Tehran University of Medical Sciences Journal of Pharmaceutical Care 2322-4630 13 4 2025 12 31 283 293 EN Mahila Monajati Assistant Professor of Clinical Pharmacy, Golestan Rheumatology Research Center, Biomedical Research Institute, Golestan University of Medical Sciences, Gorgan, Iran Yasin Gharanjik Faculty of Medicine, Golestan University of Medical Sciences, Gorgan, Iran Fatemeh Mehravar Department of Biostatistics and Epidemiology, School of Health, Ischemic Disorders Research Center, Golestan University of Medical Sciences, Gorgan, Iran Sedigheh Erfani 4Department of Infectious Diseases, Faculty of Medicine, Infectious Diseases Clinical Research Unit, Golestan University of Medical Sciences, Gorgan, Iran 2025 12 12 2026 06 10 Background: The inappropriate use of antibiotics is prevalent in low- and middle-income countries, which can lead to serious complications such as Clostridium difficile infections and antimicrobial resistance. This study aimed to evaluate the rational use of intravenous clindamycin in hospitalized patients. Methods: A retrospective observational study was conducted to analyze the medical records of patients over 18 years old who received intravenous clindamycin. Patient characteristics, clindamycin indications, dosage, and treatment duration were recorded. Additionally, the initial diagnosis and infection type for each patient were reviewed using available information. The rational use of clindamycin was evaluated using the UpToDate® Lexidrug™ database and relevant guidelines. Data were analyzed using SPSS software. Results: Of the 208 patients, 56% were female. The most prevalent initial diagnosis was sepsis (16.8%). More than half of the prescriptions were made by internists. Confirmed infections primarily included aspiration pneumonia (24.5%), diabetic foot infections (11.1%), and prophylaxis for gynecological surgery (10.6%). After reviewing the patients’ records, it was found that 49.5% of clindamycin indications, 98.6% of dosages, and 48.6% of treatment durations were appropriate. Considering all three factors—and excluding cases involving unnecessary duplicate therapy for anaerobes or methicillin-resistant Staphylococcus aureus (MRSA), as well as those lacking adequate evidence for clindamycin use—only 25.5% of the clindamycin regimens were deemed appropriate. Mild adverse effects were reported in four patients. Conclusion: The study revealed that only one-fourth of clindamycin use was entirely appropriate. These findings underscore the need to implement anti-anaerobic stewardship programs that consider the type of infection, standard antibiotic regimens, prophylaxis duration, and concurrent antibiotic use to promote rational antibiotic prescribing. https://jpc.tums.ac.ir/index.php/jpc/article/view/927 https://jpc.tums.ac.ir/index.php/jpc/article/download/927/444