How the dose is calculated
Clindamycin dose is calculated in mg/kg/day, and differs by route: oral dosing is 20 mg/kg/day divided every 6 hours (4×/day), up to a maximum of 1.8 g/day; IV dosing is 30 mg/kg/day divided every 8 hours (3×/day), also up to a maximum of 1.8 g/day.
Typical dosing by route
| Route | Dose | Frequency | Max |
|---|---|---|---|
| Oral | 20 mg/kg/day | every 6h (4×/day) | 1.8 g/day |
| IV | 30 mg/kg/day | every 8h (3×/day) | 1.8 g/day |
Clinical use
- Clindamycin is a useful option for penicillin-allergic patients with skin/soft-tissue infection, and covers many anaerobic organisms not reliably covered by amoxicillin or cephalexin.
- Often chosen empirically for suspected community-acquired MRSA skin infection where local resistance rates are low — check local clindamycin susceptibility patterns first.
- Associated with a higher risk of Clostridioides difficile-associated diarrhoea than many other antibiotics — counsel on this and review if new/worsening diarrhoea develops.
- Used in combination regimens for toxin-mediated infections (e.g. severe streptococcal/staphylococcal toxic shock) for its protein-synthesis-inhibiting, toxin-suppressing effect, in addition to the primary agent.
Frequently asked questions
What is clindamycin used for?
Clindamycin covers many Gram-positive and anaerobic bacteria and is often used for skin and soft-tissue infections, dental infections, and as an alternative in patients allergic to penicillin.
What is the difference between oral and IV clindamycin dosing?
Oral clindamycin is dosed at 20 mg/kg/day, divided every 6 hours (4 times a day); IV clindamycin is dosed higher, at 30 mg/kg/day, divided every 8 hours (3 times a day) — both are capped at a maximum of 1.8 g/day.
Why does clindamycin carry a diarrhoea warning?
Clindamycin is more strongly associated with Clostridioides difficile-associated diarrhoea than many other antibiotics — patients should be told to report new or worsening diarrhoea, especially if it persists after stopping the antibiotic.
Is clindamycin a good option for penicillin allergy?
Yes, for many skin and soft-tissue infections clindamycin is a reasonable alternative in penicillin-allergic patients, since it belongs to a different antibiotic class (lincosamides).
Why is clindamycin sometimes combined with another antibiotic?
In severe toxin-mediated infections (like toxic shock syndrome), clindamycin's ability to suppress bacterial toxin production is used alongside a primary bactericidal agent, rather than as monotherapy.
References
- World Health Organization. Model Formulary — Clindamycin.
- Chatri GL. Pediatric Drug Doses, 2nd edition — Clindamycin.