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clindamycin
generic
Black Box Warnings .
C. difficile-assoc. Diarrhea
rxns ranging in severity from mild diarrhea to fatal colitis reported during tx and even >2mo after D/C; reserve clindamycin for serious infections where less toxic abx inappropriate; do not use in nonbacterial infections incl. most URI; abx alter colon flora, leading to C. difficile overgrowth; C. difficile produces toxins A and B, which contribute to C. difficile-assoc. diarrhea; hypertoxin-producing strains cause incr. morbidity and mortality since infections can be refractory to abx tx and may require colectomy; consider C. difficile-assoc. diarrhea in all pts presenting w/ diarrhea after abx tx; consider D/C clindamycin if C. difficile-assoc. diarrhea suspected or confirmed; provide appropriate fluids, electrolytes, protein supplementation, abx, and surgical eval. as clinically indicated
Adult Dosing .
Dosage forms: CAP: 75 mg, 150 mg, 300 mg; INJ: various
infections, bacterial
- [150-450 mg PO q6h]
- Max: 600 mg/dose IM; 4800 mg/day IV; Alt: 600-2700 mg/day IM/IV divided q6-12h; Info: use IV for severe infections; give cap w/ water, avoid lying down x30min
pharyngitis, streptococcal
- [300 mg PO q8h x10 days]
- Info: give cap w/ water, avoid lying down x30min
bacterial vaginosis
- [300 mg PO q12h x7 days]
- Info: not 1st-line agent; give cap w/ water, avoid lying down x30min
PID, severe
- [900 mg IV q8h x14 days]
- Info: give w/ gentamicin; not 1st-line agent; switch to PO regimen ASAP to complete course
pneumonia, community-acquired
- [600-900 mg IM/IV q6-8h for at least 5 days]
- Info: for inpatient tx; may be part of multi-drug regimen
babesiosis (off-label)
- [mild-moderate infection, immunocompetent pts]
- Dose: 600 mg PO q8h x7-10 days; Info: give w/ quinine sulfate; not 1st-line regimen; give cap w/ water, avoid lying down x30min
- [severe infection, immunocompetent pts]
- Dose: 600 mg IV q6h x7-10 days; Info: give w/ quinine sulfate; not 1st-line regimen; switch to clindamycin 600 mg PO q8h for step-down tx
- [immunocompromised pts]
- Dose: 600 mg IV q6h for at least 6wk; Info: give w/ quinine sulfate; not 1st-line regimen; switch to clindamycin 600 mg PO q8h for step-down tx
infection prophylaxis, surgical (off-label)
- [900 mg IV x1]
- Start: w/in 60min preop; Info: may repeat dose q6h intraop
anthrax (off-label)
- [systemic]
- Dose: 900 mg IV q8h for at least 2wk; Info: part of multi-drug regimen; switch to PO abx for post-exposure prophylaxis if inhalational exposure
- [cutaneous]
- Dose: 600 mg PO q8h x7-10 days; Info: for non-systemic infection; not 1st-line agent; give cap w/ water, avoid lying down x30min; use extended duration for post-exposure prophylaxis if bioterrorism suspected
- [post-exposure prophylaxis]
- Dose: 600 mg PO q8h x60 days; Info: not 1st-line agent; give in combo w/ anthrax vaccine; give cap w/ water, avoid lying down x30min; may give x42 days or x14 days after last vaccine dose in immunocompetent pts 18-65 yo if anthrax vaccine regimen completed
PCP (off-label)
- [mild-moderate infection]
- Dose: 600 mg PO q8h x21 days; Alt: 450 mg PO q6h x21 days; Info: not 1st-line agent; give w/ primaquine; give cap w/ water, avoid lying down x30min
- [severe infection]
- Dose: 900 mg IV q8h x21 days or 600 mg PO q8h x21 days; Alt: 600 mg IV q6h x21 days; 450 mg PO q6h x21 days; Info: not 1st-line agent; give w/ primaquine; give cap w/ water, avoid lying down x30min
malaria, uncomplicated (off-label)
- [20 mg/kg/day PO divided q8h x7 days]
- Info: give w/ quinine sulfate; give cap w/ water, avoid lying down x30min; to avoid relapse in acute P. vivax or P. ovale infection, follow up tx w/ primaquine; refer to CDC guidelines
toxoplasmosis (off-label)
- [treatment]
- Dose: 600 mg PO/IV q6h for at least 6wk; Info: not 1st-line agent; give w/ pyrimethamine, leucovorin; give cap w/ water, avoid lying down x30min
- [maintenance tx]
- Dose: 600 mg PO q8h; Info: not 1st-line agent; give w/ pyrimethamine, leucovorin; give cap w/ water, avoid lying down x30min
endophthalmitis, bacterial (off-label)
- [1 mg in 0.1 ml sterile water or saline intravitreally x1]
- Info: part of multi-drug regimen; refer to institution protocol; may repeat q48h x1
renal dosing
- [no adjustment]
- renal impairment: no adjustment
- HD/PD: no adjustment; no supplement
hepatic dosing
- [no adjustment]
Peds Dosing .
