Clostridioides difficile-associated diarrhea (CDAD) has been reported with use of nearly all antibacterial agents, including clindamycin, and may range in severity from mild diarrhea to fatal colitis. Treatment with antibacterial agents alters the normal flora of the colon, leading to overgrowth of C. difficile.
Because clindamycin therapy has been associated with severe colitis, which may end fatally, reserve it for serious infections for which less toxic antimicrobial agents are inappropriate. Do not use clindamycin in patients with nonbacterial infections, such as most upper respiratory tract infections.
C. difficile produces toxins A and B, which contribute to the development of CDAD. Hypertoxin-producing strains of C. difficile cause increased morbidity and mortality, as these infections can be refractory to antimicrobial therapy and may require colectomy. CDAD must be considered in all patients who present with diarrhea following antibiotic use. Careful medical history is necessary because CDAD has been reported to occur more than 2 months after the administration of antibacterial agents.
If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile may need to be discontinued. Institute appropriate fluid and electrolyte management, protein supplementation, antibiotic treatment of C. difficile, and surgical evaluation as clinically indicated.
Usual dose:
Oral: 600 to 1,800 mg/day in 2 to 4 divided doses; up to 2,400 mg/day in 4 divided doses may be given for severe infections.
IM, IV: 600 to 2,700 mg/day in 2 to 4 divided doses; according to the manufacturer, up to 4,800 mg/day IV (in divided doses) has been used in life-threatening infections; however, data supporting this dose are lacking; maximum: 600 mg/dose IM.
Anthrax (off-label use): Note: Consult public health officials for event-specific recommendations.
Inhalational exposure postexposure prophylaxis (PEP) (alternative agent): Oral: 600 mg every 8 hours for 42 to 60 days.
Note: Anthrax vaccine should also be administered to exposed individuals (Ref). Duration of therapy: If the PEP anthrax vaccine series is administered on schedule (for all regimens), antibiotics may be discontinued in immunocompetent adults 18 to 65 years of age at 42 days after initiation of vaccine or 2 weeks after the last dose of the vaccine (whichever comes last and not to exceed 60 days); if the vaccination series cannot be completed, antibiotics should continue for 60 days (Ref). In addition, adults with immunocompromising conditions or receiving immunosuppressive therapy, patients >65 years of age, and patients who are pregnant or breastfeeding should receive antibiotics for 60 days (Ref).
Cutaneous, without systemic involvement, empiric therapy (alternative agent): Oral: 600 mg every 8 hours for 60 days following biological weapon-related event; duration is 7 to 10 days after naturally acquired infection. Note: Patients with cutaneous lesions of the head or neck or extensive edema should be treated for systemic involvement (Ref).
Systemic, meningitis excluded: IV: 900 mg every 8 hours in combination with other appropriate agents for at least 2 weeks or until clinically stable, whichever is longer (Ref).
Meningitis (alternative agent): IV: 900 mg every 8 hours in combination with other appropriate agents for at least 2 to 3 weeks or until clinically stable, whichever is longer (Ref).
Note: Antitoxin should also be administered for systemic anthrax. Following the course of IV combination therapy for systemic anthrax infection (including meningitis), patients exposed to aerosolized spores require oral monotherapy to complete a total antimicrobial course of 60 days (Ref).
Babesiosis (alternative agent) (off-label use):
Mild to moderate disease or oral step-down therapy following initial parenteral treatment: Oral: 600 mg every 8 hours in combination with quinine for a total of 7 to 10 days; a longer duration of ≥6 weeks, including 2 weeks after resolution of parasitemia, may be necessary for patients at high risk of relapse (eg, highly immunocompromised patients) (Ref).
Severe disease, initial therapy: IV: 600 mg every 6 hours in combination with quinine; may switch to oral clindamycin once symptoms improve (Ref).
Bite wound infection, prophylaxis of high-risk bite or treatment (animal or human bite) (alternative agent) (off-label use): Note: For animal bite, use in combination with an appropriate agent for Pasteurella multocida. For human bite, use in combination with an appropriate agent for Eikenella corrodens (Ref).
Oral: 300 to 450 mg 3 times daily (Ref).
IV: 600 mg every 6 to 8 hours (Ref). Note: In selected patients with high-risk wounds, some experts recommend parenteral therapy be given initially until infection is resolving, followed by oral therapy (Ref).
Note: For prophylaxis, duration is 3 to 5 days (Ref); for treatment of established infection, duration is typically 5 to 14 days and varies based on patient-specific factors, including clinical response (Ref).
Diabetic foot infection, mild to moderate (alternative agent) (off-label use): Oral: 300 to 450 mg every 6 to 8 hours (Ref). Note: May be used alone for empiric therapy of mild infections; if there are risk factors for gram-negative bacilli, must be used in combination with other appropriate agents. Duration of therapy should be tailored to individual clinical circumstances; most patients respond to 1 to 2 weeks of therapy (Ref).
Gingivitis, acute simple, plaque-associated (alternative agent) (off-label use):
Note: For patients unable to take beta-lactams. Reserve systemic therapy for patients with rapidly progressive disease, severe pain, or immunocompromising conditions (Ref).
Oral: 450 mg every 8 hours for 5 to 7 days (Ref).
Hidradenitis suppurativa (off-label use): Oral: 300 mg twice daily in combination with rifampin for 10 to 12 weeks (Ref).
Malaria, treatment (alternative agent) (off-label use): Oral: 20 mg/kg/day in divided doses every 8 hours for 7 days in combination with quinine sulfate (quinine sulfate duration is region specific). Note: If used for P. vivax or P. ovale, use this regimen in combination with primaquine. If used for severe malaria (after completion of IV therapy), use full 7-day schedule of clindamycin (Ref).
Mastitis, lactational (alternative agent):
Note: Reserve for patients unable to use first-line agents or for patients at risk for methicillin-resistant S. aureus (Ref).
Oral: 300 mg 4 times daily or 450 mg 3 times daily for 10 to 14 days; shorter courses (eg, 5 to 7 days) may be considered for patients with rapid clinical resolution (Ref).
Neutropenic fever, empiric therapy for low-risk cancer patients (alternative agent for penicillin-allergic patients) (off-label use): Oral: 600 mg every 8 hours (Ref); some experts recommend 300 mg every 6 hours (Ref) (data on appropriate dose are limited). Use in combination with oral ciprofloxacin; continue until afebrile and neutropenia has resolved. Note: Avoid in patients who have received fluoroquinolone prophylaxis. Administer first dose in the health care setting (after blood cultures are drawn); observe patient for ≥4 hours before discharge (Ref).
