Objectives <p>The purpose of study is to compare early failure rate in patients with self-reported penicillin allergy (SRPA) who take clindamycin after implant surgery with non-allergic patients.</p> Materials and methods <p>This retrospective cohort study was conducted on patients who had dental implant surgery. The predictor variable was the type of antibiotics. SRPA patients who received clindamycin were obtained from database. The patients in non-allergic group were randomly selected to be identical to allergic patients in terms of age, gender, diabetes, and surface features of implant. Kruskal-Wallis tests were used analysis early implant failure rate between the two groups implant level. The Pearson chi-square test was used to compare categorical data. Multivariate logistic regression analysis was performed with Hosmer and Lemeshow Test.</p> Results <p>The study completed with 406 patients. The mean age was 49.64 ± 13.72 years. 104 were male and 302 were female. The patients in both groups were the same in terms of age, gender, and implant surface characteristics. The failure rate of the implant 10(4.93%) in clindamycin group and 4(1.97%) at patient level. The failure rate of the implant 17(1.56%) in amoxicillin group and 9(0.75%) at implant level. There was no statistically significant difference between the groups in terms of failure rate at patient (<i>p</i> = 0.172) and implant level (<i>p</i> = 0.106). The failure rate in male patients was 4.11 time higher than female patients (<i>p</i> = 0.011).</p> Conclusion <p>The results showed that clindamycin use in SRPA patients did not significantly increase the implant failure with the limitations of this study.</p> Clinical relevance <p>This is first study compared early implant failure rate in patients with who received clindamycin after implant surgery with non-allergic patients with similar age, gender, health status.</p>