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Antibiotic (Lincosamide) — Surgical Prophylaxis Pregnancy: B — used when benefit outweighs risk; safe in obstetric use

Clindamycin (Surgical Prophylaxis — Penicillin Allergy)

Brand names: Dalacin C

Adult dose

Dose: Surgical prophylaxis: 600 mg IV at induction. Treatment of SSI/soft tissue infections: 600–900 mg IV every 8h, or 150–450 mg oral every 6h
Route: IV or oral
Frequency: Single dose (prophylaxis); every 6–8h (treatment)
Max: 2.7 g/day (IV treatment); 1.8 g/day (oral)
First-line alternative surgical prophylaxis in patients with penicillin or cephalosporin allergy. WHO SSI guidelines 2016: clindamycin + gentamicin as alternative to beta-lactam prophylaxis. Active against Gram-positive cocci (MRSA, streptococci) and anaerobes. No Gram-negative coverage — add gentamicin if Gram-negative cover needed.

Paediatric dose

Dose: 10 mg/kg
Route: IV or oral
Frequency: Every 6–8h
Max: 40 mg/kg/day
Concentration: 150 mg/mL (IV); 75 mg/5 mL (oral) mg/ml
Children: 10 mg/kg every 6–8h IV. Neonates: 5–7.5 mg/kg every 8h (caution — benzyl alcohol in some preparations).

Dose adjustments

Renal

No dose adjustment required

Hepatic

Reduce dose in severe hepatic impairment (prolonged half-life)

Paediatric weight-based calculator

Children: 10 mg/kg every 6–8h IV. Neonates: 5–7.5 mg/kg every 8h (caution — benzyl alcohol in some preparations).

Clinical pearls

  • Highest C. difficile risk of all antibiotics — limit to penicillin-allergic patients for surgical prophylaxis; use single dose only
  • MSSA and MRSA coverage: excellent Gram-positive activity including many MRSA strains (check local susceptibility)
  • Oesophagitis risk: oral clindamycin capsules cause oesophageal injury if not taken with sufficient fluid (200 mL) and remaining upright
  • No Gram-negative cover: always combine with gentamicin if broad-spectrum prophylaxis needed (e.g., colorectal surgery in penicillin-allergic patient)
  • Single prophylactic dose: repeat only if surgery >4h or blood loss >1.5L (same as other surgical prophylaxis agents)

Contraindications

  • Hypersensitivity to clindamycin or lincomycin
  • Diarrhoeal illness (risk of C. difficile)

Side effects

  • Clostridium difficile-associated diarrhoea (highest risk of any antibiotic class)
  • Diarrhoea
  • Nausea
  • Rash
  • Oesophagitis (oral — take with large glass of water, remain upright)

Interactions

  • Neuromuscular blocking agents — potentiates blockade
  • Erythromycin — antagonism (same ribosomal binding site — avoid combination)

Monitoring

  • Diarrhoea (C. difficile — especially if course >5 days)
  • Renal and hepatic function (prolonged courses)
  • Neuromuscular function (if NMBAs co-administered)

Reference: BNFc; WHO SSI Guidelines 2016; BNF; PHE Penicillin Allergy Guidance; SIGN 104. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

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