Osteomyelitis :
Osteomyelitis due to methicillin-resistant Staphylococcus aureus (MRSA) (alternative agent): IV, Oral: 600 mg 3 times daily for a minimum of 8 weeks; some experts combine with rifampin (Ref).
Osteomyelitis, native vertebral due to staphylococci, methicillin-susceptible (alternative agent):
IV: 600 to 900 mg every 8 hours for 6 weeks (Ref).
Oral: 300 to 450 mg 4 times daily (Ref) or 600 mg 3 times daily (Ref) for 6 weeks (Ref). Note: Clindamycin may also be used as suppressive therapy in selected patients (Ref).
Osteomyelitis, native vertebral due to Cutibacterium acnes (alternative agent): IV: 600 to 900 mg every 8 hours for 6 weeks (Ref).
Pelvic inflammatory disease, severe (including tubo-ovarian abscess) (alternative agent):
IV: 900 mg every 8 hours in combination with gentamicin; after 24 to 48 hours of sustained clinical improvement, transition to an oral regimen to complete 14 days of treatment (Ref). Note: Some experts reserve this regimen for patients who cannot use preferred agents due to greater associated adverse effects (Ref).
Oral: 450 mg 4 times daily, beginning after 24 to 48 hours of sustained clinical improvement on an appropriate parenteral regimen, to complete 14 days of therapy. Note: If tubo-ovarian abscess is present, use as part of an appropriate combination regimen (Ref).
Pneumocystis jirovecii pneumonia (PCP), treatment (alternative agent) (off-label use):
Mild to moderate disease: Oral: 450 mg every 6 hours or 600 mg every 8 hours with primaquine for 21 days (Ref).
Severe disease: IV: 600 mg every 6 hours or 900 mg every 8 hours with primaquine for 21 days; following clinical improvement, clindamycin can be given orally at 450 mg every 6 hours or 600 mg every 8 hours (Ref).
Note: Patients with moderate or severe infection (PaO2 <70 mm Hg at room air or alveolar-arterial oxygen gradient ≥35 mm Hg) should receive adjunctive glucocorticoids (Ref).
Pneumonia
Aspiration pneumonia (alternative agent):
Note: Reserve for patients with penicillin allergy, as initial treatment for mild, community-acquired infection or as oral step-down therapy for patients requiring initial parenteral therapy (Ref).
Oral: 300 to 450 mg 3 times daily; duration of therapy is generally 5 to 7 days (Ref).
Pathogen-specific therapy for methicillin-resistant S. aureus pneumonia (alternative agent):
Note: Data in adults are limited (Ref).
Oral, IV: 600 mg 3 times daily; duration of therapy varies based on disease severity and response to therapy; treatment is typically given for 7 days (Ref).
Postpartum endometritis: IV: 900 mg every 8 hours as part of an appropriate combination regimen; treat until the patient is clinically improved (no fundal tenderness) and afebrile for 24 to 48 hours (Ref).
Prosthetic joint infection (off-label use):
Cutibacterium acnes, treatment (alternative agent for penicillin allergy):
IV: 600 to 900 mg every 8 hours for 4 to 6 weeks (Ref).
Oral: 300 to 450 mg every 6 hours (Ref), following at least 2 weeks of parenteral therapy (Ref).
Methicillin-resistant staphylococci, treatment (chronic suppression): Oral: 600 mg every 8 hours (Ref).
Rhinosinusitis, acute bacterial (alternative agent for patients with penicillin allergy who are able to tolerate cephalosporins) (off-label use):
Note: In uncomplicated acute bacterial rhinosinusitis, initial observation and symptom management without antibiotic therapy is appropriate in most patients. Reserve antibiotic therapy for poor follow-up or lack of improvement over the observation period (Ref).
Oral: 300 mg every 6 to 8 hours in combination with an oral third-generation cephalosporin for 5 to 7 days (Ref).
Skin and soft tissue infection:
Cellulitis, nonpurulent with risk for methicillin-resistant S. aureus or erysipelas (alternative agent):
Oral: 300 mg 4 times daily or 450 mg 3 times daily (Ref).
IV: 600 to 900 mg every 8 hours; transition to oral therapy once patient begins to clinically improve (Ref).
Cellulitis, purulent or abscess: Oral: 300 mg 4 times daily or 450 mg 3 times daily. Note: Systemic antibiotics only indicated for abscess in certain instances (eg, immunocompromised patients, signs of systemic infection, large or multiple abscesses, indwelling device, high risk for adverse outcome with endocarditis). If at risk for gram-negative bacilli, use in combination with an appropriate agent (Ref).
Duration: Treat for ≥5 days but may extend up to 14 days depending on severity and clinical response (Ref).
Cellulitis, long-term suppression of recurrent infection: Note: For patients with ≥3 episodes/year of known or presumed staphylococcal cellulitis when predisposing factors cannot be controlled (Ref).
Oral: 150 mg once daily after completion of treatment (Ref).
Impetigo or ecthyma if methicillin-resistant S. aureus is suspected or confirmed (alternative agent): Note: For impetigo, reserve systemic therapy for patients with numerous lesions or in outbreak settings to decrease transmission (Ref).
Oral: 300 mg 4 times daily or 450 mg 3 times daily for 7 days (Ref).
Necrotizing soft tissue infection (alternative agent): IV: 600 to 900 mg every 8 hours as part of an appropriate combination regimen. Note: Antibiotic therapy must be used in conjunction with early and aggressive surgical exploration and debridement of necrotic tissue (Ref).
Streptococcus (group A):
Bloodstream infection: IV: 900 mg every 8 hours in combination with IV penicillin G; duration is individualized, but clindamycin may be discontinued within 48 hours for patients without septic shock, organ failure, or necrotizing infection. Continue penicillin G to complete ≥14 days of therapy (Ref).
Pharyngitis (alternative agent for penicillin-allergic patients) (off-label use): Oral: 300 mg 3 times daily for 10 days (Ref).
Chronic carriage (off-label use): Oral: 300 mg 3 times daily for 10 days. Note: Most individuals with chronic carriage do not require antimicrobial treatment (Ref).
Streptococcus (group B) , maternal prophylaxis for prevention of neonatal disease (alternative agent) (off-label use):
IV: 900 mg at onset of labor or prelabor rupture of membranes, then every 8 hours until delivery. Note: Reserve use for patients with penicillin allergy that are at high risk for anaphylaxis and who have documented clindamycin-susceptible group B streptococci (Ref).
