A patient has mitral valve prolapse with atrial fibrillation and a documented penicillin allergy. What antibiotic prophylaxis is indicated before dental extraction?

Per AHA guidelines, mitral valve prolapse — even with regurgitation or atrial fibrillation — is NOT an indication for endocarditis prophylaxis. Prophylaxis is reserved for: prosthetic valves, previous IE, certain congenital heart disease, and cardiac transplant with valvulopathy. Additionally, clindamycin is no longer a preferred second-line alternative.