From the Guidelines
Vancomycin is contraindicated in patients with a known hypersensitivity or allergic reaction to vancomycin or any component of its formulation. According to the guidelines, vancomycin therapy is recommended only for patients unable to tolerate penicillin or ceftriaxone 1. Patients with a history of "Red Man Syndrome" may receive vancomycin with slower infusion rates and antihistamine premedication rather than complete avoidance.
Key Considerations
- Caution is warranted in patients with renal impairment as vancomycin is primarily eliminated by the kidneys, requiring dose adjustments based on creatinine clearance and therapeutic drug monitoring to prevent toxicity 1.
- Patients with hearing impairment or previous ototoxicity should use vancomycin cautiously as it can cause or worsen hearing loss.
- Pregnant women should only receive vancomycin when clearly needed as it is pregnancy category C.
- Vancomycin should be used with caution in patients receiving other nephrotoxic or ototoxic medications such as aminoglycosides, loop diuretics, or cisplatin due to potential additive toxicity 1.
Monitoring and Precautions
- Vancomycin dosages should be infused during the course of at least 1 h to reduce the risk of histamine-release “red man” syndrome 1.
- Peak and trough serum concentrations of vancomycin should be monitored to ensure therapeutic levels and prevent toxicity 1.
From the Research
Contraindications to Vancomycin
- Vancomycin is associated with several hypersensitivity reactions, including anaphylaxis, linear IgA bullous dermatosis, drug rash eosinophilia and systemic symptoms (DRESS) syndrome, acute interstitial nephritis, and Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) 2, 3
- The incidence of renal dysfunction is higher in vancomycin-induced DIHS cases compared to non-vancomycin-associated cases 2
- Vancomycin can cause severe anaphylactic reactions, as reported in a case study of a 23-year-old man 4
- Desensitization protocols are available for vancomycin hypersensitivity, including rapid and slow desensitization protocols 5
- Common hypersensitivity reactions to vancomycin include rash, red man syndrome, and anaphylaxis, with drug reaction eosinophilia and systemic symptoms syndrome being a common severe cutaneous adverse reaction 6
Specific Contraindications
- History of vancomycin-induced hypersensitivity reactions, such as anaphylaxis or DRESS syndrome 3, 4
- Renal impairment, as vancomycin can exacerbate renal dysfunction 2
- Caution should be exercised when using vancomycin in patients with a history of vancomycin-induced red man syndrome or other hypersensitivity reactions 5, 6