Diferencia entre revisiones de «Clindamycin»
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==General== | ==General== | ||
*Type: Other | *Type: Other [[antibiotic]] | ||
*Dosage Forms: IM, IV, PO (75mg; 150mg; 300mg; 75mg/5mL) | *Dosage Forms: IM, IV, PO (75mg; 150mg; 300mg; 75mg/5mL) | ||
*Common Trade Names: Cleocin | *Common Trade Names: Cleocin | ||
| Línea 6: | Línea 6: | ||
==Adult Dosing== | ==Adult Dosing== | ||
===General=== | ===General=== | ||
* | *PO: | ||
**150-450mg PO q6h | **150-450mg PO q6h | ||
**First Dose: 150-450mg PO x 1 | **First Dose: 150-450mg PO x 1 | ||
**Max: | **Max: 450mg/dose PO (increased risk of [[C. diff]] at higher doses) | ||
* | *IM: | ||
**1200- | **1200-2700mg/day IM divided q6-12h | ||
**First Dose: | **First Dose: 600mg IM x 1 | ||
**Max: | **Max: 600mg/dose IM | ||
* | *IV | ||
**1200- | **1200-2700mg/day IV divided q6-12h | ||
**First Dose: 600- | **First Dose: 600-900mg IV x 1 | ||
** | **4800mg/day IV | ||
===[[ | ===Indications by Disease=== | ||
{{#ask: [[Has DrugName::Clindamycin]] [[Has Population::Adult]] | |||
|?Treats disease=Disease | |||
|?Has Dose=Dose | |||
|?Has Context=Context | |||
|format=table | |||
|limit=50 | |||
|mainlabel=- | |||
|headers=show | |||
|sort=Treats disease | |||
}} | |||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
===General Infection (Severe)=== | ===General Infection (Severe)=== | ||
* | *<1 week old | ||
**''<2kg'' | **''<2kg'' | ||
*** | ***10mg/kg/day IM/IV divided q12 | ||
***First Dose: | ***First Dose: 5mg/kg IM/IV x 1 | ||
**''>2kg'' | **''>2kg'' | ||
*** | ***15mg/kg/day IM/IV divided q8h | ||
***First Dose: | ***First Dose: 5mg/kg IM/IV x 1 | ||
* | *1 week - 1 month | ||
**''<1.2kg'' | **''<1.2kg'' | ||
*** | ***10mg/kg/day IM/IV divided q12h | ||
***First Dose: | ***First Dose: 5mg/kg IM/IV x 1 | ||
**''1.2-2kg'' | **''1.2-2kg'' | ||
*** | ***15mg/kg/day IM/IV divided q8h | ||
***First Dose: | ***First Dose: 5mg/kg IM/IV x 1 | ||
**''>2kg'' | **''>2kg'' | ||
*** | ***20mg/kg/day IM/IV divided q6-8h | ||
***Alt: | ***Alt: 30mg/kg/day IM/IV divided q6h | ||
***First Dose: 5-7. | ***First Dose: 5-7.5mg/kg IM/IV x 1 | ||
* | *>1 Month - Children | ||
**25- | **25-40mg/kg/day IM/IV divided q6-8h | ||
**First Dose: 6.25-13. | **First Dose: 6.25-13.3mg/kg IM/IV x 1 | ||
**Max: 4.8 g/day IM/IV | **Max: 4.8 g/day IM/IV | ||
* | *Adolescents | ||
**25- | **25-40mg/kg/day IM/IV divided q6-8h | ||
**First Dose: 6.25-13. | **First Dose: 6.25-13.3mg/kg IM/IV x 1 | ||
**Max: 4.8 g/day IM/IV | **Max: 4.8 g/day IM/IV | ||
===General Infection (Mild-Moderate)=== | ===General Infection (Mild-Moderate)=== | ||
* | *Infants & Children | ||
