Uses
Acute Otitis Media (AOM)
Alternative for treatment of AOM† known or presumed to be caused by penicillin-resistant Streptococcus pneumoniae.
Not a first-line agent, but AAP and AAFP state clindamycin may be considered in individuals with penicillin hypersensitivity who may have AOM caused by penicillin-resistant S. pneumoniae.
Use of clindamycin also may be considered if AOM persists after treatment with amoxicillin and clavulanate or ceftriaxone and tympanocentesis is not available to make a bacteriologic diagnosis.
Bone and Joint Infections
Treatment of serious bone and joint infections (including acute hematogenous osteomyelitis) caused by susceptible Staphylococcus aureus.
Adjunct in the surgical treatment of chronic bone and joint infections caused by susceptible bacteria.
Gynecologic Infections
Treatment of serious gynecologic infections (e.g., endometritis, nongonococcal tubo-ovarian abscess, pelvic cellulitis, postsurgical vaginal cuff infection) caused by susceptible anaerobes.
Treatment of pelvic inflammatory disease (PID); used in conjunction with other anti-infectives. When a parenteral regimen is indicated for treatment of PID, IV clindamycin in conjunction with an IV or IM aminoglycoside (e.g., gentamicin) is one possible regimen since it provides good coverage for anaerobes. However, this regimen may not provide optimal coverage for Neisseria gonorrhoeae and Chlamydia trachomatis, and a regimen of cefoxitin (or cefotetan) and doxycycline may be preferred when these organisms are suspected as primary pathogens.
Intra-abdominal Infections
Treatment of serious intra-abdominal infections (e.g., peritonitis, intra-abdominal abscess) caused by susceptible anaerobes.
Pharyngitis and Tonsillitis
Alternative for treatment of pharyngitis and tonsillitis† caused by susceptible Streptococcus pyogenes (group A β-hemolytic streptococci) in patients who cannot receive β-lactam anti-infectives and have infections caused by macrolide-resistant S. pyogenes.
CDC, AAP, IDSA, AHA, and others recommend oral penicillin V or IM penicillin G benzathine as treatments of choice for pharyngitis and tonsillitis; oral cephalosporins and oral macrolides are considered alternatives. Amoxicillin sometimes used instead of penicillin V, especially for young children.
Alternative for treatment of symptomatic patients who have multiple, recurrent episodes of pharyngitis known to be caused by S. pyogenes.
Consider that multiple, recurrent episodes of symptomatic pharyngitis within several months to years may indicate that the patient is a streptococcal carrier experiencing repeated episodes of nonstreptococcal pharyngitis (e.g., viral) pharyngitis; treatment not usually recommended for streptococcal pharyngeal carriers.
Respiratory Tract Infections
Treatment of serious respiratory tract infections (e.g., pneumonia, empyema, lung abscess) caused by susceptible anaerobes, S. pneumoniae, other streptococci, or S. aureus.
A drug of choice for use in multiple-drug regimens for treatment of pneumonia when anaerobes are identified or suspected or when lung abscess is present.
Septicemia
Treatment of serious septicemia caused by susceptible anaerobes, streptococci, or S. aureus.
Skin and Skin Structure Infections
Treatment of serious skin and skin structure infections caused by susceptible anaerobes, S. pyogenes, other streptococci, or staphylococci.
Actinomycosis
Treatment of actinomycosis† caused by Actinomyces israelii; follow-up treatment (6–12 months) after initial parenteral treatment (4–6 weeks) with penicillin G.
Anthrax
Alternative for treatment of anthrax†.
Component of multiple-drug parenteral regimens recommended for treatment of inhalational anthrax that occurs as the result of exposure to B. anthracis spores in the context of biologic warfare or bioterrorism. Initiate treatment with IV ciprofloxacin or doxycycline and 1 or 2 other anti-infective agents predicted to be effective (e.g., chloramphenicol, clindamycin, rifampin, vancomycin, clarithromycin, imipenem, penicillin, ampicillin); if meningitis is established or suspected, use IV ciprofloxacin (rather than doxycycline) and chloramphenicol, rifampin, or penicillin.
Babesiosis
Treatment of babesiosis† caused by Babesia microti.
Regimens of choice for moderate to severe babesiosis are clindamycin in conjunction with quinine or atovaquone in conjunction with azithromycin; also consider exchange transfusions in severely ill patients with high levels of parasitemia (>10%).
Bacillus cereus Infections
Treatment of invasive disease caused by Bacillus cereus†. Anti-infectives not usually indicated for gastroenteritis caused by B. cereus.
Bacterial Vaginosis
Treatment of bacterial vaginosis† (formerly called Haemophilus vaginitis, Gardnerella vaginitis, nonspecific vaginitis, Corynebacterium vaginitis, or anaerobic vaginosis) in pregnant or nonpregnant women.
CDC recommends treatment of bacterial vaginosis in all symptomatic nonpregnant women, in symptomatic pregnant women, and asymptomatic pregnant women at high risk for complications of pregnancy. Treatment recommendations for bacterial vaginosis in HIV-infected women are the same as those for women without HIV infection.
Regimens of choice in nonpregnant women are a 7-day regimen of oral metronidazole; a 5-day regimen of intravaginal metronidazole; or a 7-day regimen of intravaginal clindamycin; alternative regimens are a single oral dose of metronidazole; 7-day regimen of oral clindamycin; or 3-day regimen of intravaginal clindamycin. The preferred regimens for symptomatic or asymptomatic pregnant women at high risk are a 7-day regimen of oral metronidazole or a 7-day regimen of oral clindamycin.
Regardless of regimen used, relapse or recurrence is common; an alternative regimen (e.g., oral therapy when topical was used initially) may be used in such situations. Long-term maintenance therapy does not appear to be beneficial in women with recurrent or relapsing disease and is not recommended.
