Clindamycin

These indications are based on manufacturer information for both originator and generic products. For product specific registered indications, please refer to product specific manufacturer information

Registered South African indications:

• Staphylococcus aureus: Abscesses, bacteraemia, endocarditis, pneumonia and osteomyelitis, but not in meningitis or in methicillin-resistant organisms
• Streptococcus (anaerobic species): Bacteraemia, endocarditis, abscesses and upper respiratory infections (sinusitis)
• Streptococcus pneumoniae: Pneumonia, arthritis, and upper respiratory tract infections
• Clostridium perfringens: Gas gangrene
• Campylobacter jejuni: Enteritis
• Bacteroides species: Oral disease, upper respiratory tract infections and lung abscess
• Fusobacterium nucleatum: Ulcerative pharyngitis, lung abscess, empyema, genital infections, gingivitis

Contraindications

• Hypersensitivity to the active ingredient or any of its excipients
• Porphyria
• Patients with existing diarrhoea

Cautions

• Pregnancy
• Breastfeeding
• Hepatic impairment
• Elderly
• History of gastrointestinal disease, especially colitis
• Infants
• Prolonged administration
• Atopic patients
• Patients requiring sodium controlled diet (inj)
• Staphylococci resistant to erythromycin
• Galactose intolerance (cap)
• Lapp lactose deficiency (cap)
• Glucose-galactose malabsorption (cap)

Forms avail. in SA and covered in this monograph: cap, inj

Dosages below include:

• General dosing range
• South African Standard Treatment Guidelines indications and dosages
• South African registered indications and dosages & Indications and dosages registered in other jurisdictions

Infections caused by: Gram-positive aerobic cocci (excluding enterococci); Anaerobes; Limited Gram-negative bacilli (Campylobacter spp.)

General dosing range

• IM/IV: 600-2700mg/day, in 2-4 divided doses; Max: 4.8g/24hrs
• Oral (cap): 150-450mg, 6-8hrly; Max: 1.8g/24hrs

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Single IM injections of > 600mg not recommended

Infusion of > 1.2g per hour not recommended

See additional prescribing points for administration directions

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Specific doses based on individual indications

Please note that the dosages below should be used in combination with regional guidelines, taking into account local antibiotic sensitivities

South African Standard Treatment Guidelines indications and dosages

Infective endocarditis prophylaxis 
- Severe penicillin allergy 

• Oral (cap): 600mg, 1hr before procedure 
  (STG, Adult 2019)

- If cannot take oral 

• IV: 600mg, 1hr before procedure 
  (STG, Adult 2019)

Cellulitis - severe
- Severe penicillin allergy
Erysipelas - severe
- Severe penicillin allergy
Furuncles and abscesses 
- Severe penicillin allergy 

• IV: 600mg, 8hrly 
  (STG, Adult 2019)

- When clinical improvement occurs change to 

• Oral (cap): 450mg, 8hrly 
  (STG, Adult 2019)

Atopic eczema
- Severe penicillin allergy
Dermatitis
- Severe penicillin allergy

• Oral (cap): 450mg, 8hrly; Treatment duration: 5 days

Pelvic inflammatory disease stage II-IV (Additional agent required) 
- Severe penicillin allergy 

• IV: 600mg, 8hrly; Treatment duration: 24-48hrs; Then switch to oral when there is definite clinical improvement 
• Oral (cap): 450mg, 8hrly; Treatment duration: 10 days 
  (STG, Adult 2019)

Septic miscarriage (Additional agent required) 
- Severe penicillin allergy 

• IV: 600mg, 8hrly; Then switch to oral after improvement 
• Oral (cap): 450mg, 8hrly; Treatment duration: 5 days 
  (STG, Adult 2019)

Diabetic foot ulcer (Additional agent required) 
- Severe penicillin allergy 

• Oral (cap): 150-450mg, 8hrly 
  (STG, Adult 2019)

Intravascular catheter infections (Peripheral line infection) 
- Larger area(s) of erythema and tenderness extending beyond insertion site and systemically well  

