Q: Clindamycin is metabolized in the liver but should be adjusted for patients on dialysis?
Clindamycin is an interesting antibiotic in the sense that it is metabolized in the liver and its active metabolite N-demethyl clindamycin is more active than clindamycin itself. This activated compound gets excreted via bile and kidney. This is an important concept. Clindamycin's dose needs to be adjusted for both liver and kidney insufficiencies. Clindamycin cannot be effectively removed via either peritoneal dialysis or hemodialysis.
Clindamycin: FDA access data: https://www.accessdata.fda.gov/drugsatfda_docs/label/2017/050162s098s099lbl.pdf (Last accessed on February 26, 2021)