Surgical prophylaxis (in combination with other appropriate agents when coverage for MRSA is indicated or for gram-positive coverage in patients unable to tolerate cephalosporins) (off-label use): IV: 900 mg started within 60 minutes prior to initial surgical incision. Clindamycin doses may be repeated intraoperatively at 6-hour intervals if procedure is lengthy or if there is excessive blood loss (Ref). In cases where an extension of prophylaxis is warranted postoperatively, total duration should be ≤24 hours (Ref). For clean and clean-contaminated procedures, continued prophylactic antibiotics beyond surgical incision closure is not recommended, even in the presence of a drain (Ref).
Toxic shock syndrome, toxin production suppression (empiric therapy): IV: 900 mg every 8 hours as part of an appropriate combination regimen (Ref). Duration is until clinically and hemodynamically stable for at least 48 to 72 hours; then discontinue clindamycin and give monotherapy with an appropriate agent (Ref).
Toxoplasma gondii encephalitis and pneumonitis (alternative agent) (off-label use):
Initial treatment: Oral, IV: 600 mg every 6 hours in combination with pyrimethamine and leucovorin. Continue therapy for at least 6 weeks; longer duration may be required if incomplete response or extensive disease; after completion of acute therapy, all patients should receive long-term maintenance therapy (Ref).
Long-term maintenance therapy: Oral: 600 mg every 8 hours in combination with pyrimethamine and leucovorin (Ref); in patients with HIV, may discontinue when asymptomatic with a CD4 count >200 cells/mm3 and an undetectable HIV viral load for >6 months in response to ART (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
The renal dosing recommendations are based upon the best available evidence and clinical expertise. Senior Editorial Team: Bruce Mueller, PharmD, FCCP, FASN, FNKF; Jason A. Roberts, PhD, BPharm (Hons), B App Sc, FSHP, FISAC; Michael Heung, MD, MS.
IV, Oral:
Mild to severe impairment: No dosage adjustment necessary (Ref).
Hemodialysis, intermittent (thrice weekly): Poorly dialyzed; no supplemental dose or dosage adjustment necessary (Ref).
Peritoneal dialysis: Poorly dialyzed; no dosage adjustment necessary (Ref).
CRRT: No dosage adjustment necessary (Ref).
PIRRT (eg, sustained, low-efficiency diafiltration): No dosage adjustment necessary (Ref).
Mild impairment: There are no dosage adjustments provided in the manufacturer's labeling.
Moderate to severe impairment: There are no dosage adjustments provided in the manufacturer's labeling. In studies of patients with moderate or severe liver disease, half-life is prolonged; however, when administered on an every-8-hour schedule, accumulation should rarely occur. In severe liver disease, use caution and monitor liver enzymes periodically during therapy.
(For additional information see "Clindamycin (systemic): Pediatric drug information")
Note: Dosing presented in mg/kg/dose and mg/kg/day; use caution. Dosage should be based on total body weight for children ≥2 years of age and adolescents with and without obesity (Ref).
General dosing, susceptible infection:
Infants, Children, and Adolescents:
IM, IV: 20 to 40 mg/kg/day divided every 6 to 8 hours; maximum daily dose: 2,700 mg/day (Ref).
Oral: 10 to 25 mg/kg/day divided every 8 hours (Ref); higher doses of 30 to 40 mg/kg/day divided every 6 to 8 hours recommended for some infections; maximum daily dose: 1,800 mg/day (Ref).
Anthrax: Note: Consult public health officials for event-specific recommendations. After completion of therapy, initiate antimicrobial prophylaxis to complete an antimicrobial course of 60 days from onset of illness.
Infants, Children, and Adolescents: Limited data available:
Postexposure prophylaxis (inhalational exposure): Oral: 30 mg/kg/day divided every 8 hours for 60 days; maximum dose: 900 mg/dose.
Cutaneous, without systemic involvement: Oral: 30 mg/kg/day divided every 8 hours for 7 to 10 days for a naturally acquired infection or 60 days for a biological weapon-related event; maximum dose: 600 mg/dose.
Systemic involvement (including severe disease): IV: 40 mg/kg/day divided every 8 hours as part of an appropriate combination regimen for ≥14 days if meningitis is excluded or ≥14 to 21 days if meningitis cannot be excluded, and until patient clinically stable; maximum dose: 900 mg/dose.
Step-down therapy for severe infection: Oral: 30 mg/kg/day divided every 8 hours as part of an appropriate combination regimen to complete ≥14 days total therapy following appropriate initial treatment; maximum dose: 600 mg/dose.
Babesiosis (alternative agent):
Infants, Children, and Adolescents: Limited data available:
Mild to moderate disease or oral step-down therapy following initial parenteral treatment: Oral: 7 to 10 mg/kg/dose every 6 to 8 hours in combination with quinine for a total of 7 to 10 days; maximum dose: 600 mg/dose. A longer duration of ≥6 weeks, including 2 weeks after resolution of parasitemia, may be necessary in highly immunocompromised patients (Ref).
Severe disease, initial therapy: IV: 7 to 10 mg/kg/dose every 6 to 8 hours in combination with quinine; maximum dose: 600 mg/dose; change to oral clindamycin once symptoms improve (Ref).
Catheter (peritoneal dialysis); exit-site or tunnel infection: Infant, Children, and Adolescents: Oral: 10 mg/kg/dose 3 times daily; maximum dose: 600 mg/dose (Ref).
Endocarditis, prophylaxis before invasive dental or respiratory tract procedures:
Note: Clindamycin is NOT recommended for prevention of endocarditis in penicillin-allergic patients at high risk due to C. difficile risk; preferred options include cephalexin, azithromycin, clarithromycin, and doxycycline. Recommended only in patients who are at highest risk for infective endocarditis (IE) or adverse outcomes (Ref).
Infants, Children, and Adolescents: Limited data available: Oral, IV, IM: 20 mg/kg administered 30 to 60 minutes prior to procedure; maximum dose: 600 mg/dose (Ref).
Intra-abdominal infection, complicated: Note: Not routinely recommended due to Bacteroides fragilis resistance.
Infants, Children, and Adolescents: IV: 30 to 40 mg/kg/day divided every 6 to 8 hours in combination with other antibiotics; maximum daily dose: 2,700 mg/day (Ref).
Malaria, uncomplicated; treatment (alternative agent): Infants, Children, and Adolescents: Oral: 20 mg/kg/day divided every 8 hours for 7 days in combination with quinine (Ref).
