affected by pregnancy (Philipson 1976; Weinstein 1976).

Clindamycin is recommended for use in pregnant patients for the prophylaxis of group B streptococcal disease in newborns (alternative option for patients at high risk for anaphylaxis to penicillin [or whose risk is unknown], and who have GBS susceptible to clindamycin) (ACOG 797 2020); prophylaxis and treatment of Toxoplasma gondii encephalitis (alternative therapy), or treatment of Pneumocystis pneumonia (PCP) (alternative therapy) (HHS [OI adult 2020]); bacterial vaginosis (CDC [Workowski 2021]); anthrax (Meaney-Delman 2014); or malaria (CDC 2023). Clindamycin is also one of the antibiotics recommended for prophylactic use prior to cesarean delivery and may be used in certain situations prior to vaginal delivery in patients at high risk for endocarditis (ACOG 199 2018).

Monitoring Parameters

Observe for changes in bowel frequency; during prolonged therapy, monitor CBC with differential and hepatic and renal function tests periodically.

Mechanism of Action

Reversibly binds to 50S ribosomal subunits preventing peptide bond formation thus inhibiting bacterial protein synthesis; bacteriostatic or bactericidal depending on drug concentration, infection site, and organism

Pharmacokinetics (Adult Data Unless Noted)

Absorption: Oral, hydrochloride: Rapid (90%); clindamycin palmitate must be hydrolyzed in the GI tract before it is active.

Distribution: Distributed in body fluids and tissues; no significant levels in CSF, even with inflamed meninges.

Neonates (Gonzalez 2016):

PMA ≤28 weeks: Median: 1.2 L/kg (range: 0.87 to 2.26 L/kg).

PMA >28 to 32 weeks: Median: 1.3 L/kg (range: 0.74 to 1.88 L/kg).

PMA >32 to 40 weeks: Median: 1.03 L/kg (range: 0.7 to 2.12 L/kg).

Neonates and Infants ≤5 months (PMA >40 to 60 weeks): Median: 0.99 L/kg (range: 0.64 to 1.27 L/kg) (Gonzalez 2016).

Infants >5 months: Median: 0.83 L/kg (range: 0.7 to 1.17 L/kg) (Gonzalez 2016).

Children ≥2 years and Adolescents (Smith 2017):

Non-obese: Median range: 0.81 to 0.9 L/kg.

Obese: Median range: 0.86 to 1.03 L/kg.

Protein binding: 94%

Metabolism: Biologically inactive clindamycin phosphate (intravenous formulation) is rapidly converted to active clindamycin. Clindamycin is metabolized predominantly by CYP3A4, with minor contribution by CYP3A5, to form clindamycin sulfoxide (major metabolite) and N-desmethylclindamycin (minor metabolite).

Bioavailability: Oral: ~90%.

Half-life elimination:

Neonates (Gonzalez 2016):

PMA ≤28 weeks: Median: 5.89 hours (range: 2.42 to 12.9 hours).

PMA >28 to 32 weeks: Median: 5.25 hours (range: 2.34 to 8.87 hours).

PMA >32 to 40 weeks: Median: 3.96 hours (range: 1.3 to 8.83 hours).

Neonates and Infants ≤5 months (Gonzalez 2016): PMA >40 to 60 weeks: Median: 2.35 hours (range: 0.94 to 6.44 hours).

Infants >5 months to 1 year (Gonzalez 2016): Median: 2.05 hours (range: 1.26 to 3.47 hours).

Children ≥2 years and Adolescents (Smith 2017):

Non-obese: Median range: 2.15 to 2.84 hours.

Obese: Median range: 2.15 to 3.55 hours.

Adults: 3 hours.

Elderly (oral) ~4 hours (range: 3.4 to 5.1 hours).

Time to peak, serum: Oral: Within 60 minutes; IM: 1 to 3 hours.

Excretion: Urine (~10%) and feces (3.6%) as active drug and metabolites.

Pharmacokinetics: Additional Considerations (Adult Data Unless Noted)

Anti-infective considerations:

Parameters associated with efficacy: AUC₂₄/minimum inhibitory concentration (MIC), goal: ≥ ~27 (LaPlante 2008; Levison 2009; Muller 2010).

Expected drug exposure in normal renal function:

C _max (peak): Steady state:

Neonates (preterm and term) and Infants <4 months of age: IV: Median dose 15 mg/kg/day in divided doses: ~7.9 to 8.9 mg/L (Greenberg 2020).

Children 2 to 6 years of age: IV: 12 mg/kg/dose every 8 hours: 14.1 mg/L (Smith 2017).

Children >6 years and Adolescents: IV: 10 mg/kg/dose every 8 hours: 12.2 mg/L (Smith 2017).

Adults: IV: 600 mg every 6 or 8 hours: 12.2 mg/dL (Flaherty 1988; Smith 2017).

AUC_0-24 (total): Steady state:

Neonates (preterm and term) and Infants <4 months of age: IV: Median dose 15 mg/kg/day in divided doses: 8.3 mg/L: 96 mg•hour/L (Greenberg 2020).

Children 2 to 6 years of age: IV: 12 mg/kg/dose every 8 hours: 132.6 mg•hour/L (Smith 2017).

Children >6 years of age: IV: 10 mg/kg/dose every 8 hours: 134.4 mg•hour/L (Smith 2017).

Adolescents: IV 10 mg/kg/dose every 8 hours: 145.8 mg•hour/L (Smith 2017).

Adults: IV: 600 mg every 6 to 8 hours: 105.6 to 134.1 mg•hour/L (Flaherty 1988; Smith 2017).

Postantibiotic effect: Varies based on the organism and antimicrobial exposure (concentration and duration):

Bacillus anthracis: 2 hours (Athamna 2004).

S. aureus: Mean: 1.7 to 4 hours (range: 0.4 to 6.7 hours) (Xue 1996).

Streptococcus pneumoniae: ~1 to 6.9 hours (Kuenzi 1987).

S. pyogenes: ~1 to 5.5 hours (Kuenzi 1987).

Brand Names: International

International Brand Names by Country

For country code abbreviations (show table)

