From the Research
Vancomycin flushing syndrome can potentially cause hypoxia in severe cases, though it is not among the most common symptoms, and management should prioritize prevention of hypoxia and other severe reactions. Vancomycin flushing syndrome typically presents as flushing, erythema, and pruritus primarily affecting the face, neck, and upper torso, but in more severe reactions, patients may develop hypotension, angioedema, and bronchospasm which can lead to hypoxia 1. This reaction is not a true allergic response but rather results from histamine release caused by rapid vancomycin infusion. To prevent this syndrome, vancomycin should be administered slowly, typically over at least 60 minutes (or longer for higher doses), with recommended infusion rates not exceeding 10 mg/minute.
Some key points to consider in management include:
- Administering vancomycin slowly to prevent rapid histamine release
- Monitoring patients closely for signs of vancomycin flushing syndrome
- Having a plan in place for managing severe reactions, including hypoxia
- Considering premedication with antihistamines for patients with a history of vancomycin flushing syndrome
- Being aware that vancomycin flushing syndrome can occur not only with intravenous administration but also with local use, such as in vancomycin-loaded bone cement 2.
In cases where hypoxia develops, oxygen supplementation and possibly bronchodilators may be required, and the infusion should be temporarily stopped or slowed 1. For patients with a history of vancomycin flushing syndrome, premedication with antihistamines 30-60 minutes before vancomycin administration can help prevent recurrence. It's also important to note that desensitization protocols may be considered for patients who require vancomycin therapy but have a history of hypersensitivity reactions 3, 4.