Clindamycin is sometimes used as an alternative for people with penicillin allergies. To ensure the drugs target as much of the bacterial growth as possible, some doctors choose to prescribe a combination of two different antibiotics. The close balance between desirable and undesirable consequences made it difficult for them (and the panel) to decide which options most individuals would choose.Competing interests: All authors have completed the Funding: This guideline was not funded. 1.2-2.7 g/day IV/IM divided q6-12hr; not to exceed 4.8 g/day900 mg IV q8hr with ciprofloxacin 400 mg PO q12hr or doxycycline 150-300 mg PO q12hr900 mg PO/IV 1 hr prior to procedure; may redose q6hr if necessary150-450 mg PO q6hr for at least 7 days; not to exceed 1.8 g/day, OR900 mg IV q8hr with gentamicin 2 mg/kg; THEN 1.5 mg/kg q8hr; continue after discharge with doxycycline 100 mg PO q12hr to complete 14 days of therapy900 mg IV q8hr plus oxacillin or nafcillin (2 g IV q4hr) or vancomycin (30 mg/kg/day IV divided q12hrAvoid IM injections in patients receiving anticoagulant therapy; administer PO in these circumstances; in general, administer IV only if patient does not tolerate or is unable to absorp oral medications20 mg/kg IV/IM within 30-60 minutes before procedureMay consider use in patients allergic to penicillin (IDSA guidelines)Chronic carrier treatment: 20-30 mg/kg/day PO divided q8hr; not to exceed 300 mg/doseAcute treatment in penicillin-allergic patients: 7 mg/kg/dose TID for 10 days; not to exceed 300 mg/dose May adjust dose as necessary not to exceed 40 mg/kg/dayEndocarditis: Recent AHA guidelines recommend only for invasive procedures in high-risk patientsClostridium difficile-associated diarrhea (CDAD) has been reported and may range in severity from mild diarrhea to fatal colitisC difficile produces toxins A and B, which contribute to CDAD; hypertoxin-producing C difficile strains increase morbidity and mortality (more likely to be refractory to antimicrobial therapy and may require colectomy)If CDAD suspected or confirmed, ongoing antibiotic use not directed against C difficile may need to be discontinuedHypersensitivity to clindamycin, lincomycin, or formulation componentsEndocarditis prophylaxis: Use only for high-risk patients, per recent AHA guidelinesRisk of potentially fatal pseudomembranous colitis, fungal or bacterial superinfection on prolonged use; discontinue therapy if significant abdominal cramps, diarrhea, or passage of blood and mucus occursMay increase risk of drug-resistant bacteria if prescribed in the absence of proven or strongly suspected bacterial infectionUse caution in hepatic impairment, monitor for hepatic abnormalities; periodic liver enzyme determinations should be made when treating patients with severe liver diseaseNot for use in meningitis due to inadequate penetration into CSFSevere skin reactions including toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (DRESS), and Stevens-Johnson syndrome (SJS), some with fatal outcome, reported; permanently discontinue if reactions occurParenteral product contains benzyl alcohol, which has been associated with gasping syndrome and death in newbornsUse with caution in patients with history of gastrointestinal disease, especially colitisNot for administration as a bolus; infuse over 10-60 minConsider possibility of clostridium difficile in all patients who present with diarrhea following antibiotic useSerious anaphylactic reactions require immediate emergency treatment with epinephrine; oxygen and intravenous corticosteroids should also be administered as indicatedIndicated surgical procedures should be performed in conjunction with antibiotic therapyClindamycin dosage modification may not be necessary in patients with renal diseaseDiscontinue therapy permanently and institute appropriate therapy if anaphylactic or severe hypersensitivity reaction occursIn clinical trials with pregnant women, systemic administration of clindamycin during the second and third trimesters, has not been associated with increased frequency of congenital abnormalitiesClindamycin should be used during first trimester of pregnancy only if clearly needed; there are no adequate and well-controlled studies in pregnant women during first trimester of pregnancy.

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