(AE) United Arab Emirates: Dalacin c;
(AR) Argentina: Clidan | Clindalaf | Clindamicina | Clindamicina pharmavial | Clindamicina richet | Dalacin c | Dexacne | Microbion | Resbiotic | Resbiotic pediatrico;
(AT) Austria: Clindac | Clindac Sandoz | Clindamycin | Clindamycin 1a pharma gmbh | Clindamycin lannacher | Clindamycin sandoz | Clindamycin stada | Dalacin c | Lanacine;
(AU) Australia: Apo-clindamycin | Calindamin | Chemmart clindamycin | Cleocin | Clindamycin | Clindamycin bnm | Clindamycin link | Clindamycin lu | Clindamyk | Dalacin c | Terry white chemists clindamycin;
(BD) Bangladesh: Anobac | Cinamycin | Cleocin | Cleodin | Climed | Climycin | Clinacyn | Clindacap | Clindacin | Clindamet | Clindax | Clinex | Daclin | Dalacin | Dalatic | Endamycin | Fortior | Lincocin | Lindamax | Qcin | Riboclin | Xindal;
(BE) Belgium: Clindamycin sandoz | Clindamycine EG | Dalacin;
(BF) Burkina Faso: Dalacine;
(BG) Bulgaria: Clindamycin | Clindamycin abr | Clindamycin mip | Daclyne | Dalacin c | Klimicin;
(BR) Brazil: Clindabiotic | Clindamicil | Clindamin c | Clindarix | Cloridrato de clindamicina | Dalacin c;
(CH) Switzerland: Clindamycin mepha | Clindamycin pfizer | Clindamycin sandoz | Clindamycin Zentiva | Dalacin c;
(CL) Chile: Biomicin | Dalacin c;
(CN) China: Clindamycin | Dalacin c | De bao sheng | Fu si ka | Hai mai ke | Hu yi | Jing dan | Ke er sheng | Ke lin mei | Lizhu ling | She yue | Shuai jie | Suo ning | Ta di xian | Tang ni wei | Te li xian | Xin fu;
(CO) Colombia: Acniben | Baclin | Clinbac | Clindacil | Clindamicina | Dalacin c | Damicine | Damiclin | Euroclin;
(CZ) Czech Republic: Dalacin | Dalacin c | Klimicin | Klindamycin;
(DE) Germany: Aclinda | Clin sanorania | Clinda 1a pharma | Clinda lich | Clindabeta | Clindadura | Clindahexal | Clindalind | Clindamycin | Clindamycin 1a pharma | Clindamycin abz | Clindamycin Acis | Clindamycin al | Clindamycin aristo | Clindamycin Billix | Clindamycin dura | Clindamycin holsten | Clindamycin klast | Clindamycin ratiopharm | Clindamycin sandoz | Clindamycin von CT | Clindastad | Clindatop | Dalacin | Dentomycin | Sobelin | Turimycin;
(DK) Denmark: Dalacin;
(DO) Dominican Republic: Clindamicina | Clindamicina mk | Clindaris | Daltrex | Euroclin | Globacin;
(EC) Ecuador: Clindamichem | Clindamicina | Clindamicina mk | Clindana | Cluvax | Dalacin | Dalacin c | Dalacin C Fosfato | Euroclin;
(EE) Estonia: Clindamycin | Dalacin c | Klimicin;
(EG) Egypt: Clinacyn | Clindacin | Clindacine | Clindam | Clindariv | Clindatech | Dalacin c | Mepaclind;
(ES) Spain: Clindamicina qualigen | Dalacin;
(ET) Ethiopia: Cindi 150 | Clindamycin abr | Dalacin c;
(FI) Finland: Clindamycin orion | Clindamycin sandoz | Clindamycin SanoSwiss | Dalacin | Klindagol;
(FR) France: Clindamycine mylan | Dalacine;
(GB) United Kingdom: Clindamycin | Clindamycin sandoz | Dalacin c;
(GH) Ghana: C cin | Dacillin | Entracin | Kinamycin | Klinda 150;
(GR) Greece: Dalacin c;
(HK) Hong Kong: B.b | Climadan | Clindamycin rivopharm | Dalacin c;
(HR) Croatia: Dalacin c | Klimicin;
(HU) Hungary: Dalacin | Dalacin c | Klimicin;
(ID) Indonesia: Albiotin | Anerocid | Biodasin | Cindala | Clidacor | Climadan | Clinatic | Clinbercin | Clindamycin | Clindexin | Clinex | Clinidac | Clinika | Clinium | Clinjos | Clinmas | Comdasin | Dacin | Daclin | Dalacin c | Ethidan | Indanox | Lando | Librodan | Lindacyn | Lindan | Milorin | Niladacin | Nufaclind | Opiclam | Probiotin | Prolic | Xeldac | Zumatic;
(IE) Ireland: Clindamycin | Dalacin c;
(IL) Israel: Dalacin | Dalacin c;
(IN) India: Clid | Clin | Clincin | Clindaness | Clindanol | Clindaset | Clindasure | Clindatec | Clindatime | Clindol | Clingram | Clinsof | Clinviva | Clinzucia | Cliza | Dalacin c | Dalcap | Dalcinex | Egyclin | Hiclinamycin | Muclin | Nexclin;
(IS) Iceland: Dalacin;
(IT) Italy: Dalacin c;
(JO) Jordan: Clinaram | Clindacin | Clindamyl | Clindox | Clinimycin | Dalacin c | Lanacin;
(JP) Japan: Dalacin;
(KE) Kenya: Bergclin | Cindi 150 | Cindi 300 | Clindacin | Clindar b | Clindazed | Dacibact | Dacillin | Dalacin | Dalacin c;
(KR) Korea, Republic of: Cleocin | Clicin | Climycin | Clindacin | Dongkoo clindamycin | Fullgram | Mothers clindamycin | Neotacin | Withus clindamycin;
(KW) Kuwait: Dalacin c | Dalacin palmitate;
(LB) Lebanon: Dalacin | Dalacin c | Danalli | Torgyn;
(LT) Lithuania: Clindamycin | Dalacin | Dalacin c | Klimicin | Klindamycin;
(LU) Luxembourg: Clindamycine EG | Dalacin;
(LV) Latvia: Clindamycin | Dalacin | Dalacin c | Klimicin | Klindamycin;
(MA) Morocco: Dalacine;
(MX) Mexico: Amonadin | Ancine | Apomiclin | Cigmadil | Clendix | Clinamsa | Clindamicin | Clindamicina | Clindamicina avivia | Clindamicina gi se | Clindamicina kendr | Clindamicina le gi | Clindamicina Raam | Clindazyn | Cliran | Croci | Dalacin c | Dalacin c rtu | Dalafar | Destralina | Drastep | Foshlenn | Indacil | Indamid | Indamid dx | Klamoxyl | Klin amsa | Lindacil | Lisiken | Losertrin | Lyrfhis | Midacyn | Noclin | Tanzanita | Ulmicy;
(MY) Malaysia: Clindac | Dalacin c | Klindam | Lindacin | Tidact;
(NG) Nigeria: Clamysol | Dalacin;
(NL) Netherlands: Clindamycine | Dalacin | Dalacin c;
(NO) Norway: Cleocin | Clindamycin | Clindamycin navamedic | Clindamycin villerton | Dalacin | Dalacin c | Sobelin;
(NZ) New Zealand: Clindamycin Abm | Dalacin c;
(PE) Peru: Clendabrax | Clincheck | Clinda C | Clindabiot | Clindabiotech | Clindacin | Clindamax | Clindamed | Clindamicina | Clindapharm | Clindasted | Clindess | Dalacin c | Damizit | Euroclin | Inkabiotic | Kilacinox;
(PH) Philippines: Abanxl | Acresil | Anerocin | Biogenerics clindamycin | Climaxin | Clin d | Clin gen | Clindacin | Clindacyn | Clindagen | Clindagold | Clindal | Clindamycin | Clindamycin Pacific | Clindamycin sandoz | Clinmicap | Dacin | Daklin | Dalacin c | Dalamax | Dalamed | Dynacin | Indanox | Indimax | Inprosyn-hp | Klindex | Kylezine | May clindamycin | Myclin | Peldacyn | Pharex Clindamycin | Potecin | Promeclin | Ritemed Clindamycin | Robecren | Tidact | Vagilin | Zindal | Zynamycin;
(PK) Pakistan: Clindacure | Clindamycin | Dalacin c | Serind | Uniclin;
(PL) Poland: Clindacin | Clindamycin | Clindo | Dalacin c | Klimicin;
(PR) Puerto Rico: Camyda | Cleocin | Cleocin phosphate | Clindamycin HCL | Clindamycin in 5% dextrose | Clindamycin injection in 5% dextrose;
(PT) Portugal: Clincina | Clindamicina | Clindamicina atral | Clindamicina labesfal | Dalacin c;
(PY) Paraguay: Clindamicina dallas | Clindamicina prosalud | Cluvax;
(QA) Qatar: Cleocin | Clindacin | Clinimycin | Dalacin C | Dalacin C (IV/IM) | Dalacin C Granules | Klindaver | Lanacin;
(RO) Romania: Clindacin | Dalacin c;
(RU) Russian Federation: Clindacin | Clindafer | Clindamycin | Dalacin c | Klinoksin;
(SA) Saudi Arabia: Apo-clindamycin | Clindamycin | Dalacin c;
(SE) Sweden: Clindamycin | Clindamycin actavis | Clindamycin alternova | Clindamycin bijon | Clindamycin Orifarm | Clindamycin villerton | Dalacin | Klindamycin ebb;
(SG) Singapore: Dalacin c | Tidact;
(SI) Slovenia: Dalacin | Dalacin c | Klimicin;
(SK) Slovakia: Dalacin | Dalacin c | Klimicin;
(TH) Thailand: Acnocin | Clinda | Clinda p | Clindacap | Clindaman | Clindarax | Clindastar | Clindin | Clinott | Dacin-f | Dalacin c | Klimicin | Klinda rx | Klindamycin | Millda | Rosil | Todacin;
(TN) Tunisia: Dalacine;
(TR) Turkey: Cleocin | Clin | Klindan | Klinoksin | Klitopsin | Meneklin;
(TW) Taiwan: B.b | Bibi u | Cledomycin | Cleocin | Clicin | Clincin | Clindamycin | Clindamycin Patron | Dalcine | Damicin | Kanolin | Kingdacin | Kojarclinda | Lindacin | Tidact | Ulecin | Vicin;
(UA) Ukraine: Clindahexal | Clindamycin | Dalacin c | Klimicin | Ultrex;
(UG) Uganda: Zeemycin;
(UY) Uruguay: Clinda | Clinda pediatrico | Clindamicina | Dalacin c;
(VE) Venezuela, Bolivarian Republic of: Clindacin | Clindamicina | Clindox | Dalacin;
(VN) Viet Nam: Bilclacin | Cledamed | Clindamark | Dakina | Fabaclin c | Flamiclinda | Kamicingsv | Nakai | Pyclin | Zurer;
(ZA) South Africa: Clindahexal | Dalacin c;
(ZM) Zambia: Clindahexal | Dalacin c;
(ZW) Zimbabwe: Dalacin c

