ADC Practice Question — Prophylaxis regimens and drug choices

Given his severe penicillin allergy with anaphylaxis, what is the most appropriate endocarditis prophylaxis regimen?

Pharmacology questions in the ADC written exam test applied prescribing decisions, not rote recall of drug names. This exam-level vignette tests your ability to work through clinical details and arrive at the correct management.

Rajesh Kumar, a 69-year-old man with prosthetic aortic valve, type 2 diabetes, and chronic kidney disease, presents to his dentist for extraction of an infected molar. He reports a severe penicillin allergy with previous anaphylaxis to amoxicillin 5 years ago. He takes metformin, lisinopril, and warfarin. His cardiologist has confirmed the need for endocarditis prophylaxis. The dentist is planning the antibiotic regimen and considering surgical antibiotic prophylaxis as well. Given his severe penicillin allergy with anaphylaxis, what is the most appropriate endocarditis prophylaxis regimen?

A. Cephalexin 2g orally 60 minutes before procedure
B. Doxycycline 100mg orally 60 minutes before procedure
C. Amoxicillin 2g orally since he's on warfarin
D. No antibiotics needed due to allergy severity
E. Clindamycin 600mg intravenously within 120 minutes

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Sources cited

Therapeutic Guidelines v4 Odell's 3rd & 4th Ed IADT 2020 Code of Conduct CMS (Evans) Infection Control + more

Show the answer and cited explanation

Correct answer: B

According to TG, for patients with severe hypersensitivity to penicillin, doxycycline 100mg orally 60 minutes before procedure is appropriate for endocarditis prophylaxis.

Source: Ch 10: Oral antibiotic regimens for endocarditis prophylaxis

Remy's study tip — For pharmacology vignettes, read the patient’s medical history and allergies BEFORE looking at the drug options.

Exam preparation FAQ

How should I prepare for Pharmacology & Therapeutics in the ADC exam?

Build competence across all topics. The exam tests application of guidelines to clinical scenarios, not memorisation.

How do I approach an unfamiliar Prophylaxis regimens and drug choices vignette?

Extract key clinical data from the stem before reading options. There are usually 3–4 critical variables that determine the correct answer.

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Given his severe penicillin allergy with anaphylaxis, what is the most appropriate endocarditis prophylaxis regimen?

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