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Clindamycin is metabolized predominantly by CYP3A4, with minor contribution by CYP3A5, to form clindamycin sulfoxide (major metabolite) and N-desmethylclindamycin (minor metabolite)Urine (~10%) and feces (3.6%) as active drug and metabolitesPMA ≤28 weeks: Median: 5.89 hours (range: 2.42 to 12.9 hours).PMA >28 to 32 weeks: Median: 5.25 hours (range: 2.34 to 8.87 hours).PMA >32 to 40 weeks: Median: 3.96 hours (range: 1.3 to 8.83 hours).Neonates and Infants ≤5 months (Gonzalez 2016): PMA >40 to 60 weeks: Median: 2.35 hours (range: 0.94 to 6.44 hours).Infants >5 months to 1 year (Gonzalez 2016): Median: 2.05 hours (range: 1.26 to 3.47 hours).Data from a prospective, observational cohort study and a retrospective cohort study suggest that clindamycin, in combination with rifampin, may be beneficial for the treatment of hidradenitis suppurativa Based on the CDC Treatment of Malaria: Guidelines for Clinicians (United States), clindamycin, in combination with quinine, is an effective and recommended alternative option for the treatment of malaria (CDC 2020).Data from a prospective, randomized, open-label study support the use of clindamycin (in combination with ciprofloxacin) for the outpatient management of neutropenic fever in low-risk cancer patients Data from two randomized, prospective, blinded (one single-blind, one double-blind) studies support the use of clindamycin for the treatment of odontogenic infections Clinical experience suggests the utility of clindamycin as chronic suppressive treatment of prosthetic joint infection caused by methicillin-resistant staphylococci Clinical experience suggests the utility of clindamycin (in combination with cefixime or cefpodoxime) for the treatment of ABRS Hypersensitivity to clindamycin, lincomycin, or any component of the formulation.Inhalational exposure postexposure prophylaxis (PEP) (alternative agent): Cutaneous, without systemic involvement, empiric therapy (alternative agent): Manufacturer's labeling: Infants, Children, and Adolescents 1 month to 16 years:Weight-directed dosing: 20 to 40 mg/kg/day divided every 6 to 8 hours.Mild to moderate infections: 20 mg/kg/day divided every 8 hours; maximum daily dose: 1,800 mg/Severe infections: 40 mg/kg/day divided every 6 to 8 hours; maximum daily dose: 2,700 mg/Manufacturer's labeling: Infants, Children, and Adolescents:Hydrochloride salt (capsule): 8 to 20 mg/kg/day divided every 6 to 8 hours.Palmitate salt (solution): 8 to 25 mg/kg/day divided every 6 to 8 hours; minimum dose: 37.5 mg 3 times daily.Mild to moderate infections: 10 to 25 mg/kg/day divided every 8 hours; maximum daily dose: 1,800 mg/Severe infections: 30 to 40 mg/kg/day divided every 6 to 8 hours; maximum daily dose: 1,800 mg/IM, IV: 20 mg/kg 30 minutes before procedure; maximum single dose: 600 mg.Oral: 20 mg/kg 1 hour before procedure; maximum single dose: 600 mg.Invasive dental procedures: Oral: 20 mg/kg administered 30 to 60 minutes before procedure; maximum dose: 600 mg.Gastrointestinal or genitourinary procedures: IV: 10 mg/kg administered 30 to 60 minutes before procedure; maximum dose: 600 mg.Treatment and primary prevention of rheumatic fever: 21 mg/kg/day in divided doses 3 times daily for 10 days; maximum single dose: 300 mg.Treatment of chronic carriers: 20 to 30 mg/kg/day in divided doses 3 times daily for 10 days; maximum single dose: 300 mg.Mild to moderate disease: Oral: 10 mg/kg 3 to 4 times daily for 21 days; in combination with other agents; maximum single dose: 450 mg.Moderate to severe disease: IV: 15 to 25 mg/kg 3 to 4 times daily for 21 days; give with pentamidine or primaquine; maximum single dose: 600 mg. May switch to oral dose after clinical improvement.Mild to moderate disease: Oral: 300 mg every 6 hours Moderate to severe infection: IV: 40 mg/kg/day divided every 6 to 8 hours.Mild infection, step-down therapy: Oral: 30 to 40 mg/kg/day divided every 6 to 8 hours.IV: 25 to 40 mg/kg/day in divided doses 3 times daily (IDSA [Stevens 2014]) or 40 mg/kg/day in divided doses every 6 to 8 hours (IDSA [Liu 2011]); maximum dose: 600 mg/dose.Oral: 30 to 40 mg/kg/day in divided doses 3 times daily (IDSA [Stevens 2014]) or 30 to 40 mg/kg/day in divided doses every 6 to 8 hours (IDSA [Liu 2011]); maximum dose: 450 mg/dose.IV: 25 to 40 mg/kg/day in divided doses 3 times daily; maximum dose: 600 mg/dose.Oral: 25 to 30 mg/kg/day in divided doses 3 times daily; maximum dose: 450 mg/dose.HIV-exposed/-positive: Oral: 7 to 10 mg/kg/dose every 8 hours and pyrimethamine plus leucovorin; maximum single dose: 600 mg (DHHS [pediatric] 2013).Hematopoietic cell transplantation recipients: Oral: 5 to 7.5 mg/kg/dose every 6 hours and pyrimethamine plus leucovorin; maximum single dose: 450 mg.HIV-exposed/-positive: Oral: 600 mg every 8 hours with pyrimethamine and leucovorin.Hematopoietic cell transplantation recipients: Oral: 300 to 450 mg every 6 to 8 hours with pyrimethamine and leucovorin.Injection: Never administer undiluted as bolus. Excretion: Via urine (Oral: Approx 10%; Topical lotion, foam, solution: <0.2%) as active drug and metabolites, faeces (approx. All rights reserved. Clindamycin is also one of the antibiotics recommended for prophylactic use prior to cesarean delivery and may be used in certain situations prior to vaginal delivery in women at high risk for endocarditis (ACOG 199 2018).
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