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Clindamycin
Paul A. Pham Pharm.D. and John G. Bartlett M.D.
03-20-2008
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Available formulations in Zambia: Capsule: 150 mg. Injection: 150 mg (as phosphate)/ml.
- Cellulitis in PCN allergic pts: clindamycin 600 mg IV q8h or 300 mg PO q8h
- PID in PCN allergic pts: Clindamycin 900 mg IV q8h plus gentamicin 5mg/kg/d until clinical improvement, then switch to doxycycline plus metronidazole for 14 days.
- Diabetic foot ulcer in PCN allergic pts: Clindamycin 600 mg IV q8h plus gentamicin 5 mg/kg/d
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PCP treatment in SMX/TMP allergic pts: Clindamycin 600 mg q8h plus primaquine 15 mg qd x 21 days.
- Surgical prophylaxis in PCN allergic pts: Clindamycin 300 mg IV x 1 (add gentamicin 3mg/kg for colorectal, biliary, or pelvic surgery).
- Peritonsillar abscess in PCN allergic pts: clindamycin 600 mg IV q8h or 300 mg PO q8h
- Falciparum malaria in pregnancy and children <8 years: Clindamycin 5mg/kg tid x 7d PLUS quinine.
Zambia Information Author: Paul A. Pham, Pharm. D.
- Osteomyelitis
- Pelvic infections (endometritis, nongonococcal tubo-ovarian abscess, pelvic cellulitis, and postsurgical vaginal cuff infections)
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Streptococcus pneumoniae (empyema, pneumonitis, and lung abscess)
- Septicemia
- Skin and soft tissue infections
- Actinomycosis
- Acute bacterial sinusitis
brand
name
| generic
| Mfg
| brand
forms
| cost*
|
|
Cleocin
| Clindamycin HCl | Pfizer | oral
capsule
150 mg | $3.23 |
|
|
|
| oral
capsule
300 mg | $3.72 |
|
Cleocin phosphate
| Clindamycin phosphate | ~Pfizer | IV
vial
300 mg; 600 mg; 900 mg | $4.70; $9.16; $12.04 |
| Cleocin pediatric solution | Clindamycin palmitate | ~Pfizer | oral
solution
75 mg/5 ml | $1.50 per 5 ml |
| Cleocin vaginal suppository | Clindamycin phosphate | Pfizer | vaginal
ovule suppository
100 mg | $15.50 |
|
Cleocin T
| Clindamycin phosphate | Pfizer | topical
gel
1% (30 g; 60 g) | $51.00.60; $92.00 |
|
|
|
| topical
lotion
1% (30 ml; 60 ml) | $34; $57.00 |
| Clindamycin | Clindamycin HCL | Various generic manufacturers | oral
capsule
150 mg | $1.15 |
|
|
|
| oral
capsule
300 mg | $3.70 |
*Prices represent cost per unit specified and are representative of "Average Wholesale Price" (AWP).
AWP Prices were obtained and gathered by Lakshmi Vasist Pharm D using the Red Book, manufacturer's
information, and the McKesson database.
^Dosage is indicated in mg unless otherwise noted.
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PCP: clindamycin 600 mg IV q 6-8h or 300-450 mg PO q6-8h + primaquine 15-30 mg PO qd (base) +/- prednisone (recommended for PO2<70) x 21 days.
- CNS toxoplasmosis: clindamycin 600 mg IV q6h or clindamycin 450-600 mg PO q6h + pyrimethamine 200 mg PO loading dose, then 50-75 mg PO qd + leucovorin 10-20 mg qd until immune reconstitution (CD4 >200 on stable HAART for 6-12 mos).
- Soft tissue (including CA-MRSA) infections: 300-450 mg PO qid or 600 mg IV q8h x14 d then reassess.
- Pelvic inflammatory disease: 900 mg IV q8h (in combination with gentamicin) x 14d.
- Bacterial vaginosis: 100 mg vaginal suppository qhs x 3-7 d
- Acne: 1-2 applications qd
- Osteomyelitis: 600 mg IV q8h x 6-8 wks then reassess
- Acute bacterial sinusitis: 300 mg PO qid x 2-3 wks.
- Actinomycosis: 600 mg IV q 8h x 2-6 wks, then 300 mg PO qid x 6-12 mos
- Capsules should be taken with full glass of water to avoid esophageal irritation
Usual dose
Usual dose
Usual dose
Usual regimen
Usual regimen
Some removal during CAVH
- Generalized morbilliform rash
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C. difficile colitis in 6% of pts (clindamycin is most common cause on per pt basis);
- Stevens-Johnson syndrome
- Allergic-type reactions (including bronchial asthma) in pts with aspirin hypersensitivity (from tartrazine found in 75 and 150 mg caps)
- Nondepolarizing muscle relaxant (pancuronium, tubocurarine): clindamycin may enhance action of nondepolarizing muscle relaxants. Use with caution in pts receiving such agents.
- Loperamide and diphenoxylate/atropine: may increase risk of diarrhea and C. difficile-associated colitis. Avoid use with clindamycin.
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Erythromycin: in vitro antagonism. Clinical significance unclear. Avoid co-administration.
- Kaolin-pectin: decreases clindamycin absorption
Active against most gram-positive cocci except Enterococcus and nosocomial MRSA. Active against most CA-MRSA. Increasing resistance seen with B. fragilis.
Oral and parenteral lincomycins have good activity against anaerobes; increasing resistance with B. fragilis makes metronidazole more reliable for intrabdominal infections. On per pt basis, clindamycin is antimicrobial most likely to cause C. difficile colitis, but many more pts get diarrhea without C. difficile colitis. Prescribe with caution in individuals with h/o colitis. QID dosing may limit patient adherence. Clindamycin-primaquine is good 2nd-line regimen for PCP in pts who can not tolerate TMP/SMX. Inferior to pyrimethamine/sulfadiazine for treatment to CNS toxoplasmosis but clindamycin/pyrimethamine can be considered as an alternative treatment regimen in sulfa allergic pts. A first-line oral treatment option for CA-MRSA soft tissue infection.
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