Clindamycin

Edina Avdic, Pharm.D., Paul A. Pham, Pharm.D.
Pediatric Dosing Author: Alice Jenh Hsu, PharmD, BCPS, AQ-ID
Clindamycin is a topic covered in the Johns Hopkins HIV Guide.

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INDICATIONS

FDA

  • Skin and soft tissue infections caused by streptococci, staphylococci and anaerobes
  • Pelvic infections (endometritis, nongonococcal tubo-ovarian abscess, pelvic cellulitis, and post-surgical vaginal cuff infections)
  • Intra-abdominal infections such as peritonitis and intra-abdominal abscess caused by anaerobes (note: IDSA guideline no longer recommends clindamycin due to increased B. fragilis resistance rate)
  • Streptococcus pneumoniae (empyema, pneumonitis, and lung abscess)
  • Septicemia (no longer recommended)
  • Acne vulgaris (topical gel)
  • Bacterial vaginosis in non-pregnant women and pregnant women during the second and third trimesters (intra-vaginal administration)

NON-FDA APPROVED USES

  • Alternative treatment of PCP in combination with primaquine
  • Alternative treatment of CNS toxoplasmosis in combination with pyrimethamine and leucovorin
  • MRSA skin and soft tissue infections
  • Necrotizing fasciitis including Fournier gangrene: may be considered in combination with other agents to decrease toxin production caused by MRSA, S. pyogenes, C. perfringens
  • Oral abscess in patients with PCN allergies
  • Acute bacterial sinusitis
  • Intrapartum prophylaxis for Group B strep; alternative to beta-lactam only if susceptibility testing is done
  • Bacterial vaginosis
  • Actinomycosis
  • Osteomyelitis
  • Acute bacterial sinusitis
  • Non-severe malaria as part of alternative regimen, especially in pregnancy
  • Diphtheria
  • Alternative therapy for bebesiosis in combination with quinine

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INDICATIONS

FDA

  • Skin and soft tissue infections caused by streptococci, staphylococci and anaerobes
  • Pelvic infections (endometritis, nongonococcal tubo-ovarian abscess, pelvic cellulitis, and post-surgical vaginal cuff infections)
  • Intra-abdominal infections such as peritonitis and intra-abdominal abscess caused by anaerobes (note: IDSA guideline no longer recommends clindamycin due to increased B. fragilis resistance rate)
  • Streptococcus pneumoniae (empyema, pneumonitis, and lung abscess)
  • Septicemia (no longer recommended)
  • Acne vulgaris (topical gel)
  • Bacterial vaginosis in non-pregnant women and pregnant women during the second and third trimesters (intra-vaginal administration)

NON-FDA APPROVED USES

  • Alternative treatment of PCP in combination with primaquine
  • Alternative treatment of CNS toxoplasmosis in combination with pyrimethamine and leucovorin
  • MRSA skin and soft tissue infections
  • Necrotizing fasciitis including Fournier gangrene: may be considered in combination with other agents to decrease toxin production caused by MRSA, S. pyogenes, C. perfringens
  • Oral abscess in patients with PCN allergies
  • Acute bacterial sinusitis
  • Intrapartum prophylaxis for Group B strep; alternative to beta-lactam only if susceptibility testing is done
  • Bacterial vaginosis
  • Actinomycosis
  • Osteomyelitis
  • Acute bacterial sinusitis
  • Non-severe malaria as part of alternative regimen, especially in pregnancy
  • Diphtheria
  • Alternative therapy for bebesiosis in combination with quinine

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