Dosing: Adult Usual dose: Oral: 150-450 mg/dose every 6-8 hours; maximum dose: 1.8 g/day
I.M., I.V.: 1.2-2.7 g/day in 2-4 divided doses; maximum dose: 4.8 g/day
Amnionitis: I.V.: 450-900 mg every 8 hours
Anthrax (unlabeled use): I.V.: 900 mg every 8 hours with ciprofloxacin or doxycycline
Babesiosis (unlabeled use):Oral: 600 mg 3 times/day for 7-10 days with quinine (Medical Letter, 2007)
I.V.: 1.2 g twice daily for 7-10 days with quinine (Medical Letter, 2007)
Bacterial vaginosis (unlabeled use): Oral: 300 mg twice daily for 7 days (CDC, 2010)
Bite wounds (canine): Oral: 300 mg 4 times/day with a fluoroquinolone
Cellulitis due to MRSA (unlabeled use): Oral: 300-450 mg 3 times/day for 5-10 days (Liu, 2011)
Complicated skin/soft tissue infection due to MRSA (unlabeled use): I.V., Oral: 600 mg 3 times/day for 7-14 days (Liu, 2011)
Gangrenous pyomyositis: I.V.: 900 mg every 8 hours with penicillin G
Group B streptococcus (neonatal prophylaxis): I.V.: 900 mg every 8 hours until delivery
Malaria, severe (unlabeled use) : I.V.: Load: 10 mg/kg followed by 15 mg/kg/day divided every 8 hours plus I.V. quinidine gluconate; switch to oral therapy (clindamycin plus quinine) when able for total clindamycin treatment duration of 7 days (Note: Quinine duration is region specific, consult CDC for current recommendations) (CDC, 2009)
Malaria, uncomplicated treatment (unlabeled use): Oral: 20 mg/kg/day divided every 8 hours for 7 days plus quinine (CDC, 2009)
Orofacial/parapharyngeal space infections:Oral: 150-450 mg every 6 hours for at least 7 days; maximum dose: 1.8 g/day
I.V.: 600-900 mg every 8 hours
Osteomyelitis due to MRSA (unlabeled use): I.V., Oral: 600 mg 3 times/day for a minimum of 8 weeks (some experts combine with rifampin) (Liu, 2011)
Pelvic inflammatory disease: I.V.: 900 mg every 8 hours with gentamicin (conventional or single daily dosing); 24 hours after clinical improvement may convert to oral doxycycline 100 mg twice daily or clindamycin 450 mg 4 times/day to complete 14 days of total therapy. Avoid doxycycline if tubo-ovarian abscess is present. (CDC, 2010)
Pneumocystis jirovecii pneumonia (unlabeled use): I.V.: 600-900 mg every 6-8 hours with primaquine for 21 days (CDC, 2009)
Oral: 300-450 mg every 6-8 hours with primaquine for 21 days (CDC, 2009)
Pneumonia due to MRSA (unlabeled use): I.V., Oral: 600 mg 3 times/day for 7-21 days (Liu, 2011)
Prophylaxis against infective endocarditis (unlabeled use):Oral: 600 mg 30-60 minutes before procedure with no follow-up dose needed (Wilson, 2007)
I.M., I.V.: 600 mg 30-60 minutes before procedure. Intramuscular injections should be avoided in patients who are receiving anticoagulant therapy. In these circumstances, orally administered regimens should be given whenever possible. Intravenously administered antibiotics should be used for patients who are unable to tolerate or absorb oral medications (Wilson, 2007).
Note: American Heart Association (AHA) guidelines now recommend prophylaxis only in patients undergoing invasive procedures and in whom underlying cardiac conditions may predispose to a higher risk of adverse outcomes should infection occur. As of April 2007, routine prophylaxis for GI/GU procedures is no longer recommended by the AHA.