** | **PO: | ||
*** 10- | ***10-25mg/kg/day PO divided q6-8h | ||
***First Dose: 2.5-8. | ***First Dose: 2.5-8.3mg/kg PO x 1 | ||
***Max: 1.8 g/day PO | ***Max: 1.8 g/day PO | ||
** | **IM/IV: | ||
***15- | ***15-25mg/kg/day IM/IV divided q6-8 | ||
***First Dose: 3.75-8. | ***First Dose: 3.75-8.3mg/kg IM/IV x 1 | ||
***4.8 g/day IM/IV | ***4.8 g/day IM/IV | ||
* | *Adolescents | ||
** | **PO: | ||
***150-300mg PO q6h | ***150-300mg PO q6h | ||
***First Dose: 150-300mg PO x 1 | ***First Dose: 150-300mg PO x 1 | ||
***Max: 1.8 g/day PO | ***Max: 1.8 g/day PO | ||
** | **IM/IV: | ||
***25- | ***25-40mg/kg/day IM/IV divided q6-8h | ||
***First Dose: 6.25-13. | ***First Dose: 6.25-13.3mg/kg IM/IV x 1 | ||
***Max: 4.8 g/day IM/IV | ***Max: 4.8 g/day IM/IV | ||
=== | ===Indications by Disease=== | ||
{{#ask: [[Has DrugName::Clindamycin]] [[Has Population::Pediatric]] | |||
|?Treats disease=Disease | |||
|?Has Dose=Dose | |||
|?Has Context=Context | |||
|format=table | |||
|limit=50 | |||
|mainlabel=- | |||
|headers=show | |||
|sort=Treats disease | |||
}} | |||
==Special Populations== | ==Special Populations== | ||
*Pregnancy: B | *[[Pregnancy Rating]]: B | ||
*Lactation: | *[[Lactation risk categories]]: L4; enters breast milk/not recommended | ||
*Renal Dosing (Adult & Pediatric) | *Renal Dosing (Adult & Pediatric) | ||
**No adjustment | **No adjustment | ||
| Línea 168: | Línea 143: | ||
*PO: | *PO: | ||
**Give with full glass of water (minimize esophageal ulceration) | **Give with full glass of water (minimize esophageal ulceration) | ||
*Give spread around the day to promote constant serum levels | **Give spread around the day to promote constant serum levels | ||
*IM: | *IM: | ||
**Give to deep I.M. sites | **Give to deep I.M. sites | ||
**Rotate sites | **Rotate sites | ||
**Do not exceed | **Do not exceed 600mg per injection | ||
*IV: | *IV: | ||
**Do NOT give as bolus | **Do NOT give as bolus | ||
**Give by intermittent infusion over >10-60 minutes | **Give by intermittent infusion over >10-60 minutes | ||
**Max rate: | **Max rate: 30mg/minute (do not exceed 1200mg/hour) | ||
**Final concentration should not exceed | **Final concentration should not exceed 18mg/mL | ||
==Mechanism of Action== | |||
*Disrupts protein synthesis by binding the 50s ribosome subunit | |||
==[[Antibiotic Sensitivities]]<ref>Sanford Guide to Antimicrobial Therapy 2014</ref>== | |||
{| class="wikitable" | |||
| align="center" style="background:#f0f0f0;"|'''Group''' | |||
| align="center" style="background:#f0f0f0;"|'''Organism''' | |||
| align="center" style="background:#f0f0f0;"|'''Sensitivity''' | |||
|- | |||
| Gram Positive||[[Strep. Group A, B, C, G]]||'''S''' | |||
|- | |||
| ||[[Strep. Pneumoniae]]||'''S''' | |||
|- | |||
| ||[[Viridans strep]]||X1 | |||
|- | |||
| ||Strep. anginosus gp||X1 | |||
|- | |||
| ||[[Enterococcus faecalis]]||R | |||
|- | |||
| ||[[Enterococcus faecium]]||R | |||
|- | |||
| ||[[MSSA]]||'''S''' | |||
|- | |||
| ||[[MRSA]]||R | |||
|- | |||
| ||[[CA-MRSA]]||I | |||
|- | |||