Osteoarticular infection, acute (eg, septic [bacterial] arthritis, osteomyelitis): Infants, Children, and Adolescents: IV, Oral: 30 to 40 mg/kg/day divided every 6 to 8 hours; maximum dose: IV: 900 mg/dose; Oral: 600 mg/dose. Duration should be individualized based on several factors including causative pathogen, response to therapy, and normalization of inflammatory markers. Minimum total duration is ≥2 to 3 weeks for septic arthritis and ≥3 to 4 weeks for osteomyelitis; longer duration commonly necessary, particularly for infections caused by methicillin-resistant Staphylococcus aureus (MRSA) (Ref).
Otitis media, acute (alternative agent): Note: Typically reserved for patients who cannot tolerate beta-lactam antibiotics or as an alternative in patients in whom initial therapy for acute otitis media (AOM) fails. In some instances, it may be necessary to use as part of a combination regimen (eg, when activity is desired against Haemophilus influenzae or Moraxella catarrhalis) (Ref).
Infants ≥6 months, Children, and Adolescents: Oral: 30 to 40 mg/kg/day divided every 6 to 8 hours; maximum daily dose: 1,800 mg/day (Ref). For patients with severe or recurrent AOM, tympanic membrane perforation, or who are <2 years of age, treat for 10 days; for patients ≥2 years of age with mild to moderate, non-recurrent disease without tympanic membrane perforation, shorter durations of 5 to 7 days may be sufficient (Ref).
Peritonitis (peritoneal dialysis):
Infants, Children, and Adolescents:
Prophylaxis in patients receiving peritoneal dialysis (Ref):
Invasive dental procedures: Oral: 20 mg/kg administered 30 to 60 minutes before procedure; maximum dose: 600 mg.
GI or genitourinary procedures: IV: 10 mg/kg administered 30 to 60 minutes before procedure; maximum dose: 600 mg.
Treatment: Intraperitoneal, continuous: Loading dose: 300 mg per liter of dialysate; maintenance dose: 125 to 150 mg per liter of dialysate (Ref).
Pneumocystis jirovecii pneumonia (PCP), treatment (alternative agent):
HIV-exposed/-infected: Note: Patients with moderate or severe infection (PaO2 <70 mm Hg at room air or alveolar-arterial oxygen gradient ≥35 mm Hg) should receive adjunctive glucocorticoids (Ref).
Infants and Children: Limited data available: IV, Oral: 10 mg/kg/dose every 6 hours in combination with primaquine for 21 days; maximum IV dose: 600 mg/dose; maximum oral dose: 300 to 450 mg/dose (Ref).
Adolescents (Ref):
Oral: Mild to severe disease: 450 mg every 6 hours or 600 mg every 8 hours in combination with primaquine for 21 days.
IV: Moderate to severe disease: 600 mg every 6 hours or 900 mg every 8 hours in combination with primaquine for 21 days.
Pneumonia, community-acquired: Note: Duration dependent upon pathogen and clinical course. Typical duration for uncomplicated infections is 5 to 10 days; however, infections caused by MRSA may require longer treatment (Ref).
Infants ≥3 months, Children, and Adolescents (Ref):
Moderate to severe infection: IV: 40 mg/kg/day divided every 6 to 8 hours; maximum daily dose: 2,700 mg/day.
Mild infection or oral step-down therapy: Oral: 30 to 40 mg/kg/day divided every 6 to 8 hours; maximum daily dose: 1,800 mg/day.
Skin and soft tissue infection (SSTI):
Infants, Children, and Adolescents:
Impetigo, ecthyma (if MRSA is suspected or confirmed): Oral: 20 mg/kg/day in divided doses every 8 hours for 7 days; maximum dose: 400 mg/dose (Ref).
Cellulitis, erysipelas, purulent/fluctuant SSTI: Note: Typical duration is 5 days for uncomplicated infection but may be extended if clinical response is inadequate (Ref).
IV: 25 to 40 mg/kg/day in divided doses every 8 hours; maximum dose: 600 mg/dose (Ref).
Oral:
Methicillin-susceptible Staphylococcus aureus (MSSA) infection: Oral: 25 to 30 mg/kg/day in divided doses every 8 hours; maximum dose: 450 mg/dose (Ref).
MRSA infection: Oral: 30 to 40 mg/kg/day in divided doses every 6 to 8 hours; maximum dose: 450 mg/dose (Ref).
Necrotizing soft tissue infections: IV: 10 to 13 mg/kg/dose every 8 hours as part of an appropriate combination regimen in addition to surgical intervention; maximum dose: 900 mg/dose. Continue until further debridement is not necessary, patient has clinically improved, and patient is afebrile for 48 to 72 hours (Ref).
Streptococcus, group A:
Pharyngitis/tonsillitis (alternative agent for severe penicillin allergy): Children and Adolescents: Oral: 21 mg/kg/day in divided doses every 8 hours for 10 days; maximum dose: 300 mg/dose (Ref).
Chronic carriage: Note: Most individuals with chronic carriage do not require antibiotic treatment (Ref).
Children and Adolescents: Oral: 20 to 30 mg/kg/day in divided doses every 8 hours for 10 days; maximum dose: 300 mg/dose (Ref).
Surgical prophylaxis: Children and Adolescents: IV: 10 mg/kg within 30 to 60 minutes prior to procedure; may repeat dose in 6 hours for prolonged procedure or excessive blood loss; maximum dose: 900 mg/dose (Ref).
Toxic shock syndrome, toxin production suppression (empiric therapy): Infants, Children, and Adolescents: IV: 40 mg/kg/day in divided doses every 6 to 8 hours; maximum dose: 900 mg/dose (Ref).
Toxoplasmosis (alternative agent):
HIV-exposed/-infected: Infants, Children, and Adolescents:
Initial treatment: IV, Oral: 5 to 7.5 mg/kg/dose every 6 hours in combination with pyrimethamine and leucovorin; maximum dose: 600 mg/dose. For congenital toxoplasmosis, continue therapy for 12 months. For acquired toxoplasmosis, continue for ≥6 weeks followed by chronic maintenance therapy; longer duration may be required if incomplete response or extensive disease (Ref).
Chronic maintenance therapy (secondary prophylaxis): Oral: 7 to 10 mg/kg/dose every 8 hours in combination with pyrimethamine and leucovorin; maximum dose: 600 mg/dose. May consider discontinuation when asymptomatic, CD4 percentage is ≥15% (or CD4 count is >200 cells/mm3 for ages ≥6 years), and the patient has an undetectable HIV viral load in response to antiretroviral therapy for ≥6 months (Ref).
