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Medical Forum / General / Dentistry / February 2007Clindamycin dosage
I have an abscessed tooth and my dentist prescribed clindamycin 150 mg. twice daily. He originally wrote the prescription for 150 mg. four times daily but while I was at the pharmacy, one of the dental employees came up to me and said the prescription needed to be changed so I went back to the dentist office and they gave me a new prescription for the antibiotic to be taken twice daily. When I got home I looked it up on the internet and everything I can find seems to indicate that it should be taken every six or eight hours at 150-300 mg. I am 80 years old and weigh 140 lbs. Shall I question my dentist about the dosage. I have a swollen jaw and want to do the right thing. Liz > I have an abscessed tooth and my dentist prescribed clindamycin 150 mg. > twice daily. He originally wrote the prescription for 150 mg. four times [quoted text clipped - 11 lines] > > Liz I took that once for an infected tooth and ended up with bloody stool. That stuff was too strong for me so my dentist switched me to erythrmycin.  Signature. Erythromycin has had a lot of bad press lately (within the medical/dental community...heart trouble IIRC) and it was never a great drug anyway. It was better than nothing for patients allergic to penicillin in years past. I very rarely prescribe it anymore. Clindamycin is an excellent antibiotic. One person's side effects ("too strong" is not correct) should not be a condemnation to the whole use of the drug. D > I took that once for an infected tooth and ended up with bloody stool. > That stuff was too strong for me so my dentist switched me to erythrmycin. However Clindamycin can cause pseudo membranous colitis, should be used cautiously in patients with existing bowel disease. IIRC there is some ototoxicity. Have used it for years and rarely Rx Erythromycin any more. Have been using Zithromax in some patients not responsive to Clindamycin. Z-pack works well but is a bit pricey. >Erythromycin has had a lot of bad press lately (within the >medical/dental community...heart trouble IIRC) and it was [quoted text clipped - 10 lines] >> I took that once for an infected tooth and ended up with bloody stool. >> That stuff was too strong for me so my dentist switched me to erythrmycin. "> > However Clindamycin can cause pseudo membranous colitis, All antibiotics can cause pseudomembranous colitis, it just seems to be a little bit more common with Clindamycin. J Suljak DDS >"> >> However Clindamycin can cause pseudo membranous colitis, [quoted text clipped - 3 lines] > >J Suljak DDS Had a patient with Crohns that was allergic to PCN. Used a Z-pack with good results. Was just mentioning it because with clinda PMC is much more common. >I have an abscessed tooth and my dentist prescribed clindamycin 150 mg. twice >daily. He originally wrote the prescription for 150 mg. four times daily but [quoted text clipped - 10 lines] > >Liz The correct interval is 4 times a day or every 6 hours. >>I have an abscessed tooth and my dentist prescribed clindamycin 150 mg. twice >>daily. He originally wrote the prescription for 150 mg. four times daily but [quoted text clipped - 12 lines] > >The correct interval is 4 times a day or every 6 hours. Agreed. Dave do you ever use the 300 mg tabs, and if so qid, tid, bid ? >>> I have an abscessed tooth and my dentist prescribed clindamycin 150 mg. twice >>> daily. He originally wrote the prescription for 150 mg. four times daily but [quoted text clipped - 16 lines] > Dave do you ever use the 300 mg tabs, and if so > qid, tid, bid ? Well, obviously for SBE px in penicillin-allergic patients. I'm hoping the pharmacist didn't choose to change the prescription without consulting the dentist. Everything I've read matches what Dave said. With an 80-year old there may be a concern with liver function and delayed clearing. Steve >>>> I have an abscessed tooth and my dentist prescribed clindamycin 150 mg. twice >>>> daily. He originally wrote the prescription for 150 mg. four times daily but [quoted text clipped - 24 lines] > >Steve I only get excited about renal/hepatic clearance when the LFT's and renal tests are through the roof. Clinda is very safe as is PCN. Gent, tobra, vanco and others can be a different story. Dave >>>>> I have an abscessed tooth and my dentist prescribed clindamycin 150 mg. twice >>>>> daily. He originally wrote the prescription for 150 mg. four times daily but [quoted text clipped - 30 lines] > > Dave Ya. I once had a c and s for a middle ear infection--I had done what they always tell you not to--a curettage of my middle cranial fossa through my eardrum with a cotton bud. It was some pseudomonas sp. and gentamycin was the most effective antibiotic. But apparently back then (c. 1981 they didn't make otic preparations, so the prescription was written for ophthalmic drops, which led to an interesting "Who's on first" conversation with the pharmacist. Luckily I can laugh now (and even still hear). Steve >>>I have an abscessed tooth and my dentist prescribed clindamycin 150 mg. twice >>>daily. He originally wrote the prescription for 150 mg. four times daily but [quoted text clipped - 17 lines] >Dave do you ever use the 300 mg tabs, and if so >qid, tid, bid ? Regardless of the dosage the interval doesnt change. Unless your using IV clinda (which is a TID drug) the correct interval is every 6 hrs. Yes I have used 300mg when necessary. Dave Around here, the pharmacies rarely stock the 300mg. so patients have to double up on the 150s. Certainly not my first choice antibiotic, but I prescribe it 5-10 times a year. D > Yes I have used 300mg when necessary. > > Dave >Around here, the pharmacies rarely stock the 300mg. so patients >have to double up on the 150s. [quoted text clipped - 3 lines] > >D I never hesitate to prescribe it even without a PCN allergy. >> Yes I have used 300mg when necessary. >> >> Dave >>Around here, the pharmacies rarely stock the 300mg. so patients >>have to double up on the 150s. [quoted text clipped - 5 lines] > >I never hesitate to prescribe it even without a PCN allergy. Same here with good results. However in the last 2 months have had some apparently resistant infections, (pt. still hurting after 7 days, no cultures taken) Switched to Z-pack. Dunno if this is a bad batch of clind in this area or what... haven't had this occur before and it could just be a fluke. >>> Yes I have used 300mg when necessary. >>> >>> Dave >>>Around here, the pharmacies rarely stock the 300mg. so patients >>>have to double up on the 150s. [quoted text clipped - 12 lines] >Dunno if this is a bad batch of clind in this area or what... >haven't had this occur before and it could just be a fluke. Certain staph species it isnt as strong against but it tends to be good against community MRSA. I seldom use a Zpack but it is very convenient. Levoquin is another that is BID and a good spectrum for oral bugs with a PCN allergy. I realize that being an OMFS means getting the wackier infections but clinda is usually numero uno since it has excellent anaerobic coverage as well as oral flora and the plasma/bone concentrations from oral dosing is better than the PCN's. >>>> Yes I have used 300mg when necessary. >>>> >>>> Dave Thanks LeFort. Good info. LevaQ 250 or 500mg BID ? PDR says qd, What seems to be most effective periapical infections v. cellulitis ? >>>>Around here, the pharmacies rarely stock the 300mg. so patients >>>>have to double up on the 150s. [quoted text clipped - 27 lines] >>>>> >>>>> Dave >I have an abscessed tooth and my dentist prescribed clindamycin 150 mg. twice >daily. He originally wrote the prescription for 150 mg. four times daily but [quoted text clipped - 10 lines] > >Liz I went back to the dentist today and got a new prescription with additional pills so I can take it four times daily for a week. Thanks to all for your help. Liz |
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