From the Guidelines
Red Man Syndrome is a common adverse reaction to intravenous vancomycin, characterized by flushing, itching, and a red rash on the face, neck, and upper body, which can be prevented or managed by slowing the infusion rate to at least 60 minutes, as recommended by the American Heart Association in 2015 1. To minimize the risk of Red Man Syndrome:
- Administer vancomycin over at least 1 hour to reduce the likelihood of this reaction, as suggested by the study published in Circulation in 2015 1.
- Monitor patients closely during vancomycin infusion, especially for the first few doses, for signs of Red Man Syndrome, such as flushing, itching, and rash.
- If symptoms occur, stop the infusion immediately and notify the healthcare provider, as this reaction can occasionally cause hypotension or other severe symptoms. The syndrome is caused by histamine release from mast cells, triggered by rapid vancomycin administration, and is generally not an allergic reaction, allowing for future vancomycin use if necessary, as noted in the 2015 study 1. Key considerations for managing Red Man Syndrome include:
- Slowing the infusion rate to prevent the reaction
- Monitoring patients closely for signs of the reaction
- Being prepared to stop the infusion and notify the healthcare provider if symptoms occur
- Considering alternative antibiotics if severe cases of Red Man Syndrome occur, as recommended by the American Heart Association in 2015 1.
From the Research
Definition and Characteristics of Red Man Syndrome
- Red Man Syndrome (RMS) is a side effect of vancomycin therapy, characterized by a red blotchy rash with itching, and sometimes muscle pain and a decrease of arterial blood pressure 2.
- RMS is a non-IgE-mediated histamine release reaction, which is different from vancomycin allergy 3.
- Symptoms of RMS can range from flushing, erythematous rash, pruritus, mild to profound hypotension, and even cardiac arrest 4.
Diagnosis and Treatment of Red Man Syndrome
- RMS should be distinguished from anaphylaxis and treated according to the diagnosis 2.
- Treatment of RMS may involve administering medications such as cetirizine to resolve symptoms 2.
- RMS can be caused by intravenous administration of vancomycin, as well as local application of vancomycin powder in a surgical wound 4.
Implications and Recommendations
- The term "Red Man Syndrome" is considered imprecise and can lead to suboptimal classification and management, and its use should be discontinued 5.
- Patients with RMS are at risk for unnecessary vancomycin avoidance and linezolid utilization, and care should be taken to differentiate RMS from vancomycin allergy 3.
- RMS may be a marker for true vancomycin allergy, and patients with RMS should be closely monitored for signs of anaphylaxis 6.