Pharmacology · single question
According to the 2021 AHA Scientific Statement, which drug is NO LONGER recommended for endocarditis prophylaxis in penicillin-allergic patients?
Show answer and explanation
Correct answer: A. Clindamycin
The 2021 AHA Scientific Statement removed clindamycin entirely from the recommended list due to risk of severe C. difficile infections. Current alternatives for penicillin-allergic patients are: cephalexin 2g, azithromycin/clarithromycin 500mg, or doxycycline 100mg. The correct dose for cephalexin is 2g (not clindamycin 300mg — that dose was from older guidelines). If asked 'which is NOT recommended,' the answer is clindamycin.
- A. ✅ CORRECT – Clindamycin was removed from AHA endocarditis prophylaxis guidelines in 2021 due to the high risk of C. difficile-associated disease.
- B. ❌ Cephalexin 2g is the first-line alternative for penicillin-allergic patients (do not use if history of anaphylaxis to penicillin).
- C. ❌ Doxycycline 100mg is an acceptable alternative, especially when multiple appointments are planned.
- D. ❌ Azithromycin 500mg is a currently recommended alternative for penicillin-allergic patients who cannot take oral cephalosporins.
Note: The dose was also wrong (old dose was 600mg, not 300mg). Current alternatives: cephalexin 2g, azithromycin 500mg, or doxycycline 100mg.