Start practicing

Pharmacology · single question

According to current guidelines for infective endocarditis prophylaxis, which of the following regimens is NOT included?

  1. Cephalexin 2 g orally
  2. Amoxicillin 2 g orally
  3. Ampicillin 2 g intramuscularly or intravenously
  4. Clindamycin 300 mg orally
Show answer and explanation

Correct answer: D. Clindamycin 300 mg orally

  • A. Cephalexin 2 g orally is one of the current penicillin-allergy alternatives, provided there is no history of anaphylaxis, angio-oedema or urticaria with penicillin.
  • B. Amoxicillin 2 g orally, 30–60 minutes before the procedure, remains the standard regimen for adults.
  • C. Ampicillin 2 g IM or IV is the regimen for a patient unable to take oral medication.
  • D. CORRECT. The 2021 American Heart Association scientific statement REMOVED clindamycin entirely from endocarditis prophylaxis. The stated reason is that clindamycin causes more frequent and more severe adverse reactions than the alternatives, notably Clostridioides difficile colitis. It is no longer a recommended option at any dose.

Note: Current 2021 AHA penicillin-allergy oral alternatives: cephalexin 2 g, OR azithromycin/clarithromycin 500 mg, OR doxycycline 100 mg. Parenteral alternative: cefazolin or ceftriaxone 1 g. The other 2021 change was the ADDITION of doxycycline. Clindamycin is out everywhere.

Practice Pharmacology questions Pharmacology study notes

More Pharmacology practice questions