Clues for dosing clindamycin
Clues for dosing clindamycin
The antibiotic clindamycin has been in service since the 1960s, but doctors still haven’t settled on the best way to dose it. Does it work better when given every eight hours, or can you get away with a twice-daily regimen?
The answer may be the latter. A recent study found the drug’s killing power may last long enough when dosed every 12 hours to keep even stubborn infections like S. aureus at bay. Measurable bactericidal activity of the drug was maintained 50% of the time with the twice-daily regimen not optimal, the authors admit, but perhaps enough to yield a good clinical response.
Against other organisms, twice-daily dosing of clindamycin worked very well. Against S. pneumoniae, both the eight- and 12-hour regimens yielded measurable killing power spanning 100% of the dosing intervals. And with B. fragiles infections, 8- and 12-hour regimens provided enough bactericidal activity to last more than 80% of the time. The authors caution that the 12 subjects studied were normal, healthy volunteers and that larger studies may be needed.
Perhaps the best news is that clindamycin was shown effective regardless of whether it was dosed orally or intravenously. And for those doctors still gun-shy about using clindamycin for fear of a C. difficile suprainfection, take note: The doses used in this study were low enough 300 mg each to almost preclude that possibility.
Selected reference
Klepser ME, et al. Bactericidal activity of low-dose clindamycin administered at 8- and 12-hour intervals against Staphylococcus aureus, Streptococcus pneumoniae, and Bacteroides fragilis. Antimicrobial Agents Chemother 1997; 41:630-635.
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