Dosage adjustment for concomitant therapy: Significant drug interactions exist, requiring dose/frequency adjustment or avoidance. Consult drug interactions database for more information.
Altered kidney function: Infants, Children, and Adolescents: IV, Oral:
Mild to severe impairment: No dosage adjustment necessary.
Hemodialysis, intermittent (thrice weekly): Poorly dialyzed; based on adult information, no supplemental dose or dosage adjustment necessary (Ref).
Peritoneal dialysis: Poorly dialyzed; based on adult information, no dosage adjustment necessary (Ref).
Continuous renal replacement therapy (CRRT): Based on adult information, no dosage adjustment necessary (Ref).
No adjustment required. Use caution with severe hepatic impairment.
Refer to adult dosing.
Excipient information presented when available (limited, particularly for generics); consult specific product labeling. [DSC] = Discontinued product
Capsule, Oral, as hydrochloride [strength expressed as base]:
Cleocin: 75 mg, 150 mg [contains fd&c blue #1 (brilliant blue), fd&c yellow #5 (tartrazine)]
Cleocin: 300 mg [contains fd&c blue #1 (brilliant blue)]
Generic: 75 mg, 150 mg, 300 mg
Kit, Injection, as phosphate [strength expressed as base]:
CLIN Single Use: 300 mg/2 mL [DSC] [contains benzyl alcohol, edetate (edta) disodium]
Solution, Injection, as phosphate [strength expressed as base]:
Cleocin Phosphate: 300 mg/2 mL (2 mL); 600 mg/4 mL (4 mL); 900 mg/6 mL (6 mL); 9 g/60 mL (60 mL) [contains benzyl alcohol, edetate (edta) disodium]
Generic: 300 mg/2 mL (2 mL); 600 mg/4 mL (4 mL); 900 mg/6 mL (6 mL); 9000 mg/60 mL (60 mL); 9 g/60 mL (60 mL)
Solution, Intravenous, as phosphate [strength expressed as base]:
Cleocin Phosphate: 300 mg/2 mL (2 mL [DSC]); 600 mg/4 mL (4 mL [DSC]); 900 mg/6 mL (6 mL [DSC]) [contains benzyl alcohol, edetate (edta) disodium]
Generic: 600 mg/50 mL (50 mL); 900 mg/50 mL (50 mL); 300 mg/2 mL (2 mL [DSC]); 600 mg/4 mL (4 mL [DSC]); 900 mg/6 mL (6 mL [DSC])
Solution, Intravenous, as phosphate [strength expressed as base, preservative free]:
Generic: 300 mg/50 mL (50 mL); 600 mg/50 mL (50 mL); 900 mg/50 mL (50 mL); 300 mg/50 mL in NaCl 0.9% (50 mL); 600 mg/50 mL in NaCl 0.9% (50 mL); 900 mg/50 mL in NaCl 0.9% (50 mL)
Solution Reconstituted, Oral, as palmitate hydrochloride [strength expressed as base]:
Cleocin: 75 mg/5 mL (100 mL) [contains ethylparaben]
Generic: 75 mg/5 mL (100 mL)
May be product dependent
Excipient information presented when available (limited, particularly for generics); consult specific product labeling.
Capsule, Oral, as hydrochloride [strength expressed as base]:
Dalacin C: 150 mg, 300 mg
Generic: 150 mg, 300 mg
Solution, Injection:
Dalacin C Phosphate: 150 mg/mL (2 mL, 4 mL, 6 mL, 60 mL) [contains benzyl alcohol, edetate (edta) disodium]
Generic: 150 mg/mL (2 mL, 4 mL, 6 mL, 60 mL, 120 mL)
Solution, Intravenous, as phosphate [strength expressed as base]:
Generic: 300 mg/50 mL (50 mL); 600 mg/50 mL (50 mL); 900 mg/50 mL (50 mL)
Solution Reconstituted, Oral, as palmitate hydrochloride [strength expressed as base]:
Dalacin C Palmitate: 75 mg/5 mL (100 mL) [contains ethylparaben]
IM: Deep IM sites, rotate sites; do not exceed 600 mg in a single injection.
IV: Never administer undiluted as bolus; administer by IV intermittent infusion over at least 10 to 60 minutes, at a maximum rate of 30 mg/minute (do not exceed 1,200 mg/hour).
Oral: Capsule should be taken with a full glass of water to avoid esophageal irritation; shake oral solution well before use; may administer with or without meals.
Oral: Capsule should be taken with a full glass of water to avoid esophageal irritation. Shake oral solution well before use; solution should be administered using an accurate measuring device (eg, oral syringe). May administer with or without meals.
Parenteral:
IM: Administer undiluted deep IM; rotate sites. Do not exceed 600 mg in a single injection.
IV: Infuse over at least 10 to 60 minutes, at a rate not to exceed 30 mg/minute; hypotension and cardiopulmonary arrest have been reported following rapid IV administration.
Bone and joint infections: Treatment of bone and joint infections, including acute hematogenous osteomyelitis caused by Staphylococcus aureus and as adjunctive therapy in the surgical treatment of chronic bone and joint infections caused by susceptible organisms.
Gynecological infections: Treatment of gynecologic infections, including endometritis, nongonococcal tubo-ovarian abscess, pelvic cellulitis, and postsurgical vaginal cuff infection caused by susceptible anaerobes.
Intraabdominal infections: Treatment of intraabdominal infections, including peritonitis and intraabdominal abscess caused by susceptible anaerobic organisms.
Lower respiratory tract infections: Treatment of lower respiratory tract infections, including pneumonia, empyema, and lung abscess caused by susceptible anaerobes, Streptococcus pneumoniae, other streptococci (except Enterococcus faecalis), and S. aureus.
Septicemia: Treatment of septicemia caused by S. aureus, streptococci (except E. faecalis), and susceptible anaerobes.
Skin and soft tissue infection: Treatment of skin and soft tissue infection caused by Streptococcus pyogenes, S. aureus, and susceptible anaerobes.
