A patient with a high-risk cardiac condition requiring antibiotic prophylaxis is allergic to penicillin. Which antibiotic regimen is recommended?

According to the 2007 American Heart Association (AHA) guidelines for prevention of infective endocarditis, patients with high-risk cardiac conditions who are allergic to penicillin/amoxicillin should receive one of the following alternatives: clindamycin 600 mg orally 1 hour before, OR azithromycin 500 mg orally 1 hour before, OR clarithromycin 500 mg orally 1 hour before. Both clindamycin and azithromycin are acceptable alternatives. Note: As of the 2021 AHA update, clindamycin is no longer preferred (due to C. difficile risk) and azithromycin/clarithromycin are now the preferred alternatives for penicillin-allergic patients. Also important: as of 2007, mitral valve prolapse alone is NO longer considered a high-risk indication for prophylaxis.