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" (a non-IgE-mediated reaction characterized by flushing, pruritus, and hypotension) may receive vancomycin with slower infusion rates and premedication rather than complete avoidance.
Key Considerations
- Caution should be exercised in patients with pre-existing hearing loss or renal impairment, as vancomycin can be ototoxic and nephrotoxic, though these are not absolute contraindications but rather situations requiring careful monitoring and potential dose adjustment 1.
- Pregnant women should use vancomycin only if clearly needed, weighing potential benefits against risks.
- Concomitant administration with other nephrotoxic or ototoxic medications requires careful consideration and monitoring.
Monitoring Requirements
- Patients receiving vancomycin require regular monitoring of serum levels, renal function, and auditory function to minimize adverse effects, with dose adjustments made accordingly in patients with renal dysfunction to prevent toxicity 1.
- Vancomycin dosages should be infused during the course of at least 1 h to reduce the risk of histamine-release “red man” syndrome 1.
From the FDA Drug Label
Vancomycin hydrochloride for injection is contraindicated in patients with known hypersensitivity to this antibiotic. The main contraindication to vancomycin is:
- Known hypersensitivity to this antibiotic 2
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) 3, 4
- The incidence of renal dysfunction is higher in vancomycin-induced cases of DIHS/DRESS compared to non-vancomycin-associated cases 3
- Vancomycin infusion reaction, also known as "red man syndrome", is a common reaction caused by infusion rate-dependent direct mast cell degranulation 5
- IgE-mediated hypersensitivity reactions to vancomycin are rare, but can occur 6, 7
- Desensitization protocols are available for vancomycin hypersensitivity, including rapid and slow desensitization protocols 7
- Vancomycin should be used with caution in patients with a history of hypersensitivity reactions, and alternative antibiotics should be considered when possible 4, 5
Specific Contraindications
- History of vancomycin-induced anaphylaxis or severe hypersensitivity reaction 6, 7
- History of vancomycin-induced DIHS/DRESS or SJS/TEN 3, 4
- Renal impairment or history of vancomycin-induced nephrotoxicity 3
- Pregnancy or breastfeeding, as vancomycin may be excreted in breast milk and has potential effects on the fetus 5
Precautions
- Vancomycin should be administered slowly and with caution to minimize the risk of infusion reaction 5
- Patients should be monitored closely for signs of hypersensitivity reaction or renal impairment during vancomycin therapy 3, 4
- Alternative antibiotics should be considered in patients with a history of vancomycin hypersensitivity or renal impairment 4, 5