Anthrax; Babesiosis; Bacterial vaginosis; Bite wound infection, prophylaxis of high-risk bite or treatment; Diabetic foot infection, mild to moderate; Gingivitis, acute simple, plaque-associated; Hidradenitis suppurativa; Malaria; Neutropenic fever, empiric therapy for low-risk cancer patients (alternative agent for penicillin-allergic patients); Pneumocystis jirovecii pneumonia, treatment; Prosthetic joint infection; Rhinosinusitis, acute bacterial; Streptococcal (group A) pharyngitis and chronic carriage; Streptococcus (group B), maternal prophylaxis for prevention of neonatal disease; Surgical prophylaxis; Toxoplasma gondii encephalitis and pneumonitis (treatment/long-term maintenance)
Cleocin may be confused with bleomycin, Clinoril, Cubicin, Lincocin
Clindamycin may be confused with clarithromycin, Claritin, vancomycin, lincomycin
GI effects range from antibiotic-associated [non-C. difficile] diarrhea (AAD), nausea, and vomiting. Most cases of AAD are mild and self-limiting. However, Clostridioides difficile may account for as many as >20% of cases in children, adolescents, and adults (discussed separately) and result in more severe AAD (Ref).
Mechanism: Dose- and time-related; antibiotic disruption of indigenous gut microbiota (Ref).
Onset: Varied; mean time to onset of AAD is 3 to 18 days for adult patients and 2 to 6 days for pediatric patients. The majority of AAD cases occur during (versus after) antibiotic therapy in pediatric patients (Ref).
Risk factors:
• Duration of therapy (Ref)
• Age (pediatric patients <2 years of age and older adults) (Ref)
• Length of hospitalization or ICU stay (Ref)
• Duration of proton pump inhibitor use (Ref)
• Parenteral nutrition (Ref)
• Combinations of antibiotics (Ref)
Clostridioides difficile infection (CDI) has occurred, including Clostridioides difficile associated diarrhea (CDAD) and Clostridioides difficile colitis. Clindamycin has been associated with a several fold increased risk of CDI (Ref). CDAD must be considered in all patients who present with diarrhea following antibiotic use. If CDAD is suspected or confirmed, ongoing antibiotic use not directed against C. difficile should be discontinued if possible. Institute appropriate fluid and electrolyte management, antibiotic treatment of C. difficile, and surgical evaluation as clinically indicated.
Mechanism: Dose- and time-related; related to cumulative antibiotic exposure. Clindamycin causes disruption of the intestinal microbiota resulting in the overgrowth of pathogens, such as C. difficile (Ref). In addition, C. difficile is highly resistant to clindamycin (Ref).
Onset: Varied; may start on the first day of antibiotic therapy or up to 3 months postantibiotic (Ref).
Risk factors:
• Antibiotic exposure (highest risk factor) (Ref)
• Type of antibiotic (clindamycin among the highest risk) (Ref)
• Long durations in a hospital or other health care setting (recent or current) (Ref)
• Older adults (Ref)
• Immunocompromised conditions (Ref)
• A serious underlying condition (Ref)
• GI surgery/manipulation (Ref)
• Antiulcer medications (eg, proton pump inhibitors and H2 blockers) (Ref)
• Chemotherapy (Ref)
Hypersensitivity reactions (immediate and delayed) range from maculopapular rash to rare cases of anaphylaxis (Ref). Severe cutaneous adverse reactions (SCARs), including drug reaction with eosinophilia and systemic symptoms, acute generalized exanthematous pustulosis, Stevens-Johnson syndrome, and toxic epidermal necrolysis have been reported (Ref).
Mechanism: Non–dose-related; immunologic.
Immediate hypersensitivity reactions (eg, anaphylaxis): IgE-mediated (Ref).
Delayed hypersensitivity reactions (eg, maculopapular rash, SCARs), T-cell-mediated (Ref).
Onset:
Immediate hypersensitivity reactions (eg, anaphylaxis): Rapid; may occur within an hour of administration (Ref).
Delayed hypersensitivity reaction: Maculopapular rash: Intermediate; usually 7 to 10 days after initiation (Ref). Other reactions: Varied; may occur after days to weeks of therapy (Ref).
Risk factors:
• HLA-B*51:01 allele in Han Chinese (Ref)
The following adverse drug reactions and incidences are derived from product labeling unless otherwise specified.
Frequency not defined:
Dermatologic: Urticaria, vesiculobullous dermatitis
Gastrointestinal: Abdominal pain, nausea, vomiting
Postmarketing:
Cardiovascular: Hypotension (following rapid IV administration), thrombophlebitis (IV)
Dermatological: Acute generalized exanthematous pustulosis (Aiempanakit 2020), erythema multiforme, exfoliative dermatitis, maculopapular rash (Dilley 2022), Stevens-Johnson syndrome, Sweet syndrome (Dilley 2022), toxic epidermal necrolysis (Paquet 1995)
Gastrointestinal: Clostridioides difficile-associated diarrhea (Slimings 2014), Clostridioides difficile colitis (Slimings 2014), diarrhea (Nasiri 2018), dysgeusia (de Groot 2007), esophageal ulcer (Bestari 2019), esophagitis (Bestari 2019)
Genitourinary: Vaginitis
Hematologic & oncologic: Agranulocytosis (Pisciotta 1993), eosinophilia (transient), neutropenia (transient) (Bubalo 2003), pancytopenia (Morales 2014), thrombocytopenia (Morales 2014)
Hepatic: Cholestatic hepatitis (Aygun 2007)
Hypersensitivity: Anaphylactic shock (Chiou 2006), anaphylaxis (Paradis 2020, Vilchez-Sánchez 2020), angioedema, drug reaction with eosinophilia and systemic symptoms (Miller Quidley 2012), hypersensitivity angiitis (Fransen 2021)
Local: Abscess at injection site (IM), induration at injection site (IM), irritation at injection site (IM), pain at injection site (IM)
Neuromuscular & skeletal: Inflammatory polyarthritis
Renal: Acute kidney injury (Subedi 2019)
Hypersensitivity to clindamycin, lincomycin, or any component of the formulation.
Canadian labeling: Additional contraindications (not in US labeling): Oral clindamycin: Infants <30 days of age.
Concerns related to adverse effects:
• Renal toxicity: Acute kidney injury has been reported; discontinue treatment if clindamycin-induced acute kidney injury is suspected and no other etiology is identified.
• Superinfection: Use may result in overgrowth of nonsusceptible organisms, particularly yeast. Should superinfection occur, appropriate measures should be taken as indicated by the clinical situation.
Disease-related concerns:
• GI disease: Use with caution in patients with a history of GI disease, particularly colitis.
• Hepatic impairment: Use with caution in patients with moderate to severe liver disease, however, when administered at every-8-hour intervals, drug accumulation is rare. Monitor hepatic enzymes periodically as dosage adjustments may be necessary in patients with severe liver disease.
