Antimicrobials

Active against:

• Streptococci (resistance prevalence: ), Staphylococcus aureus (cloxacillin-sensitive strains) (resistance prevalence: )
• Anaerobes (including Bacteroides fragilis) (resistance prevalence: )

Not active against:

• Enterococci
• Methicillin-resistant Staphylococcus aureus (MRSA)
• Listeria
• Aerobic gram-negative rods

Appropriate Uses:

• Staphylococcal and streptococcal infection (with or without anaerobes) of soft tissues or bone in patients in whom penicillins or cephalosporins are contraindicated
• Mixed anaerobic/aerobic gram-positive infections
• Aspiration pneumonia in combination with another agent against aerobic gram negative rods (i.e., clindamycin used in combination with levofloxacin) ONLY in cases where patients have a severe beta-lactam allergy
• Alternative to amoxicillin for prophylaxis of bacterial endocarditis
• Initial treatment of anaerobic lung infections in seriously ill patients
• Anaerobic infections where metronidazole cannot be used

Inappropriate Uses:

• Meningitis and other CNS infections (exception: useful for cerebral toxoplasmosis)
• Treatment of serious gram-positive infections such as septicemia or endocarditis requiring bactericidal activity (other agents, such as beta-lactams, are preferred)
• As empiric therapy for cellulitis (due to Streptococal resistance)

• Clindamycin has been associated, as have many other antibiotics, with development of diarrhea and colitis due to Clostridium difficile
• Pregnancy: not expected to increase risk of major congenital malformations
• Breastfeeding: Monitor nursing infant for possible diarrhea, oral thrush, and for blood in stool suggestive of antibiotic-associated colitis (rare).

• Nausea, vomiting, diarrhea, colitis
• Rash, reversible neutropenia
• Transient elevations of liver function tests

Usual dosage:

• Oral: 300 mg PO q6h (450 mg PO q6h for bone infections)
• Intravenous: 600 mg IV q8h

Note: Due to high bioavailability of clindamycin, IV is rarely required unless used for treatment of toxic shock. IV doses higher than 1800 mg per day will be automatically converted to 600 mg IV q8h. Exceptions include the following: treatment of necrotizing fasciitis, pelvic inflammatory disease, post-partum endometritis, cerebral toxoplasmosis, and prevention of group B streptococcal disease in penicllin-allergic patients.

Renal insufficiency: no dosage reduction required
Hepatic impairment: dose should not exceed 1800 mg IV per day

• Direct Injection: not recommended (except in severe fluid restriction)
• Intermittent Infusion: infuse over 30 minutes
• Please refer to IV drug monograph on pharmacy intranet page for additional administration information.