--the 1997 American Heart Foundation guideline on prevention of bacterial endocarditis, recommends:
“Regimens for Dental, Oral, Respiratory Tract, or Esophageal Procedures
Individuals who are allergic to penicillins (such as amoxicillin, ampicillin, or penicillin) should be treated with the provided alternative oral regimens. Clindamycin hydrochloride is one recommended alternative. Individuals who can tolerate first-generation cephalosporins (cephalexin or cefadroxil) may receive these agents, provided they have not had an immediate, local, or systemic IgE-mediated anaphylactic allergic reaction to penicillin.
Azithromycin or clarithromycin are also acceptable alternative agents for the penicillin-allergic individual, although they are more expensive than the other regimens. When parenteral administration is needed in an individual who is allergic to penicillin, clindamycin phosphate is recommended; cefazolin may be used if the individual does not have an immediate type local or systemic anaphylactic hypersensitivity to penicillin.
The previous recommendations from this committee listed erythromycin as an alternate agent for the penicillin-allergic patient. Erythromycin is no longer included because of gastrointestinal upset and complicated pharmacokinetics of the various formulations.Practitioners who have successfully used erythromycin for prophylaxis in individual patients may choose to continue with this antibiotic. The regimen is included in our previous recommendations.”
