ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Lincosamide Antibiotic — Obstetric / Gynaecological Pregnancy: Oral/vaginal clindamycin used in pregnancy for BV — safety data acceptable; IV for GBS intrapartum

Clindamycin (BV / GBS Prophylaxis)

Brand names: Dalacin C, Dalacin T (vaginal)

Adult dose

Dose: BV: 300 mg oral twice daily for 7 days, or 2% vaginal cream 5 g nightly for 7 days. GBS intrapartum prophylaxis (penicillin allergy, high risk): 900 mg IV every 8 hours
Route: Oral / Vaginal / Intravenous
Frequency: Twice daily (oral BV); nightly (vaginal); every 8 hours (IV intrapartum)
Max: 2700 mg/day IV
Bacterial vaginosis in pregnancy: treat to reduce risk of preterm birth (RCOG). GBS prophylaxis: only if GBS known susceptible to clindamycin — check sensitivity before use

Paediatric dose

Dose: Not applicable in this obstetric context N/A/kg
Route: Oral / Vaginal
Frequency: N/A
Max: N/A
Maternal medication

Dose adjustments

Renal

No dose adjustment required

Hepatic

Use with caution — reduce dose in severe hepatic impairment

Paediatric weight-based calculator

Maternal medication

Clinical pearls

  • MHRA and PHE: Clindamycin has the highest risk of C. difficile-associated diarrhoea among antibiotics — reserve for specific indications; stop immediately if diarrhoea develops and test for C. diff toxin
  • BV in pregnancy: vaginal clindamycin cream is effective and has less systemic C. diff risk than oral — preferred route if available; treat symptomatic BV to reduce preterm birth risk
  • GBS resistance: approximately 20-30% of GBS isolates are clindamycin-resistant — always check sensitivity before using for intrapartum GBS prophylaxis; vancomycin IV is the fallback for resistant GBS in severely penicillin-allergic patients
  • Capsules and oesophagitis: must be taken with at least 200 mL water while upright — oesophageal ulceration reported with inadequate fluid
  • Vaginal clindamycin cream: does not significantly penetrate systemic circulation — lower C. diff risk; however, vaginal administration may affect latex condoms and diaphragms (oil-based — may cause latex damage)

Contraindications

  • History of clindamycin-associated colitis
  • History of antibiotic-associated diarrhoea (risk of C. difficile)

Side effects

  • C. difficile-associated diarrhoea (highest risk of any antibiotic — MHRA warning)
  • Nausea and vomiting
  • Oesophagitis (capsules — take with full glass of water upright)
  • Rash
  • Hepatotoxicity (rare)

Interactions

  • Neuromuscular blocking agents (enhances blockade)
  • Erythromycin (antagonism — avoid combination)
  • Warfarin (increased INR)

Monitoring

  • Bowel function (C. diff — stop if diarrhoea)
  • LFTs (prolonged use)
  • Treatment response (BV symptoms)

Reference: BNFc; BNF 90; BASHH BV Guidelines 2021; RCOG Green-top 36 (GBS); MHRA Drug Safety Update (clindamycin C. diff). Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators