A lincosamide antibiotic with excellent activity against gram-positive cocci (including many community-acquired MRSA strains), anaerobes, and certain protozoa (Toxoplasma, Plasmodium). Used for skin and soft tissue infections (including MRSA), bone and joint infections, intra-abdominal/pelvic infections (with gram-negative coverage), bacterial vaginosis, toxoplasmosis (with pyrimethamine), and dental infections. Also used topically for acne.
Treats intra-abdominal and pelvic infections (anaerobic coverage)2,6
Suppresses toxin production in necrotizing fasciitis/toxic shock
What to watch for
Diarrhea (common, up to 20%)
Clostridioides difficile-associated diarrhea/pseudomembranous colitis (higher risk than most antibiotics)
Nausea
Known hypersensitivity to clindamycin or lincomycin1,2
History of Clostridioides difficile-associated diarrhea
The bottom line
Evidence rating strong. Most-documented uses: treats skin and soft tissue infections (including ca-mrsa), treats dental and orofacial infections, treats bone and joint infections. 10 sources indexed (1991–2022), with 3 interaction records on file.
The science
How it works, mechanistically.
Core mechanism
Binds to the 50S ribosomal subunit at the 23S rRNA of the peptidyl transferase center, preventing peptide bond formation and blocking bacterial protein synthesis. Primarily bacteriostatic, but may be bactericidal at high concentrations or against highly susceptible organisms. Notably suppresses toxin production by S. aureus and group A Streptococcus, making it useful as an adjunct in toxin-mediated diseases like necrotizing fasciitis and toxic shock syndrome.
Class
Lincosamide Antibiotic
Dosing
Dosing & protocol.
Common range
150-450 mg every 6-8 hours orally; IV: 600-900 mg every 8 hours; max 1.8 g/day orally or 4.8 g/day IV (as prescribed by your physician)
Recommended form
Oral capsules, oral solution, IV, topical gel/lotion, or vaginal cream
Well absorbed orally (~90% bioavailability). Food delays but does not reduce absorption. Take with a full glass of water to prevent esophageal irritation. Excellent penetration into bone, making it useful for osteomyelitis.
Depletions
What it depletes.
Nutrients this medication can lower over time, and what to replace.
Vitamin K
Mild
Broad-spectrum antibiotic exposure can suppress gut bacteria that synthesize menaquinones, lowering vitamin K availability in susceptible patients.
Monitor PT/INROnset Usually with prolonged therapy, poor intake, or malabsorption
Safety
Full safety detail.
Side effects
Diarrhea (common, up to 20%)
Clostridioides difficile-associated diarrhea/pseudomembranous colitis (higher risk than most antibiotics)
Nausea
Abdominal pain
Skin rash
Elevated liver enzymes
Esophageal irritation (if taken without adequate water)
Contraindications
Known hypersensitivity to clindamycin or lincomycin1,2
History of Clostridioides difficile-associated diarrhea
History of pseudomembranous colitis
Severe hepatic impairment (dose adjustment required)
Clindamycin carries one of the highest risks of C. difficile-associated colitis among commonly used antibiotics. Saccharomyces boulardii has strong evidence for reducing antibiotic-associated diarrhea and C. difficile infection during high-risk antibiotic exposure. Because it is a yeast, it is unaffected by clindamycin.
Recommendation: Strongly consider taking Saccharomyces boulardii throughout your clindamycin course. Timing flexibility is greater than with bacterial probiotics. Continue for at least 2 weeks after the antibiotic ends.
Clindamycin is one of the highest-risk antibiotics for C. difficile-associated colitis. Probiotic supplementation during clindamycin therapy reduces antibiotic-associated diarrhea and may help reduce C. difficile risk. This protective effect is especially valuable given clindamycin's high baseline AAD rate.
Recommendation: Strongly consider taking probiotics throughout your clindamycin course, separated by at least 2 hours from each antibiotic dose. Continue for at least 2 weeks after the antibiotic ends.
Lactobacillus rhamnosus GG reduces antibiotic-associated diarrhea during clindamycin therapy, which carries one of the highest baseline rates of AAD and C. difficile infection. Separation from antibiotic dosing preserves bacterial viability.
Recommendation: Strongly consider Lactobacillus rhamnosus throughout your clindamycin course, separated by at least 2 hours from each antibiotic dose. Continue for at least 2 weeks after the antibiotic ends.
Falagas ME, Matthaiou DK, Karveli EA et al.. Meta-analysis: randomized controlled trials of clindamycin/aminoglycoside vs. beta-lactam monotherapy for the treatment of intra-abdominal infections. Alimentary pharmacology & therapeutics. 2007
McKeage K, Keating GM. Clindamycin/benzoyl peroxide gel (BenzaClin): a review of its use in the management of acne. American journal of clinical dermatology. 2008
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