USUAL ADULT DOSE 150 TO 300 MG EVERY 6 HOURS; IN SEVERE INFECTIONS THE DOSE MAY BE INCREASED TO 450 MG EVERY 6 HOURS. CHILDREN: 3 TO 6 MG/KG EVERY 6 HOURS; THOSE WEIGHING 10 KG OR LESS, 37.5 MG EVERY 8 HOURS.
FOR INTRAVENOUS USE, THE CONCENTRATION OF CLINDAMYCIN IN DILUENT FOR INFUSION SHOULD NOT EXCEED 18 MG/ML AND THE RATE OF INFUSION SHOULD BE NOT MORE THAN 30 MG/MINUTE. NOT MORE THAN 1.2 G SHOULD BE GIVEN AS A SINGLE ONE-HOUR INFUSION, AND NOT MORE THAN 600 MG SHOULD BE GIVEN AS A SINGLE INTRAMUSCULAR INJECTION.
THE USUAL PARENTERAL DOSE IS THE EQUIVALENT OF 0.6 TO 2.7 G OF CLINDAMYCIN DAILY IN DIVIDED DOSES; UP TO 4.8 G DAILY HAS BEEN GIVEN INTRAVENOUSLY IN VERY SEVERE INFECTIONS. CHILDREN OVER THE AGE OF 1 MONTH MAY BE GIVEN THE EQUIVALENT OF 15 TO 40 MG/KG DAILY IN DIVIDED DOSES; IN SEVERE INFECTIONS THEY SHOULD RECEIVE A TOTAL DOSE OF NOT LESS THAN 300 MG OF CLINDAMYCIN DAILY. NEONATES HAVE BEEN GIVEN 15 TO 20 MG/KG DAILY.
FOR PROPHYLAXIS IN PATIENTS AT RISK OF DEVELOPING ENDOCARDITIS AND WHO CANNOT BE GIVEN A PENICILLIN, 600 MG BY MOUTH OR 300 MG GIVEN IV OVER AT LEAST 10 MINUTES , 1 HOUR BEFORE DENTAL PROCEDURES & FOLLOWED 6 HOURS LATER BY 150 MG ORAL OR INTRAVENOUS CLINDAMYCIN HAS BEEN SUGGESTED.
FOR THE TREATMENT OF ACNE: APPLY 1% GEL OR CREAM 2 - 3 TIMES DAILY.
CLINDAMYCIN PHOSPHATE MAY BE GIVEN INTRAVAGINALLY AS PESSARIES OR AS A 2% CREAM FOR THE TREATMENT OF BACTERIAL VAGINOSIS; THE EQUIVALENT OF ABOUT 100 MG CLINDAMYCIN IS GIVEN AT NIGHT FOR 3 TO 7 DAYS.
CLINDAMYCIN 1.2 G TWICE DAILY INTRAVENOUSLY OR 600 MG THREE TIMES DAILY BY MOUTH, FOR 7 TO 10 DAYS, WITH QUININE 650 MG THREE TIMES DAILY BY MOUTH FOR 7 TO 10 DAYS, HAS BEEN RECOMMENDED IN THE USA FOR THE TREATMENT OF BABESIOSIS CAUSED BY BABESIA MICROTI. CHILDREN COULD BE GIVEN CLINDAMYCIN 20 TO 40 MG/KG DAILY AND QUININE 25 MG/KG DAILY, BOTH BY MOUTH IN 3 DIVIDED DOSES FOR 7 TO 10 DAYS.
QUININE SULFATE PLUS FOLLOW-ON TREATMENT WITH DOXYCYCLINE, TETRACYCLINE, OR CLINDAMYCIN ARE RECOMMENDED REGIMENS FOR THE TREATMENT OF CHLOROQUINE-RESISTANT FALCIPARUM MALARIA IN NON-ENDEMIC MALARIA AREAS. DOXYCYCLINE IS GENERALLY PREFERRED BECAUSE IT CAN BE GIVEN ONCE DAILY. HOWEVER, TETRACYCLINES ARE CONTRA-INDICATED IN CHILDREN UNDER 8 YEARS OF AGE AND IN PREGNANT WOMEN AND IN THESE GROUPS CLINDAMYCIN IS GIVEN. CLINDAMYCIN IS GIVEN IN THE USUAL ADULT DOSE OF 20 MG/KG DAILY IN 3 DIVIDED DOSES (OR 450 MG 3 TIMES DAILY) FOR 7 DAYS IN A REGIMEN WITH QUININE SULFATE 600 TO 650 MG THREE TIMES DAILY FOR 3 TO 7 DAYS, BOTH GIVEN BY MOUTH. PARENTERAL QUININE (OR QUINIDINE) PLUS FOLLOW-ON TREATMENT WITH A TETRACYCLINE OR CLINDAMYCIN MAY BE USED FOR SEVERE FALCIPARUM MALARIA IN BOTH ENDEMIC AND NON-ENDEMIC MALARIA AREAS. PATIENTS UNABLE TO TOLERATE ORAL TREATMENT, MAY INITIALLY BE GIVEN FOLLOW-ON THERAPY INTRAVENOUSLY.