| ||[[Staph. Epidermidis]]||R | |||
|- | |||
| ||[[C. jeikeium]]||R | |||
|- | |||
| ||[[L. monocytogenes]]||X1 | |||
|- | |||
| Gram Negatives||[[N. gonorrhoeae]]||R | |||
|- | |||
| ||[[N. meningitidis]]||R | |||
|- | |||
| ||[[Moraxella catarrhalis]]||R | |||
|- | |||
| ||[[H. influenzae]]||R | |||
|- | |||
| ||[[E. coli]]||R | |||
|- | |||
| ||[[Klebsiella]] sp||R | |||
|- | |||
| ||E. coli/Klebsiella ESBL+||R | |||
|- | |||
| ||E coli/Klebsiella KPC+||R | |||
|- | |||
| ||[[Enterobacter]] sp, AmpC neg||R | |||
|- | |||
| ||[[Enterobacter]] sp, AmpC pos||R | |||
|- | |||
| ||[[Serratia]] sp||X1 | |||
|- | |||
| ||Serratia marcescens||R | |||
|- | |||
| ||[[Salmonella]] sp||R | |||
|- | |||
| ||[[Shigella]] sp||R | |||
|- | |||
| ||[[Proteus mirabilis]]||X1 | |||
|- | |||
| ||[[Proteus vulgaris]]||R | |||
|- | |||
| ||[[Providencia sp.]]||X1 | |||
|- | |||
| ||[[Morganella sp.]]||X1 | |||
|- | |||
| ||[[Citrobacter freundii]]||X1 | |||
|- | |||
| ||[[Citrobacter diversus]]||X1 | |||
|- | |||
| ||[[Citrobacter sp.]]||X1 | |||
|- | |||
| ||[[Aeromonas sp]]||X1 | |||
|- | |||
| ||[[Acinetobacter sp.]]||R | |||
|- | |||
| ||[[Pseudomonas aeruginosa]]||R | |||
|- | |||
| ||[[Burkholderia cepacia]]||R | |||
|- | |||
| ||[[Stenotrophomonas maltophilia]]||R | |||
|- | |||
| ||[[Yersinia enterocolitica]]||R | |||
|- | |||
| ||[[Francisella tularensis]]||X1 | |||
|- | |||
| ||[[Brucella sp.]]||R | |||
|- | |||
| ||[[Legionella sp.]]||X1 | |||
|- | |||
| ||[[Pasteurella multocida]]||X1 | |||
|- | |||
| ||[[Haemophilus ducreyi]]||X2 | |||
|- | |||
| ||[[Vibrio vulnificus]]||X1 | |||
|- | |||
| Misc||[[Chlamydophila sp]]||I | |||
|- | |||
| ||[[Mycoplasm pneumoniae]]||R | |||
|- | |||
| ||[[Rickettsia sp]]||X1 | |||
|- | |||
| ||[[Mycobacterium avium]]||X1 | |||
|- | |||
| Anaerobes||[[Actinomyces]]||'''S''' | |||
|- | |||
| ||[[Bacteroides fragilis]]||I | |||
|- | |||
| ||[[Prevotella melaninogenica]]||'''S''' | |||
|- | |||
| ||[[Clostridium difficile]]||X1 | |||
|- | |||
| ||[[Clostridium (not difficile)]]||I | |||
|- | |||
| ||[[Fusobacterium necrophorum]]||'''S''' | |||
|- | |||
| ||[[Peptostreptococcus sp.]]||'''S''' | |||
|} | |||
===Key=== | |||
{{Template:Antibacterial Spectra Key}} | |||
==See Also== | ==See Also== | ||
*[[Antibiotics (Main)]] | *[[Antibiotics (Main)]] | ||
== | ==References== | ||
<references/> | <references/> | ||
[[Category: | [[Category:Pharmacology]] | ||
[[Category:ID]] | |||
Revisión actual - 09:09 22 mar 2026
General
- Type: Other antibiotic
- Dosage Forms: IM, IV, PO (75mg; 150mg; 300mg; 75mg/5mL)
- Common Trade Names: Cleocin
Adult Dosing
General
- PO:
- 150-450mg PO q6h
- First Dose: 150-450mg PO x 1
- Max: 450mg/dose PO (increased risk of C. diff at higher doses)
- IM:
- 1200-2700mg/day IM divided q6-12h
- First Dose: 600mg IM x 1
- Max: 600mg/dose IM
- IV