• Renal impairment: Use with caution in patients with renal impairment; acute kidney injury may occur, especially if patient is taking other nephrotoxins concurrently.
Special populations:
• Atopic patients: Use with caution in atopic patients.
• Older adult: A subgroup of older patients with associated severe illness may tolerate diarrhea less well. Monitor carefully for changes in bowel frequency.
Dosage form specific issues:
• Benzyl alcohol and derivatives: Some dosage forms may contain benzyl alcohol; large amounts of benzyl alcohol (≥99 mg/kg/day) have been associated with a potentially fatal toxicity (“gasping syndrome”) in neonates; the “gasping syndrome” consists of metabolic acidosis, respiratory distress, gasping respirations, CNS dysfunction (including convulsions, intracranial hemorrhage), hypotension and cardiovascular collapse (AAP ["Inactive" 1997]; CDC 1982); some data suggests that benzoate displaces bilirubin from protein binding sites (Ahlfors 2001); avoid or use dosage forms containing benzyl alcohol with caution in neonates. See manufacturer's labeling.
• Tartrazine: Some products may contain tartrazine (FD&C yellow no. 5), which may cause allergic reactions in certain individuals. Allergy is frequently seen in patients who also have an aspirin hypersensitivity.
Other warnings/precautions:
• Administration (IV): Do not inject IV undiluted as a bolus. Product should be diluted in compatible fluid and infused over 10 to 60 minutes.
• Appropriate use: Not appropriate for use in the treatment of meningitis due to inadequate penetration into the CSF.
Substrate of CYP3A4 (major); Note: Assignment of Major/Minor substrate status based on clinically relevant drug interaction potential
Note: Interacting drugs may not be individually listed below if they are part of a group interaction (eg, individual drugs within “CYP3A4 Inducers [Strong]” are NOT listed). For a complete list of drug interactions by individual drug name and detailed management recommendations, use the Lexicomp drug interactions program by clicking on the “Launch drug interactions program” link above.
Bacillus clausii: Antibiotics may diminish the therapeutic effect of Bacillus clausii. Management: Bacillus clausii should be taken in between antibiotic doses during concomitant therapy. Risk D: Consider therapy modification
BCG (Intravesical): Antibiotics may diminish the therapeutic effect of BCG (Intravesical). Risk X: Avoid combination
BCG Vaccine (Immunization): Antibiotics may diminish the therapeutic effect of BCG Vaccine (Immunization). Risk C: Monitor therapy
Cholera Vaccine: Antibiotics may diminish the therapeutic effect of Cholera Vaccine. Management: Avoid cholera vaccine in patients receiving systemic antibiotics, and within 14 days following the use of oral or parenteral antibiotics. Risk X: Avoid combination
Clofazimine: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk C: Monitor therapy
CYP3A4 Inducers (Moderate): May decrease the serum concentration of Clindamycin (Systemic). Risk C: Monitor therapy
CYP3A4 Inducers (Strong): May decrease the serum concentration of Clindamycin (Systemic). Risk C: Monitor therapy
CYP3A4 Inhibitors (Moderate): May increase the serum concentration of Clindamycin (Systemic). Risk C: Monitor therapy
CYP3A4 Inhibitors (Strong): May increase the serum concentration of Clindamycin (Systemic). Risk C: Monitor therapy
Fexinidazole: May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk X: Avoid combination
Fusidic Acid (Systemic): May increase the serum concentration of CYP3A4 Substrates (High risk with Inhibitors). Risk X: Avoid combination
Immune Checkpoint Inhibitors: Antibiotics may diminish the therapeutic effect of Immune Checkpoint Inhibitors. Risk C: Monitor therapy
Kaolin: May decrease the absorption of Lincosamide Antibiotics. Risk C: Monitor therapy
Lactobacillus and Estriol: Antibiotics may diminish the therapeutic effect of Lactobacillus and Estriol. Risk C: Monitor therapy
Mecamylamine: Lincosamide Antibiotics may enhance the neuromuscular-blocking effect of Mecamylamine. Risk X: Avoid combination
Neuromuscular-Blocking Agents: Lincosamide Antibiotics may enhance the neuromuscular-blocking effect of Neuromuscular-Blocking Agents. Risk C: Monitor therapy
Pectin: May decrease the absorption of Lincosamide Antibiotics. Risk C: Monitor therapy
Sodium Picosulfate: Antibiotics may diminish the therapeutic effect of Sodium Picosulfate. Management: Consider using an alternative product for bowel cleansing prior to a colonoscopy in patients who have recently used or are concurrently using an antibiotic. Risk D: Consider therapy modification
Typhoid Vaccine: Antibiotics may diminish the therapeutic effect of Typhoid Vaccine. Only the live attenuated Ty21a strain is affected. Management: Avoid use of live attenuated typhoid vaccine (Ty21a) in patients being treated with systemic antibacterial agents. Postpone vaccination until 3 days after cessation of antibiotics and avoid starting antibiotics within 3 days of last vaccine dose. Risk D: Consider therapy modification
Clindamycin crosses the placenta and can be detected in the cord blood and fetal tissue (Philipson 1973; Weinstein 1976). Clindamycin injection contains benzyl alcohol, which may also cross the placenta.
Clindamycin pharmacokinetics are not affected by pregnancy (Philipson 1976; Weinstein 1976).
Clindamycin is recommended for use in pregnant patients for the prophylaxis of group B streptococcal disease in newborns (alternative option for patients at high risk for anaphylaxis to penicillin [or whose risk is unknown], and who have GBS susceptible to clindamycin) (ACOG 797 2020); prophylaxis and treatment of Toxoplasma gondii encephalitis (alternative therapy), or treatment of Pneumocystis pneumonia (PCP) (alternative therapy) (HHS [OI adult 2020]); bacterial vaginosis (CDC [Workowski 2021]); anthrax (Meaney-Delman 2014); or malaria (CDC 2020). Clindamycin is also one of the antibiotics recommended for prophylactic use prior to cesarean delivery and may be used in certain situations prior to vaginal delivery in patients at high risk for endocarditis (ACOG 199 2018).
Clindamycin is present in breast milk.
