Pharmacokinetics of intravenous clindamycin in newborn infants

We studied 12 newborn infants (gestational ages 26-39 wk [mean ± SD, 30.6 ± 4.7]; birth weight 640-2700 g, [mean, 1,322 ± 688]; postnatal age 1-24 days [mean, 9.6 ± 8.5]) who received clindamycin phosphate for suspected or proven necrotizing enterocolitis (ten patients) or suspected anaerobic septicemia (two patients) in doses of 3.2-11 mg/kg every six hours. Range of mean serum concentration of clindamycin at steady state was between 12.7 and 40 μg/ml (therapeutic range = 2-10 μg/ml). High concentrations could be attributed to elimination T1/2 (6.3 ± 2.1 hr) 100% longer than in older children or adults. Clindamycin clearance (61.6 ± 31.6 hr ml/kg/hr) was lower than in older children or adults. Because of the observed prolongation in T1/2 and correspondingly lower clearance, the IV dose of clindamycin in newborn infants should be reduced to 15-20 mg/kg/day given in four daily doses.