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IE Prophylaxis with Penicillin Allergy — NDEB AFK MCQ

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HardPharmacologyIE Prophylaxis with Penicillin AllergyNDEB AFK

A 45-year-old patient with a history of rheumatic heart disease reports that they are allergic to penicillin (rash only, no anaphylaxis). They require extraction of two teeth. Which antibiotic prophylaxis regimen is most appropriate?

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Correct answer: B — Clindamycin 600 mg PO 30-60 minutes before procedure

Under AHA 2021 guidelines, a history of rheumatic heart disease alone does NOT require IE prophylaxis unless the patient has developed valvular disease with specific high-risk features. However, if the patient has rheumatic valvular heart disease WITH prosthetic material or previous IE, prophylaxis IS required. For a penicillin-allergic patient (non-anaphylactic type/rash), cephalexin 2 g PO is an option, but given the history of rash (potential cross-reactivity), clindamycin 600 mg PO is the safest alternative. If the allergy were anaphylaxis, cephalosporins would be contraindicated.

Reference: AHA – Prevention of Infective Endocarditis Guidelines, 2021