- Dosage forms: CAP: 75 mg, 150 mg, 300 mg; SOL: 75 mg per 5 mL; INJ: various
infections, mild-mod. bacterial
- [infants/children]
- Dose: 10-25 mg/kg/day PO divided q6-8h; Max: 1.8 g/day PO; 4.8 g/day IM/IV; Alt: 15-25 mg/kg/day IM/IV divided q6-8h; 350 mg/m^2/day IM/IV divided q6-8h; 30-40 mg/kg/day PO divided q6-8h for susceptible Staph aureus skin/soft tissue infections
- [adolescents]
- Dose: 150-300 mg PO q6h; Max: 1.8 g/day PO; 4.8 g/day IM/IV; Alt: 15-25 mg/kg/day IM/IV divided q6-8h; 350 mg/m^2/day IM/IV divided q6-8h; 30-40 mg/kg/day PO divided q6-8h for susceptible Staph aureus skin/soft tissue infections; Info: give cap w/ water, avoid lying down x30min
infections, severe bacterial
- [<1 mo, postmenstrual age <32 wk]
- Dose: 15 mg/kg/day IM/IV divided q8h
- [<1 mo, postmenstrual age 33-40 wk]
- Dose: 21 mg/kg/day IM/IV divided q8h
- [infants/children]
- Dose: 25-40 mg/kg/day IM/IV divided q6-8h; Max: 4.8 g/day; Alt: 450 mg/m^2/day IM/IV divided q6-8h; 20-30 mg/kg/day PO divided q6-8h, max 1.8 g/day
- [adolescents]
- Dose: 25-40 mg/kg/day IM/IV divided q6-8h; Max: 4.8 g/day; Alt: 450 mg/m^2/day IM/IV divided q6-8h; 300-450 mg PO q6h, max 1.8 g/day
otitis media, acute
- [6 mo-1 yo]
- Dose: 30-40 mg/kg/day PO divided q8h x10 days
- [mild-moderate infection, 2-5 yo]
- Dose: 30-40 mg/kg/day PO divided q8h x7 days
- [mild-moderate infection, 6-12 yo]
- Dose: 30-40 mg/kg/day PO divided q8h x5-7 days; Info: give cap w/ water, avoid lying down x30min
- [severe infection, 2-12 yo]
- Dose: 30-40 mg/kg/day PO divided q8h x10 days; Info: give cap w/ water, avoid lying down x30min
sinusitis, acute bacterial
- [children]
- Dose: 30-40 mg/kg/day PO divided q8h x10-14 days; Info: use w/ cefixime or cefpodoxime
pharyngitis, streptococcal
- [7 mg/kg/dose PO q8h x10 days]
- Max: 300 mg/dose
community-acquired pneumonia, bacterial
- [mild infection, >3 mo]
- Dose: 30-40 mg/kg/day PO divided q6-8h x7-10 days; Info: give cap w/ water, avoid lying down x30min
- [moderate-severe infection, >3 mo]
- Dose: 40 mg/kg/day IV divided q6-8h x10-14 days; Info: may switch to PO regimen when possible to complete course
bacterial vaginosis
- [adolescents]
- Dose: 300 mg PO q12h x7 days; Info: not 1st-line agent; give cap w/ water, avoid lying down x30min
PID, severe
- [adolescents]
- Dose: 900 mg IV q8h x14 days; Info: give w/ gentamicin; not 1st-line agent; switch to PO regimen ASAP to complete course
toxoplasmosis (off-label)
- [treatment, congenital infection]
- Dose: 20-30 mg/kg/day PO/IV divided q6h x12mo; Max: 600 mg/dose; Info: not 1st-line agent; give w/ pyrimethamine, leucovorin; give cap w/ water, avoid lying down x30min
- [treatment, acquired infection]
- Dose: 20-30 mg/kg/day PO/IV divided q6h for at least 6wk; Max: 600 mg/dose; Info: not 1st-line agent; give w/ pyrimethamine, leucovorin; give cap w/ water, avoid lying down x30min
