In the event of penicillin allergy, clindamycin is an alternative choice in treating mild or early odontogenic infection. Clindamycin, because of its broad spectrum of activity and resistance to beta-lactamase degradation is an excellent substitute for penicillin resistant bacteria. It is highly effective against almost all oral pathogens. It is not effective against mycoplasma or gram-negative aerobes. Administration with food does not significantly impair absorption. Adverse effects of clindamycin include abdominal pain, nausea, vomiting, and diarrhea.

Contraindications: Hypersensitivity to clindamycin or any component of the formulation; previous pseudomembranous colitis, regional enteritis, ulcerative colitis.

Warnings/Precautions: Use with caution in patients with liver dysfunction (modify dosage); can cause severe and fatal colitis; discontinue drug if significant diarrhea, abdominal cramps or blood and mucus passage occurs.

The usual daily oral dose for treating odontogenic infections in children is:

Children under 12 years: 10-25 mg/kg/day in 3 equally divided doses for 10 days.
Children over 12 years and adults 600-1800 mg/day in 3 divided doses for 10 days. The maximum dose is 2-3 gms/day.
Clindamycin is supplied as a 75 mg/5 ml solution or 150, 300, 450, 600, 750, 900 mg tablets.

Sample clindamycin prescription for a 3-year-old patient weighing 12 kg (25 lb) with facial swelling:

Rx: Clindamycin 75 mg/5 ml
Disp: 150 ml
Sig: Take 1 teaspoon every 8 hours for 10 days