ADA Division of Legal Affairs. A legal perspective on antibiotic prophylaxis. J Am Dent Assoc. 2003;134(9):1260. [PubMed 14529001]
Ahlfors CE. Benzyl alcohol, kernicterus, and unbound bilirubin. J Pediatr. 2001;139(2):317-319. [PubMed 11487763]
Aiempanakit K, Apinantriyo B. Clindamycin-induced acute generalized exanthematous pustulosis: a case report. Medicine (Baltimore). 2020;99(21):e20389. doi:10.1097/MD.0000000000020389 [PubMed 32481338]
Alikhan A, Sayed C, Alavi A, et al. North American clinical management guidelines for hidradenitis suppurativa: a publication from the United States and Canadian Hidradenitis Suppurativa Foundations: part II: topical, intralesional, and systemic medical management. J Am Acad Dermatol. 2019;81(1):91-101. doi:10.1016/j.jaad.2019.02.068 [PubMed 30872149]
Allewelt M, Schüler P, Bölcskei PL, Mauch H, Lode H; Study Group on Aspiration Pneumonia. Ampicillin + sulbactam vs clindamycin +/- cephalosporin for the treatment of aspiration pneumonia and primary lung abscess. Clin Microbiol Infect. 2004;10(2):163-170. doi:10.1111/j.1469-0691.2004.00774.x [PubMed 14759242]
American Academy of Pediatrics (AAP). In: Kimberlin DW, Barnett ED, Lynfield R, Sawyer MH, eds. Red Book: 2021-2024 Report of the Committee on Infectious Diseases. 32nd ed. American Academy of Pediatrics; 2021.
American College of Obstetricians and Gynecologists (ACOG). Prevention of group B streptococcal early-onset disease in newborns: ACOG committee opinion, number 797. Obstet Gynecol. 2020;135(2):e51‐e72. doi:10.1097/AOG.0000000000003668 [PubMed 31977795]
American Dental Association, American Academy of Orthopedic Surgeons. Antibiotic prophylaxis for dental patients with total joint replacements. J Am Dent Assoc. 2003;134(7):895-899. [PubMed 12892448]
American Dental Association Council on Scientific Affairs. Combating antibiotic resistance. J Am Dent Assoc. 2004;135(4):484-487. [PubMed 15127872]
Anderson DJ, Podgorny K, Berríos-Torres SI, et al. Strategies to prevent surgical site infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol. 2014;35(6):605-627. doi: 10.1086/676022. [PubMed 24799638]
Anderson PO, Sauberan JB. Modeling drug passage into human milk. Clin Pharmacol Ther. 2016;100(1):42-52. [PubMed 27060684]
Aronoff GR, Bennett WM, Berns JS, et al. Drug Prescribing in Renal Failure: Dosing Guidelines for Adults and Children. 5th ed. Philadelphia, PA: American College of Physicians; 2007.
Athamna A, Athamna M, Medlej B, Bast DJ, Rubinstein E. In vitro post-antibiotic effect of fluoroquinolones, macrolides, beta-lactams, tetracyclines, vancomycin, clindamycin, linezolid, chloramphenicol, quinupristin/dalfopristin and rifampicin on Bacillus anthracis. J Antimicrob Chemother. 2004;53(4):609-615. doi:10.1093/jac/dkh130 [PubMed 14998982]
Avant GR, Schenker S, Alford RH. The effect of cirrhosis on the disposition and elimination of clindamycin. Am J Dig Dis. 1975;20(3):223-230. doi:10.1007/BF01070725 [PubMed 1168411]
Aygun C, Kocaman O, Gurbuz Y, Senturk O, Hulagu S. Clindamycin-induced acute cholestatic hepatitis. World J Gastroenterol. 2007;13(40):5408-5410. doi:10.3748/wjg.v13.i40.5408 [PubMed 17879418]
Baddour LM, Chen AF. Prosthetic joint infection: Treatment. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed April 27, 2023a.
Baddour LM, Harper M. Animal bites (dogs, cats, and other mammals): Evaluation and management. Connor RF, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed April 19, 2024a.
Baddour LM, Harper M. Human bites: evaluation and management. Connor RF, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed April 19, 2024b.
Baddour LM. Impetigo. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed May 1, 2023c.
Bader MS. Diabetic foot infection. Am Fam Physician. 2008;78(1):71-79. [PubMed 18649613]
Baltimore RS, Gewitz M, Baddour LM, et al; American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee of the Council on Cardiovascular Disease in the Young and the Council on Cardiovascular and Stroke Nursing. Infective endocarditis in childhood: 2015 update: a scientific statement from the American Heart Association. Circulation. 2015;132(15):1487-1515. doi:10.1161/CIR.0000000000000298 [PubMed 26373317]
Based on expert opinion.
Berbari EF, Kanj SS, Kowalski TJ, et al; Infectious Diseases Society of America. 2015 Infectious Diseases Society of America (IDSA) clinical practice guidelines for the diagnosis and treatment of native vertebral osteomyelitis in adults. Clin Infect Dis. 2015;61(6):e26-e46. doi: 10.1093/cid/civ482. [PubMed 26229122]
Berríos-Torres SI, Umscheid CA, Bratzler DW, et al; Healthcare Infection Control Practices Advisory Committee. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784-791. doi: 10.1001/jamasurg.2017.0904. [PubMed 28467526]
Bestari MB, Agustanti N, Abdurachman SA. Clindamycin-induced esophageal injury: is it an underdiagnosed entity? Clin Med Insights Case Rep. 2019;12:1179547619884055. doi:10.1177/1179547619884055 [PubMed 31903026]
Blumenthal KG, Peter JG, Trubiano JA, Phillips EJ. Antibiotic allergy. Lancet. 2019;393(10167):183-198. doi:10.1016/S0140-6736(18)32218-9 [PubMed 30558872]
Bow E. Treatment and prevention of neutropenic fever syndromes in adult cancer patients at low risk for complications. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed June 20, 2022.
Bower WA, Schiffer J, Atmar RL, et al; CDC ACIP Anthrax Vaccine Work Group. Use of anthrax vaccine in the United States: recommendations of the Advisory Committee on Immunization Practices, 2019. MMWR Recomm Rep. 2019;68(4):1-14. doi:10.15585/mmwr.rr6804a1 [PubMed 31834290]
Bradley JS, Byington CL, Shah SS, et al. The management of community-acquired pneumonia in infants and children older than 3 months of age: clinical practice guidelines by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America. Clin Infect Dis. 2011;53(7):e25-e76. [PubMed 21880587]
Bradley JS, Nelson JD, Barnett ED, et al, eds. Nelson's Pediatric Microbial Therapy. 27th ed. American Academy of Pediatrics; 2021.
Bradley JS, Peacock G, Krug SE, et al; AAP Committee on Infectious Diseases and Disaster Preparedness Advisory Council. Pediatric anthrax clinical management. Pediatrics. 2014;133(5):e1411-e1436. doi: 10.1542/peds.2014-0563. [PubMed 24777226]
Bratzler DW, Dellinger EP, Olsen KM, et al; American Society of Health-System Pharmacists; Infectious Diseases Society of America; Surgical Infection Society; Society for Healthcare Epidemiology of America. Clinical practice guidelines for antimicrobial prophylaxis in surgery. Am J Health Syst Pharm. 2013;70(3):195-283. [PubMed 23327981]
Brown KA, Khanafer N, Daneman N, Fisman DN. Meta-analysis of antibiotics and the risk of community-associated Clostridium difficile infection. Antimicrob Agents Chemother. 2013;57(5):2326-2332. doi:10.1128/AAC.02176-12 [PubMed 23478961]
