A patient with a history of lung transplantation is admitted for treatment for a respiratory infection. The patient has been taking cyclosporine [Sandimmune], prednisone, and azathioprine [Imuran] for 8 months
The provider has ordered azithromycin [Zithromax] to treat the infection and acetaminophen [Tylenol] as needed for fever. The nurse will contact the provider to: a. ask whether a different antibiotic can be used.
b. ask that the prednisone be discontinued until the infection clears.
c. suggest increasing the dose of cyclospo-rine.
d. suggest using ibuprofen instead of aceta-minophen.
A
Macrolide antibiotics, such as azithromycin, can inhibit cyclosporine metabolism, leading to in-creased levels of the drug. This patient needs either a reduced dose of cyclosporine or a different antibiotic. There is no indication for discontinuing the prednisone during treatment. The dose of cyclosporine would need to be reduced, because azithromycin leads to increased drug levels. There is no contraindication to using acetaminophen.
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