Clindamycin is not adequate for empiric therapy for Staphylococcal infections due to increased resistance. Given its association with C difficile colitis, its use should be limited to severe group A Strep sepsis.
It has an adjunctive antitoxin effect also, where it decreases ribosomal toxin production, and can lead to faster clinical improvement for streptococcal infections, like non-purulent cellulitis, necrotizing infections, and streptococcal toxic shock.
- Susceptible MRSA (~2/3 of isolates at Billings Clinic)
- Group A,B,C,G Streptococci (but increasing resistance)
- Viridans Streptococci
- Essentially no aerobic gram negative coverage
- Increasing resistance in Bacteroides fragilis (do not use for gut anaerobes)
- Covers many oral anaerobes
- Pneumocyctis jiroveci
Does not cover
- Almost all aerobic gram negatives