- 1200-2700mg/day IV divided q6-12h
- First Dose: 600-900mg IV x 1
- 4800mg/day IV
Indications by Disease
| Disease | Dose | Context |
|---|---|---|
| Acute necrotizing ulcerative gingivitis | 300mg PO three times daily | Uncomplicated |
| Acute tetanus | 600mg IV (7.5mg/kg) q6hrs | Active tetanus alt |
| Anthrax | 900mg IV q8hrs | Inhalation/cutaneous with systemic illness; combined with Ciprofloxacin or Doxycycline |
| Babesiosis | 600mg PO q8hrs x 7-10 days (or 300-600mg IV q6hrs) | Severe parasitemia over 4 percent with Quinine |
| Bacterial vaginosis | 300 mg PO BID for 7 days | Alternative |
| Bacterial vaginosis | cream 2%, one full applicator (5 g) intravaginally Nightly for 7 days | First Line, Topical |
| Cellulitis | 600mg IV q8hrs | Inpatient |
| Cellulitis | 450mg PO TID | Outpatient |
| Dental abscess | 450 mg PO q8 hours x 7-14 days | Outpatient |
| Diabetic foot infection | 450mg PO q8hrs daily x 14 days | Mild DFI |
| Diabetic foot infection | 450mg PO q8hrs | Moderate DFI |
| Endocarditis | 600mg (20mg/kg) PO or IV | Dental Procedure Prophylaxis |
| Erysipelas | 450mg (5mg/kg) PO q8hrs x 10 days | PCN Allergic |
| Felon | 450mg PO q8hrs x 7 days | Outpatient |
| Impetigo | 450mg PO q8hrs (or 10mg/kg PO q6hrs) x 10 days | Oral therapy |
| Ludwig's angina | 600 mg IV q6 hrs | Immunocompetent, Penicillin allergy |
| Mammalian bites | 450mg (5mg/kg) PO q8hrs x 7 days | Human bites alt |
| Mammalian bites | 600mg IV q8hrs | Severe mammalian bite infection alt |
| Mammalian bites | 450mg (5mg/kg) PO q8hrs x 7 days | Cat and dog bites alt |
| Mastitis | 450mg PO q8hrs | Also provides MRSA coverage |
| Mastoiditis | 600mg IV q8 hours | Empiric |
| Neutropenic fever | 450mg PO q8hrs | Outpatient alt with Ciprofloxacin |
| Open fracture | 900 mg IV (immediately and q8 hours x 3 total doses) | Grade I & II, Cephalosporin allergy |
| Pelvic inflammatory disease | 900mg IV q8hr | Inpatient alternative; combined with Gentamicin |
| Periorbital cellulitis | 300mg Q8H | Outpatient |
| Peritonsillar abscess | 300mg PO Q6hrs x7-10d | Outpatient |
| Peritonsillar abscess | 600-900mg IV TID | Inpatient |
| Pneumocystis jirovecii pneumonia | 900mg IV q8hrs | Severe disease with Primaquine |
| Pneumocystis jirovecii pneumonia | 450mg PO q8hrs | Mild disease with Primaquine |
| Pneumonia (main) | 600mg IV | ICU, Low Risk (PCN allergy) |
| Postpartum endometritis | 900mg IV q8hrs | Preferred first line; <48hrs postpartum |
| Septic bursitis | 600 mg IV three times daily | Inpatient |
| Septic bursitis | 300 mg PO three times daily x 14 days | Outpatient |
| Streptococcal pharyngitis | 7 mg/kg/dose TID (maximum = 300 mg/dose) x 10 days | Penicillin Allergy (anaphylaxis) |
| Suppurative parotitis | 450mg PO three times daily | Outpatient |
| Toxoplasmosis | 600mg PO or IV q6hrs | Immunosuppressed alt |
Pediatric Dosing
