Antimicrobial Use Guidelines (AMUG) version 21 - UW Health

CLINDAMYCINUsual DoseAdult: 600-900 mg Q8H IV OR 150-450 mg Q6H PO (UWHC cost/day IV $4.03-6.05; PO $0.25-0.75).The usual tolerable adult dose orally is 300 mg 4 times a day.Pediatrics:** 25-40 mg/kg/day IM/IV/PO in divided doses Q6-8H.Indications1. Anaerobic infections above the diaphragm such as lung abscesses, peritonsillar abscess, cervical adenoiditis.2. Community-acquired aspiration pneumonia. For hospital-acquired aspiration pneumonia, clindamycin is usually givenwith an aminoglycoside, third-generation cephalosporin, or fluoroquinolone.3. Recurrent Group A beta streptococcal pharyngitis.4. Clostridial sepsis, particularly gas gangrene. Clindamycin plus penicillin may be superior to penicillin alone. NOTE: therate of clostridial resistance to clindamycin is 10 to 20%. Also, clindamycin may be effective in reducing microbialtoxigenicity in toxic shock syndrome caused by S aureus or Group A beta-hemolytic streptococci.5. Toxoplasmosis in patients allergic to sulfonamides, combined with pyrimethamine.6. Chloroquine-resistant malaria – as part of a multi-drug regimen.7. Osteomyelitis caused by S aureus or other susceptible organisms.8. Perioperative prophylaxis as an alternative to cefazolin for clean-contaminated head and neck surgery (see AppendixB).9. Diabetic foot ulcer treatment in combination with ciprofloxacin.10. Bacterial endocarditis prophylaxis in patients allergic to beta-lactam antibiotics (see Appendix A).11. Penicillin-resistant pneumococcal otitis media or sinusitis when clindamycin susceptibility is established.12. Bacterial vaginosis (2% cream 5 g intravaginally at bedtime x 7 days or 300 mg BID PO x 7 days).13. PJP treatment in combination with primaquine as second/third-line therapy.14. Community-based MRSA with confirmed clindamycin sensitivity.CommentsMetronidazole is less expensive for intra-abdominal anaerobic coverage. Clindamycin oral suspension is poorly accepteddue to unpleasant taste. Conversion to oral therapy usually occurs when the infection is under control. High doses of oralclindamycin (>450 mg Q6H) may cause esophagitis. Due to increased incidence of Bacteroides spp resistant toclindamycin, no longer recommended for community based intraabdominal infections by the 2010 IDSA and SurgicalInfection Society guidelines.CLOFAZIMINE – nonformulary at UWHCUsual DoseAdult: 100 mg Q24H PO (UWHC cost/day $0.32)Pediatrics:** 1 mg/kg/day POIndications1. Mycobacterium leprae (lepromatous leprosy).2. Second-line therapy for MAI.CommentsThe drug has a high incidence of side effects: hyperpigmentation (75-100%), GI intolerance (40-50%), ichthyosis anddryness (8- 28%) and rash/pruritus (1-5%).This drug is not available through usual commercial sources. For the treatment of leprosy, it is available through anIND application. The contact person for the IND is Renee Painter at (225)756-3773. For other indications, contact theFDA’s CDER Division of Anti-Infective and Ophthalmology Products at (301)796-1400. Use must be approved by theUWHC IRB and the Pharmaceutical Research Center should be contacted (263-8902).CLOTRIMAZOLEUsual Dose10 mg troches five times a day PO for treatment (UWHC cost/day $1.74); two to three times daily for prophylaxis (UWHCcost/day $0..69-1.04).