Clindamycin Dosing in Adults >= 18 Years (910)

Warning

exp date isn't null, but text field is

A guideline is intended to assist healthcare professionals in the choice of disease-specific treatments.

Clinical judgement should be exercised on the applicability of any guideline, influenced by individual patient characteristics. Clinicians should be mindful of the potential for harmful polypharmacy and increased susceptibility to adverse drug reactions in patients with multiple morbidities or frailty.

If, after discussion with the patient or carer, there are good reasons for not following a guideline, it is good practice to record these and communicate them to others involved in the care of the patient.

Introduction

Clindamycin is a lincosamide antibiotic that is active against most Gram-positive aerobic bacteria, many anaerobes, and protozoa. Clindamycin is a restricted antibiotic and should only be prescribed as per the Infection Management Guidelines / Adult Therapeutics Handbook or on the advice of Microbiology/Infectious Diseases (ID).

In view of oral clindamycin’s pharmacokinetic and pharmacodynamic properties, it has been agreed between Microbiology and ID that oral clindamycin can be given 8 hourly to improve compliance. See table below for oral/IV dosing guidance.

Dosing Table

Infection indication Clindamycin dosing
Mild/Moderate Cellulitis
(on advice of Microbiology/ID)
*Oral – 600 mg 8 hourly ≥70 kg
*Oral – 450 mg 8 hourly <70 kg
Bone and Joint Infection
(on advice of Microbiology/ID)
*Oral – 600 mg 8 hourly
†Moderate/Severe Cellulitis (if rapidly progressive)
†Tonsillitis/Pharyngitis (severe sepsis)
†Peri-anal infection (severe, penicillin allergy)
‡IV – 600 mg 6 hourly
†Suspected Necrotising Fasciitis ‡IV – 1.2 g 6 hourly

*Please note these are unlicensed doses (see above).
†Clindamycin given with other agents, refer to the Adult Therapeutics Handbook/Infection Management Guidelines for antibiotic regimen advice.
‡Bioavailability of oral clindamycin is 90% consider switching to oral at the earliest appropriate point in care.

 

 

Dose Adjustments

Dose adjustments may be required in severe renal/hepatic impairment and obesity, seek advice from the Antimicrobial Pharmacy team for further information.

Monitoring and Toxicity

Monitor LFTs, FBC and renal function for courses longer than 10 days. Clindamycin is associated with increased risk of Clostridioides difficile (C. diff) infection, particularly in patients aged >65. Antibiotic-associated colitis can be fatal, avoid if previous C. diff or discuss with Microbiology/ID. Patient should stop if diarrhoea occurs and discuss urgently with clinical team.

Drug Interactions

There are a number of important clindamycin interactions to be aware of including interactions with neuromuscular blocking agents, vitamin K antagonists (e.g. warfarin), and inhibitors of CYP3A4 and CYP3A5. For a full list please refer to the BNF or SPC via eMC.

Full Information

For full prescribing information on clindamycin, please refer to the BNF or SPC via eMC.

Last reviewed: 23 March 2021

Next review: 29 March 2024

Author(s): Ysobel Gourlay

Version: 2

Author Email(s): [email protected]

Approved By: Antimicrobial Utilisation Committee

Document Id: 910