THE BNF RECOMMENDS THAT CHILDREN MAY BE GIVEN CLINDAMYCIN AT A DOSE OF 20 TO 40 MG/KG DAILY IN 3 DIVIDED DOSES FOR 5 DAYS.
CLINDAMYCIN MAY BE USED WITH PRIMAQUINE AS AN ALTERNATIVE TO CO-TRIMOXAZOLE FOR THE TREATMENT OF PNEUMOCYSTIS PNEUMONIA. A SUGGESTED DOSE IS CLINDAMYCIN 600 MG INTRAVENOUSLY, OR 300 TO 450 MG BY MOUTH, EVERY 6 HOURS WITH PRIMAQUINE 30 MG BY MOUTH DAILY, FOR 21 DAYS. THE BNF SUGGESTS CLINDAMYCIN 600 MG BY MOUTH EVERY 8 HOURS WITH PRIMAQUINE 30 MG DAILY BY MOUTH FOR MILD TO MODERATE DISEASE (BUT NOTES THAT THIS COMBINATION IS ASSOCIATED WITH CONSIDERABLE TOXICITY).
CLINDAMYCIN WITH PRIMAQUINE IS NOT NORMALLY RECOMMENDED FOR PROPHYLAXIS ALTHOUGH THERE ARE REPORTS OF IT BEING TRIED. A RETROSPECTIVE EXAMINATION OF THE RECORDS OF PATIENTS WHO HAD RECEIVED PROPHYLAXIS FOUND THAT CLINDAMYCIN WITH PRIMAQUINE WAS LESS EFFECTIVE THAN CO-TRIMOXAZOLE OR DAPSONE, ALTHOUGH THIS COULD HAVE BEEN DUE IN PART TO UNDERDOSING.
CLINDAMYCIN WITH PYRIMETHAMINE HAS BEEN USED FOR THE TREATMENT OF TOXOPLASMOSIS INSTEAD OF THE MORE USUAL TREATMENT WITH PYRIMETHAMINE PLUS SULFADIAZINE, IN PATIENTS UNABLE TO TOLERATE SULFONAMIDES. IN PATIENTS WITH AIDS AND TOXOPLASMIC ENCEPHALITIS, A SUGGESTED DOSE HAS BEEN CLINDAMYCIN 600 MG BY MOUTH EVERY 6 HOURS FOR AT LEAST 3 WEEKS, THEN MAINTENANCE THERAPY WITH AT LEAST 1200 MG DAILY; PATIENTS ALSO RECEIVED PYRIMETHAMINE. ANOTHER SCHEDULE HAS BEEN ORAL CLINDAMYCIN 600 MG FOUR TIMES DAILY WITH PYRIMETHAMINE 75 MG DAILY FOR 6 WEEKS. OTHER STUDIES FOUND ACUTE THERAPY WITH PYRIMETHAMINE AND CLINDAMYCIN, 600 MG FOUR TIMES DAILY BY MOUTH OR 1200 MG EVERY 6 HOURS INTRAVENOUSLY, TO BE AS EFFECTIVE AS PYRIMETHAMINE AND SULFADIAZINE, BUT MAINTENANCE THERAPY WITH PYRIMETHAMINE AND CLINDAMYCIN 300 MG FOUR TIMES DAILY BY MOUTH WAS LESS EFFECTIVE THAN PYRIMETHAMINE AND SULFADIAZINE AT PREVENTING RELAPSES IN A POPULATION FOLLOWED FOR 3 YEARS OR MORE. CLINDAMYCIN WITH FLUOROURACIL PRODUCED BENEFICIAL RESPONSES IN A STUDY INVOLVING 16 PATIENTS.