Bubalo JS, Blasdel CS, Bearden DT. Neutropenia after single-dose clindamycin for dental prophylaxis. Pharmacotherapy. 2003;23(1):101-103. doi:10.1592/phco.23.1.101.31920 [PubMed 12523467]
Centers for Disease Control and Prevention (CDC). FAQs for clinicians about C. diff. Updated March 27, 2020. Accessed July 27, 2021. https://www.cdc.gov/cdiff/clinicians/faq.html
Centers for Disease Control and Prevention (CDC). Neonatal deaths associated with use of benzyl alcohol—United States. MMWR Morb Mortal Wkly Rep. 1982;31(22):290-291. http://www.cdc.gov/mmwr/preview/mmwrhtml/00001109.htm [PubMed 6810084]
Centers for Disease Control and Prevention (CDC). Treatment of malaria (guidelines for clinicians 2019). http://www.cdc.gov/malaria/resources/pdf/clinicalguidance.pdf. Published July 2013.
Centers for Disease Control and Prevention (CDC). Treatment of malaria: guidelines for clinicians (United States). https://www.cdc.gov/malaria/diagnosis_treatment/clinicians1.html. Updated June 28, 2023. Accessed July 26, 2023.
Chen KT. Postpartum endometritis. Connor RF, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed April 19, 2024.
Chiou CS, Lin SM, Lin SP, Chang WG, Chan KH, Ting CK. Clindamycin-induced anaphylactic shock during general anesthesia. J Chin Med Assoc. 2006;69(11):549-551. doi:10.1016/S1726-4901(09)70327-2 [PubMed 17116619]
Chow AW, Benninger MS, Brook I, et al; Infectious Diseases Society of America. IDSA clinical practice guideline for acute bacterial rhinosinusitis in children and adults. Clin Infect Dis. 2012;54(8):e72-e112. [PubMed 22438350]
Chu VH. Staphylococcal toxic shock syndrome. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 23, 2023.
Cimino JE, Tierno PM Jr. Hemodialysis properties of clindamycin (7-chloro-7-deoxylincomycin). Appl Microbiol. 1969;17(3):446-448. [PubMed 5780400]
Cleocin hydrochloride capsules (clindamycin) [prescribing information]. New York, NY: Pfizer; June 2022.
Cleocin Pediatric granule (clindamycin) [prescribing information]. New York, NY: Pharmacia & Upjohn Co; February 2020.
Cleocin Pediatric oral solution, USP (clindamycin) [prescribing information]. New York, NY: Pharmacia & Upjohn Company LLC; July 2023.
Cleocin Pediatric oral solution (clindamycin) [prescribing information]. New York, NY: Pharmacia & Upjohn Co LLC; February 2020.
Cleocin phosphate injection (clindamycin) [prescribing information]. New York, NY: Pharmacia & Upjohn Co LLC; May 2022.
Clindamycin Phosphate in Sodium Chloride injection [prescribing information]. Deerfield, IL: Baxter Healthcare Corporation; September 2022.
Collins CE, Ayturk MD, Flahive JM, Emhoff TA, Anderson FA Jr, Santry HP. Epidemiology and outcomes of community-acquired Clostridium difficile infections in Medicare beneficiaries. J Am Coll Surg. 2014;218(6):1141-1147.e1. doi:10.1016/j.jamcollsurg.2014.01.053 [PubMed 24755188]
Dalacin C (clindamycin) [product monograph]. Kirkland, Quebec, Canada: Pfizer Canada ULC; April 2024.
de Groot MC, van Puijenbroek EP. Clindamycin and taste disorders. Br J Clin Pharmacol. 2007;64(4):542-545. doi:10.1111/j.1365-2125.2007.02908.x [PubMed 17635503]
Deshpande A, Pasupuleti V, Thota P, et al. Community-associated Clostridium difficile infection and antibiotics: a meta-analysis. J Antimicrob Chemother. 2013;68(9):1951-1961. doi:10.1093/jac/dkt129 [PubMed 23620467]
Dessinioti C, Zisimou C, Tzanetakou V, Stratigos A, Antoniou C. Oral clindamycin and rifampicin combination therapy for hidradenitis suppurativa: a prospective study and 1-year follow-up. Clin Exp Dermatol. 2016;41(8):852-857. doi: 10.1111/ced.12933. [PubMed 27753139]
Dietrich ML, Steele RW. Group A Streptococcus. Pediatr Rev. 2018;39(8):379-391. doi:10.1542/pir.2017-0207 [PubMed 30068739]
Dilley M, Geng B. Immediate and delayed hypersensitivity reactions to antibiotics: aminoglycosides, clindamycin, linezolid, and metronidazole. Clin Rev Allergy Immunol. 2022;62(3):463-475. doi:10.1007/s12016-021-08878-x [PubMed 34910281]
Dixon JM. Lactational mastitis. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed May 2, 2023.
Donaldson N, Sanders J, Child J, Parker S. Acute hematogenous bacterial osteoarticular infections in children. Pediatr Rev. 2020;41(3):120-136. doi:10.1542/pir.2018-0201 [PubMed 32123023]
Duffy CR, Huang Y, Andrikopoulou M, et al. Clindamycin, gentamicin, and risk of Clostridium difficile infection and acute kidney injury during delivery hospitalizations. Obstet Gynecol. 2020;135(1):59-67. doi:10.1097/AOG.0000000000003568 [PubMed 31809424]
Ebo DG, Mertens C, Braes M, Mennes I, Bridts CH, Sabato V. Clindamycin anaphylaxis confirmed by in vivo and in vitro testing. J Allergy Clin Immunol Pract. 2019;7(1):331-333. doi:10.1016/j.jaip.2018.06.008 [PubMed 29940315]
Expert opinion. Senior Hepatic Editorial Team: Matt Harris, PharmD, MHS, BCPS, FAST; Jeong Park, PharmD, MS, BCTXP, FCCP, FAST; Arun Jesudian, MD; Sasan Sakiani, MD.
Expert opinion. Senior Renal Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
Flaherty JF, Rodondi LC, Guglielmo BJ, Fleishaker JC, Townsend RJ, Gambertoglio JG. Comparative pharmacokinetics and serum inhibitory activity of clindamycin in different dosing regimens. Antimicrob Agents Chemother. 1988;32(12):1825-1829. doi:10.1128/AAC.32.12.1825 [PubMed 3245695]
Fransen M, Verstraeten VLRM. Cutaneous vasculitis caused by clindamycin. Dermatitis. 2021;32(6):e100-e101. doi:10.1097/DER.0000000000000665 [PubMed 33332861]
Freifeld AG, Bow EJ, Sepkowitz KA, et al; Infectious Diseases Society of America. Clinical practice guideline for the use of antimicrobial agents in neutropenic patients with cancer: 2010 update by the Infectious Diseases Society of America. Clin Infect Dis. 2011;52(4):e56-e93. doi: 10.1093/cid/cir073. [PubMed 21258094]
Gall S, Koukol DH. Ampicillin/sulbactam vs. clindamycin/gentamicin in the treatment of postpartum endometritis. J Reprod Med. 1996;41(8):575-580. [PubMed 8866384]
Galli L, Venturini E, Bassi A, et al. Common community-acquired bacterial skin and soft-tissue infections in children: an intersociety consensus on impetigo, abscess, and cellulitis treatment. Clin Ther. 2019;41(3):532-551.e17. doi:10.1016/j.clinthera.2019.01.010 [PubMed 30777258]
Gener G, Canoui-Poitrine F, Revuz JE, et al. Combination therapy with clindamycin and rifampicin for hidradenitis suppurativa: a series of 116 consecutive patients. Dermatology. 2009;219(2):148-154. doi: 10.1159/000228334. [PubMed 19590173]
Goldenberg DL, Sexton DJ. Septic arthritis in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed May 1, 2023.
Gonzalez D, Delmore P, Bloom BT, et al. Clindamycin pharmacokinetics and safety in preterm and term infants. Antimicrob Agents Chemother. 2016;60(5):2888-2894. [PubMed 26926644]
