A 67-year-old man is to undergo a radical retropubic prostatectomy. He has aortic stenosis with a gradient of 37 mm Hg at rest. He has an allergy to penicillin. Which of the following is the best regimen for subacute bacterial endocarditis (SBE) prophylaxis in this patient?

A. Ampicillin and gentamicin

B. Vancomycin and gentamicin

C. Clindamycin and gentamicin

D. Clindamycin alone

E. None of the above

(E)

·       In 2007, the American Heart Association revised the guidelines for prevention of infective endocarditis (IE).

·       Presently, only patients with underlying cardiac conditions with the highest risk for an adverse outcome from IE should receive antibiotic prophylaxis for selected dental procedures.

·       Prophylaxis is not recommended for patients undergoing elective genitourinary (GU) or gastrointestinal (GI) procedures.

·       The cardiac conditions with the highest risk include: prosthetic cardiac valves, previous IE, several types of congenital heart disease (CHD), and cardiac transplantation recipients who develop cardiac valvulopathy.

·       Any of the antibiotics listed in the question or cephalexin 2 g orally (or other first or second generation oral cephalosporin in equivalent dosage) or clindamycin 600 mg orally, IM or IV should be administered 30 to 60 minutes before the procedure.

This patient has aortic stenosis and does not need any prophylaxis