A patient is taking erythromycin ethylsuccinate for a chlamydial infection and develops vaginal candidiasis. The prescriber orders ketoconazole to treat the superinfection. What will the nurse do?
a. Administer the erythromycin and the ke-toconazole as ordered.
b. Contact the provider to discuss changing to a different antifungal medication.
c. Contact the provider to discuss increasing the dose of erythromycin.
d. Contact the provider to suggest using erythromycin stearate.
B
Erythromycin can prolong the QT interval when present in large concentrations. When erythro-mycin is combined with a CYP3A4 inhibitor, such as ketoconazole, the risk of sudden cardiac death increases fivefold. The nurse should discuss changing the antifungal medication to one that is not a CYP3A4 inhibitor. It is not correct to give the ketoconazole without questioning the or-der. Increasing the dose of erythromycin would increase the risk of QT prolongation. Changing to a different preparation of erythromycin would not alter the risk.
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