Prophylaxis in total joint replacement patients undergoing dental procedures which produce bacteremia (unlabeled use):Oral: 600 mg 1 hour prior to procedure (ADA, 2003)
I.V.: 600 mg 1 hour prior to procedure (for patients unable to take oral medication) (ADA, 2003)
Septic arthritis due to MRSA (unlabeled use): I.V., Oral: 600 mg 3 times/day for 3-4 weeks (Liu, 2011)
Toxic shock syndrome: I.V.: 900 mg every 8 hours with penicillin G or ceftriaxone
Toxoplasmosis (HIV-exposed/positive; secondary prevention [unlabeled use]): Oral: 600 mg every 8 hours (with pyrimethamine and leucovorin calcium) (CDC, 2009)
Dosing: PediatricUsual dose: Infants and Children:
Oral: 8–40 mg/kg/day in 3-4 divided doses; Manufacturer’s labeling: 8-20 mg/kg/day (as hydrochloride) or 8-25 mg/kg/day (as palmitate) in 3-4 divided doses; minimum dose of palmitate: 37.5 mg 3 times/day
I.M., I.V.: Manufacturer’s labeling: 20-40 mg/kg/day in 3-4 divided doses
Anthrax (unlabeled use): I.V.: 7.5 mg/kg every 6 hours
Babesiosis (unlabeled use): Oral: 20-40 mg/kg divided every 8 hours for 7-10 days plus quinine (Medical Letter, 2007)
Cellulitis due to MRSA (unlabeled use): Oral: 10-13 mg/kg/dose every 6-8 hours for 5-10 days (maximum: 40 mg/kg/day) (Liu, 2011)
Complicated skin/soft tissue infection due to MRSA (unlabeled use): I.V., Oral: 10-13 mg/kg/dose every 6-8 hours for 7-14 days (maximum: 40 mg/kg/day) (Liu, 2011)
Malaria, severe (unlabeled use) : I.V.: Load: 10 mg/kg followed by 15 mg/kg/day divided every 8 hours plus I.V. quinidine gluconate; switch to oral therapy (clindamycin plus quinine) when able for total clindamycin treatment duration of 7 days (Note: Quinine duration is region specific, consult CDC for current recommendations) (CDC, 2009)
Malaria, uncomplicated treatment (unlabeled use): Oral: 20 mg/kg/day divided every 8 hours for 7 days plus quinine (CDC, 2009)
Osteomyelitis due to MRSA (unlabeled use): I.V., Oral: 10-13 mg/kg/dose every 6-8 hours for a minimum of 4-6 weeks (maximum: 40 mg/kg/day) (Liu, 2011)
Pneumonia due to MRSA (unlabeled use): I.V., Oral: 10-13 mg/kg/dose every 6-8 hours for 7-21 days (maximum: 40 mg/kg/day) (Liu, 2011)
Prophylaxis against infective endocarditis (unlabeled use): Oral: 20 mg/kg 30-60 minutes before procedure (Wilson, 2007)
I.M., I.V.: 20 mg/kg 30-60 minutes before procedure. Intramuscular injections should be avoided in patients who are receiving anticoagulant therapy. In these circumstances, orally administered regimens should be given whenever possible. Intravenously administered antibiotics should be used for patients who are unable to tolerate or absorb oral medications. (Wilson, 2007).
Note: American Heart Association (AHA) guidelines now recommend prophylaxis only in patients undergoing invasive procedures and in whom underlying cardiac conditions may predispose to a higher risk of adverse outcomes should infection occur. As of April 2007, routine prophylaxis for GI/GU procedures is no longer recommended by the AHA.
Septic arthritis due to MRSA (unlabeled use): I.V., Oral: 10-13 mg/kg/dose every 6-8 hours for minimum of 3-4 weeks (maximum: 40 mg/kg/day) (Liu, 2011)
Toxoplasmosis (HIV-exposed/-positive; secondary prevention [unlabeled use]): Oral: 20-30 mg/kg/day divided every 6-8 hours (plus pyrimethamine and leucovorin calcium) (CDC, 2009)
Dosing: Geriatric
Refer to adult dosing.
Dosing: Renal Impairment No dosage adjustment required in renal impairment.
Poorly dialyzed; no supplemental dose or dosage adjustment necessary, including patients on intermittent hemodialysis, peritoneal dialysis, or continuous renal replacement therapy (eg, CVVHD).
Dosing: Hepatic Impairment Systemic use: No adjustment required. Use caution with severe hepatic impairment.