Greenberg RG, Wu H, Maharaj A, et al. A pharmacoepidemiologic study of the safety and effectiveness of clindamycin in infants. Pediatr Infect Dis J. 2020;39(3):204-210. doi:10.1097/INF.0000000000002524 [PubMed 31725114]
Gulliver W, Zouboulis CC, Prens E, Jemec GB, Tzellos T. Evidence-based approach to the treatment of hidradenitis suppurativa/acne inversa, based on the European guidelines for hidradenitis suppurativa. Rev Endocr Metab Disord. 2016;17(3):343-351. doi: 10.1007/s11154-016-9328-5. [PubMed 26831295]
Halilovic J, Heintz BH. Antibiotic dosing in cirrhosis. Am J Health Syst Pharm. 2014;71(19):1621-1634. doi:10.2146/ajhp140031 [PubMed 25225448]
Hall G, Nord CE, Heimdahl A. Elimination of bacteraemia after dental extraction: comparison of erythromycin and clindamycin for prophylaxis of infective endocarditis. J Antimicrob Chemother. 1996;37(4):783-795. [PubMed 8722544]
Harris AM, Hicks LA, Qaseem A; High Value Care Task Force of the American College of Physicians and for the Centers for Disease Control and Prevention. Appropriate antibiotic use for acute respiratory tract infection in adults: advice for high-value care from the American College of Physicians and the Centers for Disease Control and Prevention. Ann Intern Med. 2016;164(6):425-434. doi: 10.7326/M15-1840. [PubMed 26785402]
Heintz BH, Matzke GR, Dager WE. Antimicrobial dosing concepts and recommendations for critically ill adult patients receiving continuous renal replacement therapy or intermittent hemodialysis. Pharmacotherapy. 2009;29(5):562-577. doi: 10.1592/phco.29.5.562. [PubMed 19397464]
Hendricks KA, Wright ME, Shadomy SV, et al; Workgroup on Anthrax clinical guidelines. Centers for Disease Control and Prevention expert panel meetings on prevention and treatment of anthrax in adults. Emerg Infect Dis. 2014;20(2):e130687. doi: 10.3201/eid2002.130687. [PubMed 24447897]
Hensgens MP, Goorhuis A, Dekkers OM, Kuijper EJ. Time interval of increased risk for Clostridium difficile infection after exposure to antibiotics. J Antimicrob Chemother. 2012;67(3):742-748. doi:10.1093/jac/dkr508 [PubMed 22146873]
Hicks CW, Sweeney DA, Cui X, Li Y, Eichacker PQ. An overview of anthrax infection including the recently identified form of disease in injection drug users. Intensive Care Med. 2012;38(7):1092-1104. [PubMed 22527064]
Hinthorn DR, Baker LH, Romig DA, Hassanein K, Liu C. Use of clindamycin in patients with liver disease. Antimicrob Agents Chemother. 1976;9(3):498-501. doi:10.1128/AAC.9.3.498 [PubMed 1259404]
Hoberman A, Paradise JL, Rockette HE, et al. Shortened antimicrobial treatment for acute otitis media in young children. N Engl J Med. 2016;375(25):2446-2456. doi:10.1056/NEJMoa1606043 [PubMed 28002709]
"Inactive" ingredients in pharmaceutical products: update (subject review). American Academy of Pediatrics (AAP) Committee on Drugs. Pediatrics. 1997;99(2):268-278. [PubMed 9024461]
Ito S. Drug therapy for breast-feeding women. N Engl J Med. 2000;343(2):118-126. [PubMed 10891521]
Jevsevar DS, Abt E. The New AAOS-ADA clinical practice guideline on prevention of orthopaedic implant infection in patients undergoing dental procedures. J Am Acad Orthop Surg. 2013;21(3):195-197. [PubMed 23457071]
Johnson S, Samore MH, Farrow KA, et al. Epidemics of diarrhea caused by a clindamycin-resistant strain of Clostridium difficile in four hospitals. N Engl J Med. 1999;341(22):1645-1651. doi:10.1056/NEJM199911253412203 [PubMed 10572152]
Kanafani ZA. Invasive Cutibacterium (formerly Propionibacterium) infections. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed April 27, 2023.
Karakayalı B, Yazar AS, Çakir D, et al. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS) syndrome associated with cefotaxime and clindamycin use in a 6 year-old boy: a case report. Pan Afr Med J. 2017;28:218. doi:10.11604/pamj.2017.28.218.10828 [PubMed 29629004]
Klempner MS, Styrt B. Prevention of recurrent staphylococcal skin infections with low-dose oral clindamycin therapy. JAMA. 1988;260(18):2682-2685. [PubMed 3184334]
Klompas M. Aspiration pneumonia in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed April 27, 2023.
Kozyrskyj A, Klassen TP, Moffatt M, Harvey K. Short-course antibiotics for acute otitis media. Cochrane Database Syst Rev. 2010;2010(9):CD001095. doi:10.1002/14651858.CD001095.pub2 [PubMed 20824827]
Krause PJ, Auwaerter PG, Bannuru RR, et al. Clinical practice guidelines by the Infectious Diseases Society of America (IDSA): 2020 guideline on diagnosis and management of babesiosis. Clin Infect Dis. 2021;72(2):185-189. doi:10.1093/cid/ciab050 [PubMed 33501959]
Krause PJ, Gewurz BE, Hill D, et al. Persistent and relapsing babesiosis in immunocompromised patients. Clin Infect Dis. 2008;46(3):370-376. doi:10.1086/525852 [PubMed 18181735]
Kuenzi B, Segessenmann C, Gerber AU. Postantibiotic effect of roxithromycin, erythromycin, and clindamycin against selected gram-positive bacteria and Haemophilus influenzae. J Antimicrob Chemother. 1987;20(suppl B):39-46. doi:10.1093/jac/20.suppl_b.39 [PubMed 3501426]
Lalani T. Overview of osteomyelitis in adults. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed July 30, 2018.
LaPlante KL, Leonard SN, Andes DR, Craig WA, Rybak MJ. Activities of clindamycin, daptomycin, doxycycline, linezolid, trimethoprim-sulfamethoxazole, and vancomycin against community-associated methicillin-resistant Staphylococcus aureus with inducible clindamycin resistance in murine thigh infection and in vitro pharmacodynamic models. Antimicrob Agents Chemother. 2008;52(6):2156-2162. doi:10.1128/AAC.01046-07 [PubMed 18411321]
Lappin E, Ferguson AJ. Gram-positive toxic shock syndromes. Lancet Infect Dis. 2009;9(5):281-290. [PubMed 19393958]
Levison ME, Levison JH. Pharmacokinetics and pharmacodynamics of antibacterial agents. Infect Dis Clin North Am. 2009;23(4):791-815, vii. doi:10.1016/j.idc.2009.06.008 [PubMed 19909885]
Lewis RE, Klepser ME, Ernst EJ, Lund BC, Biedenbach DJ, Jones RN. Evaluation of low-dose, extended-interval clindamycin regimens against Staphylococcus aureus and Streptococcus pneumoniae using a dynamic in vitro model of infection. Antimicrob Agents Chemother. 1999;43(8):2005-2009. doi:10.1128/AAC.43.8.2005 [PubMed 10428927]
Lieberthal AS, Carroll AE, Chonmaitree T, et al. The diagnosis and management of acute otitis media. Pediatrics. 2013;131(3):e964-e999. [PubMed 23439909]
Lipsky BA, Berendt AR, Cornia PB, et al; Infectious Diseases Society of America. 2012 Infectious Diseases Society of America clinical practice guideline for the diagnosis and treatment of diabetic foot infections. Clin Infect Dis. 2012;54(12):e132-e173. [PubMed 22619242]