- [suppressive therapy]
- Dose: 21-30 mg/kg/day PO divided q8h; Info: not 1st-line agent; give w/ pyrimethamine, leucovorin; give cap w/ water, avoid lying down x30min
babesiosis (off-label)
- [mild-moderate infection, immunocompetent pts]
- Dose: 7-10 mg/kg/dose PO q8h x7-10 days; Max: 600 mg/dose; Info: give w/ quinine sulfate; not 1st-line regimen; give cap w/ water, avoid lying down x30min
- [severe infection, immunocompetent pts]
- Dose: 7-10 mg/kg/dose IV q6-8h x7-10 days; Max: 600 mg/dose; Info: give w/ quinine sulfate; not 1st-line regimen; switch to clindamycin 7-10 mg/kg/dose PO q8h for step-down tx
- [immunocompromised pts]
- Dose: 7-10 mg/kg/dose IV q6-8h for at least 6wk; Max: 600 mg/dose; Info: give w/ quinine sulfate; not 1st-line regimen; switch to clindamycin 7-10 mg/kg/dose PO q8h for step-down tx
infection prophylaxis, surgical (off-label)
- [1 yo and older]
- Dose: 10 mg/kg/dose IV x1; Start: w/in 60min preop; Max: 900 mg/dose; Info: may repeat dose q6h intraop
anthrax, systemic (off-label)
- [neonates >32 wk gestation]
- Dose: 10-20 mg/kg/day IV divided q6-12h for at least 2wk; Info: part of multi-drug regimen; dose, frequency depend on gestational and post-natal age; switch to PO abx x60 days total if inhalational exposure
- [1 mo and older]
- Dose: 40 mg/kg/day IV divided q8h for at least 2wk; Alt: 30 mg/kg/day PO divided q8h for at least 2wk; Max: 900 mg/dose IV; 600 mg/dose PO; Info: part of multi-drug regimen; switch to PO abx x60 days total if inhalational exposure
anthrax, cutaneous (off-label)
- [neonates >32 wk gestation]
- Dose: 10-20 mg/kg/day PO divided q6-12h x7-10 days; Info: for pts w/ non-systemic infection; not 1st-line agent; dose, frequency depend on gestational and post-natal age; give abx x60 days total if bioterrorism suspected
- [1 mo and older]
- Dose: 30 mg/kg/day PO divided q8h x7-10 days; Max: 600 mg/dose; Info: for pts w/ non-systemic infection; not 1st-line agent; give cap w/ water, avoid lying down x30min; give abx x60 days total if bioterrorism suspected
anthrax, post-exposure prophylaxis (off-label)
- [neonates >32 wk gestation]
- Dose: 10-20 mg/kg/day PO divided q6-12h x60 days; Info: not 1st-line agent; dose, frequency depend on gestational and post-natal age
- [1 mo and older]
- Dose: 30 mg/kg/day PO divided q8h x60 days; Max: 900 mg/dose; Info: not 1st-line agent; give cap w/ water, avoid lying down x30min
malaria, uncomplicated (off-label)
- [20 mg/kg/day PO divided q8h x7 days]
- Info: give w/ quinine sulfate; give cap w/ water, avoid lying down x30min; to avoid relapse in acute P. vivax or P. ovale infection, follow up tx w/ primaquine; refer to CDC guidelines
renal dosing
- [no adjustment]
- renal impairment: no adjustment
- HD/PD: no adjustment; no supplement
hepatic dosing
- [no adjustment]