A patient with a prosthetic heart valve has a confirmed penicillin allergy. What is the appropriate antibiotic prophylaxis for a dental procedure requiring prophylaxis?

Correct answer: D. Clindamycin 600 mg orally 1 hour before

• A. Azithromycin 500 mg (not 600 mg) is an alternative option listed in some guidelines, but clindamycin 600 mg is the primary recommendation for penicillin-allergic patients with prosthetic valves.
• B. Amoxicillin 2g is the first-line drug but is contraindicated in penicillin-allergic patients due to cross-reactivity potential.
• C. Patients with prosthetic heart valves DO require antibiotic prophylaxis per current cardiac guidelines for high-risk procedures.
• D. CORRECT. Per 2007 AHA/ADA guidelines (still in use), for patients requiring endocarditis prophylaxis who are allergic to penicillin: the recommended alternative is clindamycin 600 mg orally 1 hour before the procedure. (Note: 2021 AHA guidelines significantly narrowed prophylaxis indications, but prosthetic valves remain an indication.)