Lipsky BA, Pecoraro RE, Larson SA, Hanley ME, Ahroni JH. Outpatient management of uncomplicated lower-extremity infections in diabetic patients. Arch Intern Med. 1990;150(4):790-797. [PubMed 2183732]
Litao G, Jingjing S, Yu L, Lei Z, Xiaona H, Zhijing Z. Risk factors for antibiotic-associated diarrhea in critically ill patients. Med Sci Monit. 2018;24:5000-5007. doi:10.12659/MSM.911308 [PubMed 30020891]
Liu C, Bayer A, Cosgrove SE, et al. Clinical practice guidelines by the Infectious Diseases Society of America for the treatment of methicillin-resistant Staphylococcus aureus infections in adults and children: executive summary. Clin Infect Dis. 2011;52(3):285-292. [PubMed 21217178]
Lobo LJ, Reed KD, Wunderink RG. Expanded clinical presentation of community-acquired methicillin-resistant Staphylococcus aureus pneumonia. Chest. 2010;138(1):130-136. doi:10.1378/chest.09-1562 [PubMed 20173050]
Lockhart PB, Tampi MP, Abt E, et al. Evidence-based clinical practice guideline on antibiotic use for the urgent management of pulpal- and periapical-related dental pain and intraoral swelling: A report from the American Dental Association. J Am Dent Assoc. 2019;150(11):906-921.e12. doi:10.1016/j.adaj.2019.08.020 [PubMed 31668170]
Lusk RH, Fekety FR Jr, Silva J Jr, et al. Gastrointestinal side effects of clindamycin and ampicillin therapy. J Infect Dis. 1977;135 Suppl:S111-S119. doi:10.1093/infdis/135.supplement.s111 [PubMed 850084]
Ma H, Zhang L, Zhang Y, Liu Y, He Y, Guo L. Combined administration of antibiotics increases the incidence of antibiotic-associated diarrhea in critically ill patients. Infect Drug Resist. 2019;12:1047-1054. doi:10.2147/IDR.S194715 [PubMed 31118710]
Mackeen AD, Packard RE, Ota E, Speer L. Antibiotic regimens for postpartum endometritis. Cochrane Database Syst Rev. 2015;(2):CD001067. doi: 10.1002/14651858.CD001067.pub3. [PubMed 25922861]
Malacoff RF, Finkelstein FO, Andriole VT. Effect of peritoneal dialysis on serum levels of tobramycin and clindamycin. Antimicrob Agents Chemother. 1975;8(5):574-580. [PubMed 1211913]
Mann CF. Clindamycin and breast-feeding. Pediatrics. 1980;66(6):1030-1031. [PubMed 7454470]
Marchisio P, Galli L, Bortone B, et al. Updated guidelines for the management of acute otitis media in children by the Italian Society of Pediatrics: treatment. Pediatr Infect Dis J. 2019;38(12S suppl):S10-S21. doi:10.1097/INF.0000000000002452 [PubMed 31876601]
McDonald LC, Gerding DN, Johnson S, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018;66(7):e1-e48. doi:10.1093/cid/cix1085 [PubMed 29462280]
McFarland LV, Ozen M, Dinleyici EC, Goh S. Comparison of pediatric and adult antibiotic-associated diarrhea and Clostridium difficile infections. World J Gastroenterol. 2016;22(11):3078-3104. doi:10.3748/wjg.v22.i11.3078 [PubMed 27003987]
Meaney-Delman D, Zotti ME, Creanga AA, et al; Workgroup on Anthrax in Pregnant and Postpartum Women. Special considerations for prophylaxis for and treatment of anthrax in pregnant and postpartum women. Emerg Infect Dis. 2014;20(2). doi: 10.3201/eid2002.130611. [PubMed 24457117]
Metlay JP, Waterer GW, Long AC, et al. Diagnosis and treatment of adults with community-acquired pneumonia. An official clinical practice guideline of the American Thoracic Society and Infectious Diseases Society of America. Am J Resp Crit Care Med. 2019;200(7):e45-e67. doi:10.1164/rccm.201908-1581ST. [PubMed 31573350]
Miller Quidley A, Bookstaver PB, Gainey AB, Gainey MD. Fatal clindamycin-induced drug rash with eosinophilia and systemic symptoms (DRESS) syndrome. Pharmacotherapy. 2012;32(12):e387-e392. doi:10.1002/phar.1142 [PubMed 23165860]
Mitchell KB, Johnson HM, Rodríguez JM, et al; Academy of Breastfeeding Medicine. Academy of Breastfeeding Medicine clinical protocol #36: the mastitis spectrum, revised 2022. Breastfeed Med. 2022;17(5):360-376. doi:10.1089/bfm.2022.29207.kbm [PubMed 35576513]
Morales MP, Carvallo AP, Espinosa KA, Murillo EE. A young man with myelosuppression caused by clindamycin: a case report. J Med Case Rep. 2014;8:7. doi:10.1186/1752-1947-8-7 [PubMed 24387005]
Muller AE, Mouton JW, Oostvogel PM, et al. Pharmacokinetics of clindamycin in pregnant women in the peripartum period. Antimicrob Agents Chemother. 2010;54(5):2175-2181. doi:10.1128/AAC.01017-09 [PubMed 20176904]
Nasiri MJ, Goudarzi M, Hajikhani B, Ghazi M, Goudarzi H, Pouriran R. Clostridioides (Clostridium) difficile infection in hospitalized patients with antibiotic-associated diarrhea: a systematic review and meta-analysis. Anaerobe. 2018;50:32-37. doi:10.1016/j.anaerobe.2018.01.011 [PubMed 29408016]
National Institute for Health and Care Excellence (NICE). Otitis media (acute): antimicrobial prescribing. London, UK: National Institute for Health and Care Excellence. https://www.nice.org.uk/guidance/ng91. Published March 2018. Accessed November 3, 2022.
Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. J Am Coll Cardiol. 2017;70(2):252-289. doi:10.1016/j.jacc.2017.03.011 [PubMed 28315732]
Ondusko DS, Nolt D. Staphylococcus aureus. Pediatr Rev. 2018;39(6):287-298. doi:10.1542/pir.2017-0224 [PubMed 29858291]
Osmon DR, Berbari EF, Berendt AR, et al; Infectious Diseases Society of America. Diagnosis and management of prosthetic joint infection: clinical practice guidelines by the Infectious Diseases Society of America. Clin Infect Dis. 2013;56(1):e1-e25. [PubMed 23223583]
Paquet P, Schaaf-Lafontaine N, Piérard GE. Toxic epidermal necrolysis following clindamycin treatment. Br J Dermatol. 1995;132(4):665-666. doi:10.1111/j.1365-2133.1995.tb08730.x [PubMed 7748763]
Paradis N, Marois L, Paradis L, Graham F, Bégin P, Des Roches A. Anaphylaxis to clindamycin following cutaneous exposure. Allergy Asthma Clin Immunol. 2020;16:51. doi:10.1186/s13223-020-00452-y [PubMed 32577121]
Patel ZM, Hwang PH. Uncomplicated acute sinusitis and rhinosinusitis in adults: treatment. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed April 27, 2023.
Peled N, Pitlik S, Samra Z, Kazakov A, Bloch Y, Bishara J. Predicting Clostridium difficile toxin in hospitalized patients with antibiotic-associated diarrhea. Infect Control Hosp Epidemiol. 2007;28(4):377-381. doi:10.1086/513723 [PubMed 17385141]
Pernica JM, Harman S, Kam AJ, et al. Short-course antimicrobial therapy for pediatric community-acquired pneumonia: The SAFER randomized clinical trial. JAMA Pediatr. 2021;175(5):475-482. doi:10.1001/jamapediatrics.2020.6735 [PubMed 33683325]
Philipson A, Sabath LD, Charles D. Erythromycin and clindamycin absorption and elimination in pregnant women. Clin Pharmacol Ther. 1976;19(1):68-77. [PubMed 1245094]
Philipson A, Sabath LD, Charles D. Transplacental passage of erythromycin and clindamycin. N Engl J Med, 1973;288(23):1219-1221. doi: 10.1056/NEJM197306072882307. [PubMed 4700555]
