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Lincosamide Antibiotic Pregnancy: Compatible — widely used in obstetric infections (BV, PID)

Clindamycin

Brand names: Dalacin C (oral/IV), Dalacin T (topical)

Adult dose

Dose: Oral: 150–450 mg every 6h. IV: 600 mg–1.2 g every 8h (up to 4.8 g/day in severe infections).
Route: Oral or IV
Frequency: Every 6h (oral); every 8h (IV)
Max: 4.8 g/day IV
For Staphylococcal and anaerobic infections, aspiration pneumonia, pelvic inflammatory disease. HIGH risk of C. difficile colitis — reserve for appropriate indications. Toxin suppression: used in necrotising fasciitis/invasive GAS to suppress toxin production.

Paediatric dose

Dose: 7.5 mg/kg
Route: Oral or IV
Frequency: Every 6h
Max: 450 mg per dose; 40 mg/kg/day
Concentration: 150 mg/ml
BNF for Children: oral 3–6 mg/kg every 8h (mild-moderate); IV 7.5 mg/kg every 6h. Severe: up to 12.5 mg/kg every 6h. Calculator uses 7.5 mg/kg (IV dose). Source: BNF for Children 2024

Dose adjustments

Renal

No dose adjustment required

Hepatic

Reduce dose in severe hepatic impairment

Paediatric weight-based calculator

BNF for Children: oral 3–6 mg/kg every 8h (mild-moderate); IV 7.5 mg/kg every 6h. Severe: up to 12.5 mg/kg every 6h. Calculator uses 7.5 mg/kg (IV dose). Source: BNF for Children 2024

Clinical pearls

  • C. difficile risk: one of highest risk antibiotics — STOP clindamycin if diarrhoea occurs and suspect C. diff
  • Toxin suppression: clindamycin added to beta-lactam in necrotising fasciitis and invasive GAS — suppresses toxin production (streptococcal pyrogenic exotoxin) by protein synthesis inhibition
  • Always take oral clindamycin with a full glass of water in upright position — oesophageal ulceration if capsule lodges
  • MRSA: covers CA-MRSA (SCC mec types) but NOT HA-MRSA — check D-zone test before use

Contraindications

  • Previous clindamycin-associated colitis

Side effects

  • C. difficile-associated diarrhoea (significant risk — one of the highest C. diff risk antibiotics)
  • Nausea/vomiting
  • Metallic taste
  • Oesophagitis (if taken without sufficient water)
  • Hepatotoxicity (elevated transaminases)
  • Anaphylaxis (rare)

Interactions

  • Neuromuscular blocking agents — enhanced blockade
  • Erythromycin — mutual antagonism (opposite binding site on ribosome)

Monitoring

  • C. difficile symptoms (diarrhoea)
  • LFTs (prolonged use)
  • Clinical response

Reference: BNFc; BNF; IDSA SSTI Guidelines; C. difficile risk stratification. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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