Capnocytophaga Infections
Alternative to penicillin G for treatment of infections caused by Capnocytophaga canimorsus†.
Clostridium Infections
Alternative to penicillin G for treatment of clostridial myonecrosis (gas gangrene) caused by Clostridium perfringens or other Clostridium. Anti-infectives not usually indicated for gastroenteritis caused by C. perfringens.
Malaria
Treatment of uncomplicated malaria† caused by chloroquine-resistant Plasmodium falciparum or when the plasmodial species has not been identified. Used in conjunction with oral quinine; not effective alone.
CDC and others state treatments of choice for uncomplicated chloroquine-resistant P. falciparum malaria are a regimen of oral quinine in conjunction with doxycycline, tetracycline, or clindamycin or a regimen of atovaquone and proguanil. A regimen of quinine and doxycycline (or tetracycline) generally preferred over quinine and clindamycin, except for young children or pregnant women who should not receive tetracyclines.
Treatment of severe malaria caused by P. falciparum†; used in conjunction with IV quinidine gluconate initially and then with oral quinine when an oral regimen is tolerated.
Pneumocystis jiroveci (Pneumocystis carinii) Pneumonia
Treatment of Pneumocystis jiroveci (formerly Pneumocystis carinii) pneumonia† (PCP); used in conjunction with primaquine. Designated an orphan drug by FDA for use in this condition.
Co-trimoxazole is initial drug of choice for treatment in most adults, adolescents, and children, including HIV-infected patients; a regimen of clindamycin and primaquine is an alternative for adults and adolescents with mild to moderately severe PCP who have had an inadequate response to co-trimoxazole or when co-trimoxazole is contraindicated or not tolerated.
Clindamycin in conjunction with primaquine has been used as an alternative for long-term suppressive or chronic maintenance therapy (secondary prophylaxis) of PCP†, but USPHS/IDSA states the regimen should only be considered for primary or secondary prophylaxis of PCP in unusual situations when the usually recommended agents (co-trimoxazole, dapsone, dapsone with pyrimethamine and leucovorin, aerosolized pentamidine, atovaquone) cannot be used.
Toxoplasmosis
Alternative for treatment of toxoplasmosis† in immunocompromised adults, adolescents, or children (including HIV-infected patients) who relapse or fail to respond to or are unable to tolerate the regimen of choice (pyrimethamine in conjunction with sulfadiazine and leucovorin). Clindamycin is used in conjunction with pyrimethamine and leucovorin and is the preferred alternative.
Alternative for long-term suppressive or chronic maintenance therapy (secondary prophylaxis) to prevent relapse of toxoplasmosis† in HIV-infected individuals who cannot receive the regimen of choice (sulfadiazine in conjunction with pyrimethamine and leucovorin). Clindamycin is used in conjunction with pyrimethamine and leucovorin. Consider that the clindamycin regimen may be less effective than the sulfadiazine regimen in preventing toxoplasmosis recurrence and that only the sulfadiazine regimen appears to provide protection against both toxoplasmosis and P. jiroveci.
Prevention of Bacterial Endocarditis
Alternative for prevention of α-hemolytic (viridans group) streptococcal bacterial endocarditis† in penicillin-allergic individuals undergoing certain dental, oral, respiratory tract, or esophageal procedures who have cardiac conditions that put them at high or moderate risk.
Consult most recent AHA recommendations for specific information on which cardiac conditions are associated with high or moderate risk of endocarditis and which procedures require prophylaxis. (See Appendix.)
Prevention of Perinatal Group B Streptococcal Disease
Alternative to penicillin G or ampicillin for prevention of perinatal group B streptococcal (GBS) disease† in penicillin-allergic pregnant women at risk for anaphylaxis with a β-lactam anti-infective.
Intrapartum anti-infective prophylaxis to prevent early-onset neonatal GBS disease is administered to women identified as GBS carriers during routine prenatal GBS screening performed at 35–37 weeks during the current pregnancy and to women who have GBS bacteriuria during the current pregnancy, a previous infant with invasive GBS disease, unknown GBS status with delivery at <37 weeks gestation, amniotic membrane rupture for ≥18 hours, or intrapartum temperature of ≥38°C.
Penicillin G is the regimen of choice and ampicillin is the preferred alternative. Cefazolin can be used in penicillin-allergic women who do not have immediate-type penicillin hypersensitivity, but clindamycin or erythromycin should be used in penicillin-allergic women at high risk for anaphylaxis.
Consider that S. agalactiae (group B streptococci) with in vitro resistance to clindamycin and erythromycin has been reported with increasing frequency; perform in vitro susceptibility tests of clinical isolates obtained during GBS prenatal screening. GBS resistant to erythromycin often are resistant to clindamycin, although this may not be evident in results of in vitro testing. If in vitro susceptibility testing is not possible, results are unknown, or isolates are found to be resistant to erythromycin or clindamycin, vancomycin is recommended for intrapartum prophylaxis in penicillin-allergic women at high risk for anaphylaxis with β-lactams.
Perioperative Prophylaxis
Perioperative prophylaxis† to reduce the incidence of infections in patients undergoing clean, contaminated head and neck surgery. Regimens of choice are IV clindamycin (with or without gentamicin) or IV cefazolin.
Has been used for perioperative prophylaxis in patients undergoing nonperforated appendectomy†, but cefoxitin (or cefotetan) is the regimen of choice.
Perioperative prophylaxis and postoperative treatment in patients undergoing contaminated or dirty surgery† involving perforated abdominal viscus. Preferred regimens are clindamycin (with gentamicin) or cefoxitin or cefotetan (with or without gentamicin).
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