Pisciotta AV. Agranulocytosis during antibiotic therapy: drug sensitivity or sepsis? Am J Hematol. 1993;42(1):132-137. doi:10.1002/ajh.2830420126 [PubMed 8416289]
Refer to manufacturer's labeling.
Rosenfeld RM. Clinical Practice. Acute sinusitis in adults. N Engl J Med. 2016;375(10):962-970. doi: 10.1056/NEJMcp1601749. [PubMed 27602668]
Rosenfeld RM, Piccirillo JF, Chandrasekhar SS, et al. Clinical practice guideline (update): adult sinusitis. Otolaryngol Head Neck Surg. 2015;152(2)(suppl):S1-S39. doi: 10.1177/0194599815572097. [PubMed 25832968]
Rubenstein EB, Rolston K, Benjamin RS, et al. Outpatient treatment of febrile episodes in low-risk neutropenic patients with cancer. Cancer. 1993;71(11):3640-3646. [PubMed 8490912]
Saavedra-Lozano J, Falup-Pecurariu O, Faust SN, et al. Bone and joint infections. Pediatr Infect Dis J. 2017;36(8):788-799. doi:10.1097/INF.0000000000001635 [PubMed 28708801]
Safrin S, Finkelstein DM, Feinberg J, et al. Comparison of three regimens for treatment of mild-to-moderate Pneumocystis carinii pneumonia in patients with AIDS. A double-blind, randomized, trial of oral trimethoprim-sulfamethoxazole, dapsone-trimethoprim, and clindamycin-primaquine. ACTG 108 Study Group. Ann Intern Med. 1996;124(9):792-802. [PubMed 8610948]
Same RG, Amoah J, Hsu AJ, et al. The association of antibiotic duration with successful treatment of community-acquired pneumonia in children. J Pediatric Infect Dis Soc. 2021;10(3):267-273. doi:10.1093/jpids/piaa055 [PubMed 32525203]
Sanchez E, Vannier E, Wormser GP, Hu LT. Diagnosis, treatment, and prevention of Lyme disease, human granulocytic anaplasmosis, and babesiosis: a review. JAMA. 2016;315(16):1767-1777. doi:10.1001/jama.2016.2884 [PubMed 27115378]
Schwartz BS, Mawhorter SD; AST Infectious Diseases Community of Practice. Parasitic infections in solid organ transplantation. Am J Transplant. 2013;13(suppl 4):280-303. doi: 10.1111/ajt.12120. [PubMed 23465021]
Sendi P, Christensson B, Uçkay I, et al; GBS PJI study group. Group B streptococcus in prosthetic hip and knee joint-associated infections. J Hosp Infect. 2011;79(1):64-69. doi: 10.1016/j.jhin.2011.04.022. [PubMed 21764170]
Shane AL, Mody RK, Crump JA, et al. 2017 Infectious Diseases Society of America clinical practice guidelines for the diagnosis and management of infectious diarrhea. Clin Infect Dis. 2017;65(12):e45-e80. doi:10.1093/cid/cix669 [PubMed 29053792]
Shulman ST, Bisno AL, Clegg HW, et al; Infectious Diseases Society of America. Clinical practice guideline for the diagnosis and management of group A streptococcal pharyngitis: 2012 update by the Infectious Diseases Society of America. Clin Infect Dis. 2012;55(10):e86-e102. [PubMed 22965026]
Slimings C, Riley TV. Antibiotics and hospital-acquired Clostridium difficile infection: update of systematic review and meta-analysis. J Antimicrob Chemother. 2014;69(4):881-891. doi:10.1093/jac/dkt477 [PubMed 24324224]
Smith MJ, Gonzalez D, Goldman JL, et al. Pharmacokinetics of clindamycin in obese and nonobese children. Antimicrob Agents Chemother. 2017;61(4):e02014-e02016. [PubMed 28137820]
Sollecito TP, Abt E, Lockhart PB, et al. The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints: Evidence-based clinical practice guideline for dental practitioners--a report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc. 2015;146(1):11-16. doi: 10.1016/j.adaj.2014.11.012. [PubMed 25569493]
Solomkin JS, Mazuski JE, Bradley JS, et al, "Diagnosis and Management of Complicated Intra-abdominal Infection in Adults and Children: Guidelines by the Surgical Infection Society and the Infectious Diseases Society of America," Clin Infect Dis, 2010, 50(2):133-64. [PubMed 20034345]
Spelman D, Baddour LM. Acute cellulitis and erysipelas in adults: treatment. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed July 24, 2023a.
Spelman D, Baddour LM. Skin abscesses in adults: treatment. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed July 24, 2023b.
Stéen B, Rane A. Clindamycin passage into human milk. Br J Clin Pharmacol. 1982;13(5):661-664. [PubMed 7082533 ]
Stevens DL, Baddour LM. Necrotizing soft tissue infections. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed May 1, 2023a.
Stevens DL. Invasive group A streptococcal infection and toxic shock syndrome: treatment and prevention. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 20, 2023b.
Stevens DL, Bisno AL, Chambers HF, et al. Practice guidelines for the diagnosis and management of skin and soft tissue infections: 2014 update by the Infectious Diseases Society of America. Clin Infect Dis. 2014;59(2):147-159. doi:10.1093/cid/ciu296 [PubMed 24947530]
Stevens V, Dumyati G, Fine LS, Fisher SG, van Wijngaarden E. Cumulative antibiotic exposures over time and the risk of Clostridium difficile infection. Clin Infect Dis. 2011;53(1):42-48. doi:10.1093/cid/cir301 [PubMed 21653301]
Subedi P, Chowdhury A, Tanovic K, Dumic I. Clindamycin: An unusual cause of acute kidney injury. Am J Case Rep. 2019;20:248-251. Published 2019 Feb 25. doi:10.12659/AJCR.913779 [PubMed 30799434]
Tande AJ. Nonvertebral osteomyelitis in adults: Treatment. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed April 27, 2023.
Taplitz RA, Kennedy EB, Bow EJ, et al. Outpatient management of fever and neutropenia in adults treated for malignancy: American Society of Clinical Oncology and Infectious Diseases Society of America clinical practice guideline update. J Clin Oncol. 2018;36(14):1443-1453. doi: 10.1200/JCO.2017.77.6211. [PubMed 29461916]
Thomas CF, Limper AH. Treatment and prevention of pneumocystis pneumonia in HIV-uninfected patients. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed June 6, 2018.
Tian D, Mohan RJ, Stallings G. Drug rash with eosinophilia and systemic symptoms syndrome associated with clindamycin. Am J Med. 2010;123(11):e7-e8. doi:10.1016/j.amjmed.2010.04.004 [PubMed 20843501]
Trotman RL, Williamson JC, Shoemaker DM, et al, “Antibiotic Dosing in Critically Ill Adult Patients Receiving Continuous Renal Replacement Therapy,” Clin Infect Dis, 2005, 41(8):1159-66. [PubMed 16163635]
Tseng J, Maurer T, Mutizwa MM. HIV-associated toxic epidermal necrolysis at San Francisco General Hospital. J Int Assoc Provid AIDS Care. 2017;16(1):37-41. doi:10.1177/2325957415614651 [PubMed 26685211]
Turck D, Bernet JP, Marx J, et al. Incidence and risk factors of oral antibiotic-associated diarrhea in an outpatient pediatric population. J Pediatr Gastroenterol Nutr. 2003;37(1):22-26. doi:10.1097/00005176-200307000-00004 [PubMed 12827001]
US Department of Health and Human Services (HHS) Panel on Antiretroviral Therapy and Medical Management of HIV-Infected Children. Guidelines for the use of antiretroviral agents in pediatric HIV infection. March 1, 2016. http://aidsinfo.nih.gov
