IE Prophylaxis Penicillin Allergy — ORE Part 1 MCQ
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Correct answer: D — Clindamycin 600 mg orally 1 hour before the procedure
The correct answer is D (Clindamycin 600 mg orally 1 hour before). NICE CG64 and SDCEP implementation advice recommend clindamycin 600 mg as first-line prophylaxis for patients with true penicillin allergy undergoing high-risk dental procedures. Option B (cefuroxime) is inappropriate because cephalosporin cross-reactivity with penicillin is significant (up to 3%) in patients with anaphylaxis history and carries unacceptable risk. Option C (co-amoxiclav) contains amoxicillin and is contraindicated. Option E (azithromycin) is not supported by current UK guidance for IE prophylaxis. Option A (metronidazole) is ineffective against streptococci, the primary causative organisms of IE, and the multiple-dose, multi-day regimen is incorrect for prophylaxis (which requires a single dose before procedure).
Reference: NICE Clinical Guideline 64: Prophylaxis against infective endocarditis: antimicrobial prophylaxis against infective endocarditis in adults and children undergoing interventional procedures (2016, as amended). Implemented by SDCEP Antibiotic Prophylaxis Against Infective Endocarditis guidance (endorsed across UK). https://www.nice.org.uk/guidance/cg64/chapter/Recommendations and https://www.antibioticprophylaxis.sdcep.org.uk/