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- Discussion:
    - for serious infections with Gram Neg anaerobes (B. fragilis) or staph / streptococcus infections in patients allergic to penicillin;
    - not good for gm neg aerobes;
    - clindamycin binds exclusively to the 50 S subunit of bacterial ribosomes and suppresses protein synthesis; (bacterostatic not bacterocidal);
           - although clindamycin, chloramphenicol, and erythromycin are not structurally related, they all act at this site;
    - clindamycin is almost completly absorbed orally;

- Dosing:
    - adult:150-450mg PO qid; 300-600mg IV q6hr; 900mg IV q8hr
           - w/ severe infections: 300-450mg PO q6hr or 1200-1700 mg/day IM/IV in 2-4 divided dose;
           - w/ life threatening infections may use up to 4800mg qd max dose;
    - peds: 25 mg/kg/24 hrs;
           - > 1 month: 15-40 mg/kg/24hr IM or IV divided q6-8hr; 8-25 mg/kg/24hr PO in 3-4 DD;

- Cautions:
    - beware diarrhea w/ pseudomembranous colitis by C. difficile
          - this infectious diarrhea treated with vancomycin or metronidazole PO;
    - inducible resistance with MRSA infections;   
          - inducible resistance (appears sensitive on petri dish but is not)
          - D-test: an erythromycin disk is placed near a clindamycin disk on a Kirby-Bauer plate;
          - if inducible resistance is present then, zone of inhibition around clindamycin will be flattened in direction of erythromycin disc and will resemble letter D;
    - decrease dose with severe renal or hepatic dz;
          - 10-15 % of dose will be excreted in urine (w/ nl renal f(x))
          - dosing regimens for patients w/ renal insufficiency:
          - dose for 70kg Adult (gm/dosing interval in hours):
                 - CrCl: > 80 0.6/8;
                 - CrCl: 50-79 0.6/8;
                 - CrCl: 30-49 0.6/8;
                 - CrCl: 10-29 0.6/8;
    - caution with patients with GI dz (colitis), atopic individuals, patients receiving neuromuscular blocking drugs, patients with ASA hypersensitivity;
    - note diffusion from blood into CSF is NIL even w/ inflammation;
    - will interact w/ neuromuscular blocking agents, and with theophylline (to incr serum levels, seizures, and apnea)

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