Clindamycin breast milk concentrations were determined in 5 women immediately postpartum. The dose administered was clindamycin 150 mg by mouth 3 times daily for at least 1 week. Milk was collected over a 6-hour period of time. Maternal serum was collected throughout the study period. Milk concentrations ranged from undetectable (<0.5 mcg/mL) to 3.1 mcg/mL and varied greatly between patients. These concentrations were consistent with the variable maternal serum concentrations of undetectable (<1 mcg/mL) to 33 mcg/mL. The highest breast milk concentrations were observed in the samples from the mothers with the highest serum concentrations (Stéen 1982). Using a milk concentration of 3.1 mcg/mL, the relative infant dose (RID) of clindamycin is 1.2% to 4.7% compared to an infant therapeutic dose of 10 to 40 mg/kg/day, providing an estimated daily infant dose via breast milk of 0.465 mg/kg/day. In general, breastfeeding is considered acceptable when the RID is <10% (Anderson 2016; Ito 2000).
The manufacturer reports that clindamycin breast milk concentrations range from <0.5 to 3.8 mcg/mL following doses of 150 mg orally to 600 mg IV.
One case of bloody stools in an infant occurred after a mother received clindamycin while breastfeeding; however, a causal relationship was not confirmed (Mann 1980). In general, antibiotics that are present in breast milk may cause non–dose-related modification of bowel flora.
According to the manufacturer, the decision to breastfeed during therapy should consider the risk of infant exposure, the benefits of breastfeeding to the infant, and the benefits of treatment to the mother; alternative agents may be preferred. Additional guidelines recommend avoiding clindamycin in breastfeeding patients if possible; monitor breastfeeding infants for GI disturbances, diarrhea, and bloody stools if maternal treatment is required (WHO 2002).
Clindamycin is an alternative antibiotic for the empiric treatment of bacterial mastitis in patients who are breastfeeding. Antibiotic use may be considered when symptoms are present for >24 hours and have not responded to conservative measures, or the patient has symptoms such as fever or tachycardia. Consider a milk culture if symptoms do not improve after 48 hours of antibiotic therapy. The diagnosis of mastitis does not require interruption of breastfeeding (ABM [Mitchell 2022]; WHO 2000).
Observe for changes in bowel frequency. Monitor for colitis and resolution of symptoms. In severe liver disease monitor liver function tests periodically; consider monitoring renal function periodically in patients with renal impairment or taking nephrotoxic medications; during prolonged therapy monitor CBC, liver, and renal function tests periodically.
Reversibly binds to 50S ribosomal subunits preventing peptide bond formation thus inhibiting bacterial protein synthesis; bacteriostatic or bactericidal depending on drug concentration, infection site, and organism
Absorption: Oral, hydrochloride: Rapid (90%); clindamycin palmitate must be hydrolyzed in the GI tract before it is active.
Distribution: Distributed in body fluids and tissues; no significant levels in CSF, even with inflamed meninges.
Neonates (Gonzalez 2016):
PMA ≤28 weeks: Median: 1.2 L/kg (range: 0.87 to 2.26 L/kg).
PMA >28 to 32 weeks: Median: 1.3 L/kg (range: 0.74 to 1.88 L/kg).
PMA >32 to 40 weeks: Median: 1.03 L/kg (range: 0.7 to 2.12 L/kg).
Neonates and Infants ≤5 months (PMA >40 to 60 weeks): Median: 0.99 L/kg (range: 0.64 to 1.27 L/kg) (Gonzalez 2016).
Infants >5 months: Median: 0.83 L/kg (range: 0.7 to 1.17 L/kg) (Gonzalez 2016).
Children ≥2 years and Adolescents (Smith 2017):
Non-obese: Median range: 0.81 to 0.9 L/kg.
Obese: Median range: 0.86 to 1.03 L/kg.
Protein binding: 94%
Metabolism: Biologically inactive clindamycin phosphate (intravenous formulation) is rapidly converted to active clindamycin. Clindamycin is metabolized predominantly by CYP3A4, with minor contribution by CYP3A5, to form clindamycin sulfoxide (major metabolite) and N-desmethylclindamycin (minor metabolite).
Bioavailability: Oral: ~90%.
Half-life elimination:
Neonates (Gonzalez 2016):
PMA ≤28 weeks: Median: 5.89 hours (range: 2.42 to 12.9 hours).
PMA >28 to 32 weeks: Median: 5.25 hours (range: 2.34 to 8.87 hours).
PMA >32 to 40 weeks: Median: 3.96 hours (range: 1.3 to 8.83 hours).
Neonates and Infants ≤5 months (Gonzalez 2016): PMA >40 to 60 weeks: Median: 2.35 hours (range: 0.94 to 6.44 hours).
Infants >5 months to 1 year (Gonzalez 2016): Median: 2.05 hours (range: 1.26 to 3.47 hours).
Children ≥2 years and Adolescents (Smith 2017):
Non-obese: Median range: 2.15 to 2.84 hours.
Obese: Median range: 2.15 to 3.55 hours.
Adults: 3 hours.
Elderly (oral) ~4 hours (range: 3.4 to 5.1 hours).
Time to peak, serum: Oral: Within 60 minutes; IM: 1 to 3 hours.
Excretion: Urine (~10%) and feces (3.6%) as active drug and metabolites.
Capsules (Cleocin Oral)
75 mg (per each): $0.27
150 mg (per each): $0.17
300 mg (per each): $0.34
Capsules (Clindamycin HCl Oral)
75 mg (per each): $0.72
150 mg (per each): $0.73 - $1.19
300 mg (per each): $1.31 - $3.76
Solution (Cleocin Phosphate Injection)
9 g/60 mL (per mL): $0.47
300 mg/2 mL (per mL): $1.49
600 mg/4 mL (per mL): $0.88
900 mg/6 mL (per mL): $0.85
Solution (Clindamycin Phosphate in D5W Intravenous)
300 mg/50 mL (per mL): $0.17 - $0.20
600 mg/50 mL (per mL): $0.10 - $0.30
900 mg/50 mL (per mL): $0.12 - $0.36
Solution (Clindamycin Phosphate in NaCl Intravenous)
300 mg/50 mL 0.9% (per mL): $0.17
600 mg/50 mL 0.9% (per mL): $0.26
900 mg/50 mL 0.9% (per mL): $0.31
Solution (Clindamycin Phosphate Injection)
9 g/60 mL (per mL): $0.47 - $0.59
300 mg/2 mL (per mL): $1.48 - $1.78
600 mg/4 mL (per mL): $1.05 - $1.11
900 mg/6 mL (per mL): $0.92 - $0.95
Solution (reconstituted) (Cleocin Oral)
75 mg/5 mL (per mL): $0.37
Solution (reconstituted) (Clindamycin Palmitate HCl Oral)
75 mg/5 mL (per mL): $0.29 - $1.08
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