• Oral (cap): 450mg, 8hrly; Treatment duration: 5 days 
  (STG, Adult 2019)

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If patients with peripheral or central venous catheter infections are systemically unwell should be treated as a venous catheter related systemic blood infection 

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Surgical wound infections (Additional agent required) 
- Severe penicillin allergy 

• IV: 600mg, 8hrly; Then switch to oral
• Oral (cap): 450mg, 8hrly 
  (STG, Adult 2019)

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Oral therapy: as soon as patient can swallow and temperature is <37,8^oC for 24hrs 

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Pneumocystis pneumonia (Additional agent required) 
- If intolerant and unsuccessful desensitisation 

• Oral (cap): 600mg, 8hrly; Treatment duration: 21 days 
  (STG, Adult 2019)

Surgical antibiotic prophylaxis 

• IV: 600mg
  (STG, Adult 2019)

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With prolonged procedures, re-dose after >6hrs' 

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Septic arthritis 
Acute osteomyelitis  
- Empiric antibiotic therapy (severe penicillin allergy) 

• IV: 600mg, 8hrly; Treatment duration: 2 weeks; If good clinical response, change to oral 
• Oral (cap): 450mg, 8hrly, Treatment duration: 4 weeks 
  (STG, Adult 2019)

Peritonsillar abscess 
- Severe penicillin allergy 

• IV: 600mg, 8hrly; Treatment duration: 10 days, switch to oral 
• Oral (cap): 450mg, 8hrly; Treatment duration: 10 days 
  (STG, Adult 2019)

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Oral therapy: as soon as patient can swallow and temperature is <37,8^oC for 24hrs  

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Extravasations 
- Larger area(s) of erythema and tenderness extending beyond insertion site where secondary infection is suspected 

• Oral (cap): 450mg, 8hrly; Treatment duration: 5 days 
  (STG, Adult 2019)

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South African registered indications and dosages &
Indications and dosages registered in other jurisdictions

Beta-haemolytic streptococcal infections

• IV/IM: 600-900mg, 8hrly; Treatment duration: Minimum 10 days (Manufacturer recommendation)

Skin and soft tissue infections

• IV: 600mg, 8hrly; Treatment duration: 1-2 weeks 
• Oral (cap): 450mg, 8hrly; Treatment duration: 1-2 weeks 

Paed. forms avail. in SA and covered in this monograph: cap, inj

Paed. dosages below include:

• General dosing range
• South African Standard Treatment Guidelines indications and dosages

Infections caused by: Gram-positive aerobic cocci (excluding enterococci); Anaerobes; Limited Gram-negative bacilli (Campylobacter spp.)

General dosing range

Younger than 1 month

• Not established for use

Older than 1 month

• IM/IV: 15-40mg/kg/day, in 3-4 divided doses
• Oral (cap): 8-40mg/kg/day, in 3-4 divided doses

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Doses should not exceed adult dose

In severe infections, give children at least 300mg/day regardless of body weight

Single IM injections of > 600mg or infusion of > 1.2g in a single one hour infusion are not recommended

See additional prescribing points for administration directions; Dilution should not exceed 18mg/ml and infusion rate should not exceed 30mg/min

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Specific doses based on individual indications

Please note that the dosages below should be used in combination with regional guidelines, taking into account local antibiotic sensitivities

South African Standard Treatment Guidelines indications and dosages

Uncomplicated  P. falciparum malaria - non-severe (Additional agent required) 
- 2-3 days after initiating IV treatment 

• <5kg: Oral (cap): 10mg/kg, 12hrly; Treatment duration: 7 days 
  (STG, Paed. 2017)

Severe complicated P. falciparum malaria (Additional agent required) 

• <5kg: Oral (cap): 10mg/kg, 12hrly; Treatment duration: 7 days 
  (STG, Paed. 2017)

Septic arthritis (pyogenic) 
Acute osteomyelitis/osteitis 

• Oral (cap): 6mg/kg, 6hrly; Treatment duration: 4-6 weeks 
  (STG, Paed. 2017)