US Department of Health and Human Services (HHS) Panel on Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV: recommendations from the Centers for Disease Control and Prevention, the National Institutes of Health, and the HIV Medicine Association of the Infectious Diseases Society of America. https://aidsinfo.nih.gov/guidelines/html/4/adult-and-adolescent-oi-prevention-and-treatment-guidelines/0. Accessed April 30, 2020.
US Department of Health and Human Services (HHS) Panel on Opportunistic Infections in Adults and Adolescents with HIV. Guidelines for the prevention and treatment of opportunistic infections in adults and adolescents with HIV. https://clinicalinfo.hiv.gov/en/guidelines/adult-and-adolescent-opportunistic-infection/whats-new-guidelines. Updated August 18, 2021. Accessed August 20, 2021.
US Department of Health and Human Services (HHS) Panel on Opportunistic Infections in HIV-Exposed and HIV-Infected Children. Guidelines for the prevention and treatment of opportunistic infections in HIV-exposed and HIV-infected children. https://clinicalinfo.hiv.gov/en/guidelines/pediatric-opportunistic-infection/whats-new. Updated March 19, 2021. Accessed August 20, 2021.
Vannier E, Krause PJ. Human babesiosis. N Engl J Med. 2012;366(25):2397-2407. doi: 10.1056/NEJMra1202018. [PubMed 22716978]
Vardakas KZ, Trigkidis KK, Boukouvala E, Falagas ME. Clostridium difficile infection following systemic antibiotic administration in randomised controlled trials: a systematic review and meta-analysis. Int J Antimicrob Agents. 2016;48(1):1-10. doi:10.1016/j.ijantimicag.2016.03.008 [PubMed 27216385]
Vermont Oxford Network (VON). Neonatal drug concentrations. Updated November 2022. Accessed August 10, 2023. https://public.vtoxford.org/neonatal-drug-concentrations
Vílchez-Sánchez F, Domínguez-Ortega J, González Muñoz M, et al. Two case reports of delayed-allergic reactions to clindamycin confirmed with a positive lymphocyte transformation test. Eur Ann Allergy Clin Immunol. 2020;52(2):91-93. doi:10.23822/EurAnnACI.1764-1489.117 [PubMed 31668055]
Warady BA, Bakkaloglu S, Newland J, et al "Consensus Guidelines for the Prevention and Treatment of Catheter-Related Infections and Peritonitis in Pediatric Patients Receiving Peritoneal Dialysis: 2012 Update," Perit Dial Int, 2012, 32(Suppl 2):S32-86. [PubMed 22851742]
Watson T, Hickok J, Fraker S, Korwek K, Poland RE, Septimus E. Evaluating the risk factors for hospital-onset Clostridium difficile infections in a large healthcare system. Clin Infect Dis. 2018;66(12):1957-1959. doi:10.1093/cid/cix1112 [PubMed 29272341]
Weinstein AJ, Gibbs RS, Gallagher M. Placental transfer of clindamycin and gentamicin in term pregnancy. Am J Obstet Gynecol. 1976;124(7):688-691. [PubMed 943947]
Weintrob AC, Sexton DJ. Clinical manifestations, diagnosis, and management of diabetic infections of the lower extremities. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed April 27, 2023.
Wiesenfeld HC. Pelvic inflammatory disease: treatment in adults and adolescents. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed April 11, 2022.
Wilson KH. Prevention of anthrax. Post TW, ed. UpToDate. Waltham, MA: UpToDate Inc. http://www.uptodate.com. Accessed March 21, 2023.
Wilson W, Taubert KA, Gewitz M, et al, "Prevention of Infective Endocarditis. Guidelines From the American Heart Association," Circulation, 2007, 115:1-20.
Wilson W, Taubert KA, Gewitz M, et al; American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee; American Heart Association Council on Cardiovascular Disease in the Young; American Heart Association Council on Clinical Cardiology; American Heart Association Council on Cardiovascular Surgery and Anesthesia; Quality of Care and Outcomes Research Interdisciplinary Working Group. Prevention of infective endocarditis. Guidelines from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group [published correction appears in Circulation. 2007;116(15):e376-e377]. Circulation. 2007;116(15):1736-1754. [PubMed 17446442]
Wilson WR, Gewitz M, Lockhart PB, et al; American Heart Association Young Hearts Rheumatic Fever, Endocarditis and Kawasaki Disease Committee of the Council on Lifelong Congenital Heart Disease and Heart Health in the Young; Council on Cardiovascular and Stroke Nursing; and the Council on Quality of Care and Outcomes Research. Prevention of Viridans group Streptococcal infective endocarditis: a scientific statement from the American Heart Association. Circulation. 2021;143(20):e963-e978. doi:10.1161/CIR.0000000000000969 [PubMed 33853363]
Wong CJ, Stevens DL. Serious group A streptococcal infections. Med Clin North Am. 2013;97(4):721-736. [PubMed 23809722]
Woods CR, Bradley JS, Chatterjee A, et al. Clinical practice guideline by the Pediatric Infectious Diseases Society and the Infectious Diseases Society of America: 2021 guideline on diagnosis and management of acute hematogenous osteomyelitis in pediatrics. J Pediatric Infect Dis Soc. Published online August 5, 2021. doi:10.1093/jpids/piab027 [PubMed 34350458]
Workowski KA, Bachmann LH, Chan PA, et al. Sexually transmitted infections treatment guidelines, 2021. MMWR Recomm Rep. 2021;70(4):1-187. doi:10.15585/mmwr.rr7004a1 [PubMed 34292926]
World Health Organization (WHO), Anthrax in Humans and Animals, 4th ed, 2008. http://whqlibdoc.who.int/publications/2008/9789241547536_eng.pdf
World Health Organization (WHO). Breastfeeding and maternal medication, recommendations for drugs in the Eleventh WHO Model List of Essential Drugs. 2002. https://apps.who.int/iris/handle/10665/62435
World Health Organization (WHO). WHO guidelines for malaria (2023). https://www.who.int/publications/i/item/guidelines-for-malaria. Published March 14, 2023. Accessed July 20, 2023.
World Health Organization. (‎2000)‎. Mastitis: causes and management. World Health Organization. https://apps.who.int/iris/handle/10665/66230
Xue IB, Davey PG, Phillips G. Variation in postantibiotic effect of clindamycin against clinical isolates of Staphylococcus aureus and implications for dosing of patients with osteomyelitis. Antimicrob Agents Chemother. 1996;40(6):1403-1407. doi:10.1128/AAC.40.6.1403 [PubMed 8726009]
Zhou H, Xu Q, Liu Y, Guo LT. Risk factors, incidence, and morbidity associated with antibiotic-associated diarrhea in intensive care unit patients receiving antibiotic monotherapy. World J Clin Cases. 2020;8(10):1908-1915. doi:10.12998/wjcc.v8.i10.1908 [PubMed 32518780]
Zouboulis CC, Desai N, Emtestam L, et al. European S1 guideline for the treatment of hidradenitis suppurativa/acne inversa. J Eur Acad Dermatol Venereol. 2015;29(4):619-644. doi: 10.1111/jdv.12966. [PubMed 25640693]

Topic 15953 Version 669.0

خرید پکیج

Clindamycin (systemic): Pediatric drug information