General Infection (Severe)
- <1 week old
- <2kg
- 10mg/kg/day IM/IV divided q12
- First Dose: 5mg/kg IM/IV x 1
- >2kg
- 15mg/kg/day IM/IV divided q8h
- First Dose: 5mg/kg IM/IV x 1
- <2kg
- 1 week - 1 month
- <1.2kg
- 10mg/kg/day IM/IV divided q12h
- First Dose: 5mg/kg IM/IV x 1
- 1.2-2kg
- 15mg/kg/day IM/IV divided q8h
- First Dose: 5mg/kg IM/IV x 1
- >2kg
- 20mg/kg/day IM/IV divided q6-8h
- Alt: 30mg/kg/day IM/IV divided q6h
- First Dose: 5-7.5mg/kg IM/IV x 1
- <1.2kg
- >1 Month - Children
- 25-40mg/kg/day IM/IV divided q6-8h
- First Dose: 6.25-13.3mg/kg IM/IV x 1
- Max: 4.8 g/day IM/IV
- Adolescents
- 25-40mg/kg/day IM/IV divided q6-8h
- First Dose: 6.25-13.3mg/kg IM/IV x 1
- Max: 4.8 g/day IM/IV
General Infection (Mild-Moderate)
- Infants & Children
- PO:
- 10-25mg/kg/day PO divided q6-8h
- First Dose: 2.5-8.3mg/kg PO x 1
- Max: 1.8 g/day PO
- IM/IV:
- 15-25mg/kg/day IM/IV divided q6-8
- First Dose: 3.75-8.3mg/kg IM/IV x 1
- 4.8 g/day IM/IV
- PO:
- Adolescents
- PO:
- 150-300mg PO q6h
- First Dose: 150-300mg PO x 1
- Max: 1.8 g/day PO
- IM/IV:
- 25-40mg/kg/day IM/IV divided q6-8h
- First Dose: 6.25-13.3mg/kg IM/IV x 1
- Max: 4.8 g/day IM/IV
- PO:
Indications by Disease
| Disease | Dose | Context |
|---|---|---|
| Acute otitis media | 10mg/kg PO three times daily | Penicillin Allergy |
| Acute tetanus | 10-13mg/kg IV q8hrs (max 900mg/dose) | Pediatric Active tetanus alt |
| Anthrax | 7.5mg/kg q6hrs | Pediatric; combined with Ciprofloxacin or Doxycycline |
| Babesiosis | 20-40mg/kg/day PO divided TID x 7-10 days (max 600mg/dose) | Pediatric, with Quinine |
| Cellulitis | 30-40mg/kg/day PO divided TID (max 1.8g/day) | Pediatric Outpatient |
| Cellulitis | 10-13mg/kg IV q8hrs (max 900mg/dose) | Pediatric Inpatient |
| Dental abscess | 30mg/kg/day PO divided TID x 7-10 days (max 1.8g/day) | Pediatric Outpatient |
| Endocarditis | 20mg/kg PO or IV (max 600mg) | Pediatric Dental Prophylaxis, PCN Allergy |
| Erysipelas | 30mg/kg/day PO divided TID x 10 days (max 1.8g/day) | Pediatric PCN Allergy |
| Impetigo | 30mg/kg/day PO divided TID (max 1.8g/day) | Pediatric Oral, MRSA |
| Infectious tenosynovitis | 10mg/kg IV four times daily | Pediatrics |
| Ludwig's angina | 10-13mg/kg IV q8hrs (max 900mg/dose) | Pediatric PCN Allergy |
| Mammalian bites | 30mg/kg/day PO divided TID (max 1.8g/day) | Pediatric PCN allergy |
| Mammalian bites | 30mg/kg/day PO divided TID (max 1.8g/day) | Pediatric Human bites alt |
| Mastoiditis | 10-13mg/kg IV q8hrs (max 900mg/dose) | Pediatric |
| Open fracture | 10mg/kg IV (max 900mg) immediately then q8hrs x 3 doses | Pediatric Grade I & II, allergy |
| Osteomyelitis | 10mg/kg IV PO four times daily | Sickle Cell Disease |
| Periorbital cellulitis | 30 to 40 mg/kg per day in three to four equally divided doses, maximum 1.8 grams per day | Outpatient |
