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Pharmacology · single question

Patient with mitral valve prolapse and penicillin allergy. Which antibiotic prophylaxis do you give?

  1. Amoxicillin 2g 60 min before treatment
  2. Doxycycline 200 mg 60 min before treatment
  3. Clindamycin
  4. No prophylaxis needed
Show answer and explanation

Correct answer: C. Clindamycin

  • A. Amoxicillin is contraindicated due to the stated penicillin allergy.
  • B. Doxycycline is not the standard alternative antibiotic prophylaxis regimen recommended by the AHA for penicillin-allergic patients.
  • C. Correct conceptually for a penicillin-allergic patient requiring prophylaxis — clindamycin 600 mg is the standard alternative; however, see note below regarding whether prophylaxis is even indicated for isolated MVP.
  • D. Per current AHA guidelines, isolated MVP without regurgitation or prior infective endocarditis does NOT require antibiotic prophylaxis — making 'no prophylaxis needed' actually the most current, evidence-based answer in many cases; clarify with the latest AHA endocarditis prophylaxis guidelines before treatment.

Note: Current AHA guidelines: MVP alone does NOT require antibiotic prophylaxis unless there is regurgitation or previous infective endocarditis. IF prophylaxis is required and the patient is penicillin-allergic, use clindamycin 600 mg.

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