Is Vancomycin (Vanco) causing peripheral eosinophilia?

From the Guidelines

Vancomycin is not commonly associated with peripheral eosinophilia, and its potential toxicities include leukopenia, ototoxicity, and nephrotoxicity, but not typically eosinophilia. When considering the potential side effects of vancomycin, it is essential to weigh the benefits and risks of treatment, especially in patients with complex infections such as prosthetic joint infections 1. The use of vancomycin is often recommended in combination with other antimicrobials, such as rifampin, for the treatment of staphylococcal prosthetic joint infections 1. Some alternative antibiotics, such as daptomycin and linezolid, have been associated with eosinophilic pneumonia and other cytopenias, respectively 1. Key considerations for vancomycin use include:

• Monitoring for potential toxicities, including leukopenia, ototoxicity, and nephrotoxicity
• Using vancomycin in combination with other antimicrobials, such as rifampin, for complex infections
• Considering alternative antibiotics, such as daptomycin or linezolid, in patients who are allergic or intolerant to vancomycin
• Documenting any potential adverse reactions or drug allergies in the patient's medical record.

From the FDA Drug Label

Miscellaneous Patients have been reported to have had anaphylaxis, drug fever, nausea, chills, eosinophilia, rashes including exfoliative dermatitis, Stevens-Johnson syndrome (see WARNINGS, Severe Dermatologic Reactions), and vasculitis in association with the administration of vancomycin. Severe Dermatologic Reactions Severe dermatologic reactions such as toxic epidermal necrolysis (TEN), Stevens-Johnson syndrome (SJS), drug reaction with eosinophilia and systemic symptoms (DRESS), acute generalized exanthematous pustulosis (AGEP), and linear IgA bullous dermatosis (LABD) have been reported in association with the use of vancomycin

Vancomycin may be associated with eosinophilia, as it is listed as a potential adverse reaction in the drug label 2 and 2. However, the label does not provide specific information on the incidence or characteristics of vancomycin-induced peripheral eosinophilia.

From the Research

Vancomycin and Peripheral Eosinophilia

• Vancomycin has been associated with peripheral eosinophilia in several studies 3, 4, 5, 6, 7.
• A study published in The Journal of allergy and clinical immunology found that use of vancomycin was associated with a higher hazard of having eosinophilia, with a median peak absolute eosinophil count of 726/mL 3.
• Another study published in Allergy, asthma, and clinical immunology reported a case of vancomycin-induced DRESS syndrome with severe acute interstitial nephritis, eosinophilic pneumonitis, and central nervous system involvement 4.
• A study in Allergy, asthma & immunology research found that skin rashes accompanied by peripheral eosinophilia were a common vancomycin adverse drug reaction, and that close monitoring of laboratory tests is recommended for early detection 5.
• The importance of vancomycin as a cause of DRESS syndrome was highlighted in a study published in Allergy and asthma proceedings, which found that 83% of patients with DRESS syndrome had vancomycin as the attributable cause 6.
• A case report published in Pharmacology described a female patient who developed vancomycin-induced DRESS syndrome with toxidermia, fever, and acute renal insufficiency, which was cured by withdrawal of vancomycin and administration of methylprednisolone 7.

Key Findings

• Vancomycin is a common cause of peripheral eosinophilia and DRESS syndrome.
• The onset of symptoms can vary from 12 days to 4 weeks after start of vancomycin treatment.
• Systemic findings can include atypical lymphocytes, lymphadenopathy, nephritis, hypotension, tachycardia, and pharyngitis.
• Treatment with corticosteroids may be required, and recurrence of peripheral eosinophilia can be a marker of disease relapse 3, 4, 5, 6, 7.