| Peritonsillar abscess | 30-40mg/kg/day PO divided TID (max 1.8g/day) | Pediatric Outpatient |
| Peritonsillar abscess | 10-13mg/kg IV q8hrs (max 900mg/dose) | Pediatric Inpatient |
| Pharyngitis | 7mg/kg/dose PO q8h x 10 days'"`UNIQ--ref-0000003E-QINU`"'; Max: 300mg/dose | Streptococcal Pharyngitis |
| Septic bursitis | 10mg/kg IV three times daily | Inpatient |
| Sinusitis | 30-40mg/kg/day PO divided q8h x 10-14 days; Use with cefixime or cefpodoxime | Sinusitis |
| Streptococcal pharyngitis | 7mg/kg/dose PO TID x 10 days (max 300mg/dose) | Pediatric PCN Allergy (severe) |
| Suppurative parotitis | 10mg/kg PO four times daily | Outpatient |
| Toxoplasmosis | 20-30mg/kg/day PO/IV divided q6hrs (max 2.4g/day) | Pediatric Sulfa Allergy alt |
Special Populations
- Pregnancy Rating: B
- Lactation risk categories: L4; enters breast milk/not recommended
- Renal Dosing (Adult & Pediatric)
- No adjustment
- No supplement for hemodialysis or peritoneal dialysis
- Hepatic Dosing (Adult & Pediatric)
- No adjustment
- Geriatric: See adult dosing
Contraindications
Black Box
- High risk for C. difficile associated diarrhea
- Reserve for serious infections where there is not alternative
- Discontinue immediately if significant diarrhea, abdominal cramps, or passage of blood or mucus with use
General
- Allergy to class/drug
- Ulcerative colitis
Adverse Reactions
Serious
- C. difficile associated diarrhea
- Thrombocytopenia
- Anaphylaxis
- Stevens-Johnson Syndrome
- Granulocytopenia
- Esophagitis
Common
- Diarrhea
- Nausea and Vomiting
- Abdominal Pain
- Rash
- Puritis
- Jaundice
- Urticaria
- Hypotension
- Thrombophlebitis (IV use)
Pharmacology
- Half-life: 2.4-3h
- Metabolism: Liver; CYP450
- Excretion: Urine, feces
- Mechanism of Action: Bacteriostatic or bactericidal, depending on bug/concentration
Administration
- PO:
- Give with full glass of water (minimize esophageal ulceration)
- Give spread around the day to promote constant serum levels
- IM:
- Give to deep I.M. sites
- Rotate sites
- Do not exceed 600mg per injection
- IV:
- Do NOT give as bolus
- Give by intermittent infusion over >10-60 minutes
- Max rate: 30mg/minute (do not exceed 1200mg/hour)
- Final concentration should not exceed 18mg/mL
Mechanism of Action
- Disrupts protein synthesis by binding the 50s ribosome subunit
Antibiotic Sensitivities[1]
Key
- S susceptible/sensitive (usually)
- I intermediate (variably susceptible/resistant)
- R resistant (or not effective clinically)
- S+ synergistic with cell wall antibiotics
- U sensitive for UTI only (non systemic infection)
- X1 no data
- X2 active in vitro, but not used clinically
- X3 active in vitro, but not clinically effective for Group A strep pharyngitis or infections due to E. faecalis
- X4 active in vitro, but not clinically effective for strep pneumonia
See Also
References
- ↑ Sanford Guide to Antimicrobial Therapy 2014