Allergies to penicillins 
- Milder infections e.g. impetigo, mild cellulitis

• Oral (cap): 6mg/kg, 6hrly; Treatment duration: 3 days 
  (STG, Paed. 2023)

- Severe infections e.g. osteomyelitis, pneumonia 

• Oral (cap): 6mg/kg, 6hrly 
  (STG, Paed. 2023)

Pregnancy

• Caution
• There was evidence of maternal toxicity and embryofoetal toxicity in animal studies.Clindamycin crosses the placenta in humans. After multiple doses, amniotic fluid concentrations were approximately 30% of maternal blood concentrations.In clinical trials with pregnant women, the systemic administration of clindamycin during the second and third trimesters has not been associated with an increased frequency of congenital abnormalities. There are no adequate and well-controlled studies in pregnant women during the first trimester of pregnancy.Clindamycin should be used during pregnancy only if clearly needed

Breastfeeding

• Caution; not recommended
• Orally and parenterally administered clindamycin has been reported to appear in human breast milk in ranges from 0.7 to 3.8micrograms/mL. Because of the potential for serious adverse reactions in breastfeeding infants, clindamycin should not be taken by breastfeeding mothers

Fertility

• Fertility studies in rats treated orally with clindamycin revealed no effects on fertility or mating ability

Renal Impairment

• No dose adjustment recommended

Hepatic Impairment

• Caution; no dose adjustment recommended

Elderly

• Caution; no dose adjustment recommended

Porphyria Information

• Probably porphyrinogenic (PRP)

Drugs in Sport

• Permitted - No warnings

Central Nervous System Disorders

• Dysgeusia

Cardiovascular Disorders

• Cardiopulmonary arrest
• Hypotension

Gastrointestinal Disorders

• Antibiotic associated colitis
• Oesophageal ulcers 
• Oesophagitis with oral preparations
• Nausea and vomiting
• Abdominal pain

Hepatobiliary Disorders

• Jaundice
• Abnormalities in hepatic function tests

Genitourinary Disorders

• Vaginitis

Skin and Subcutaneous Tissue Disorders

• Maculopapular rash
• Urticaria
• Generalised mild to moderate morbilliform-like skin rashes 
• Erythema multiforme some resembling Stevens-Johnson syndrome
• Pruritus 
• Exfoliative and vesiculobullous dermatitis
• Toxic epidermal necrolysis
• Local irritation (IM inj)
• Pain (IM inj)
• Abscess formation (IM inj)
• Thrombophlebitis (IV inj)

Immune, Blood and Lymphatic System Disorders

• Transient neutropenia
• Leukopenia
• Eosinophilia
• Agranulocytosis
• Thrombocytopenia

• Oral contraceptives
• Neuromuscular blocking agents
• Erythromycin
• Vitamin K antagonists
• Anticholinesterases
• Oral typhoid vaccination

None routine. Specific cases may require

• Full blood count
• Renal function
• Hepatic function

Administration directions

• IM: Single IM injection should not exceed 600mg
• IV infusion: Dilute with 0.9% sodium chloride; Infusion rate:  

Dose (mg)	Diluent (ml)	Minimum time of infusion (min)
300	50	10
600	100	20
900	150	30
1200	200	45

Clindamycin does not penetrate the blood/brain barrier in therapeutically effective quantities

Excipients

• Clindamycin may contain small amounts of ethanol (alcohol), less than 100 mg per dose

Clindamycin has a primarily bacteriostatic action. It binds to the 50S subunit of the bacterial ribosome and thus inhibits the early stages of protein synthesis.

Spectrum of activity: Gram-positive aerobic cocci (excluding enterococci); Anaerobes ; Limited Gram-negative bacilli (Campylobacter spp.)

Capsule 150mg

• Clindahexal (Sandoz)
• Clindamycin Actor (Actor Pharma)
• Dalacin C (Pfizer) originator

Injection (per 4ml) 600mg

• Clindamycin Fresenius (Fresenius)
• Dalacin C (Pfizer) originator (Discontinued: 20/12/2020)
• Pharma-Q clindamycin (Pharma-Q)

Also available in the following forms: Lotion, solution and vaginal cream