What is the treatment for Red Man Syndrome associated with Vancomycin infusion?

From the Guidelines

Red Man Syndrome associated with Vancomycin infusion is best treated by infusing Vancomycin over at least 1 hour to reduce the risk of histamine-release “red man” syndrome 1.

Treatment Details

• The infusion time can be prolonged to 2 hours and an antihistamine can be used prior to administration of the loading dose to further reduce the risk of red man syndrome 1.
• Vancomycin dosage should be adjusted to obtain a peak serum concentration of 30–45 μg/mL and a trough concentration range of 10–15 μg/mL 1.
• It is essential to note that Vancomycin therapy is only recommended for patients unable to tolerate penicillin or ceftriaxone 1.

Key Considerations

• Monitoring of serum concentrations is crucial to ensure effective treatment and minimize the risk of adverse effects 1.
• Renal function should be taken into account when determining the dosage and infusion rate of Vancomycin 1.

From the FDA Drug Label

• The most relevant text from the drug label is:

  A condition has been reported that is similar to the IV–induced syndrome with symptoms consistent with anaphylactoid reactions, including hypotension, wheezing, dyspnea, urticaria, pruritus, flushing of the upper body ("Red Man Syndrome"), pain and muscle spasm of the chest and back. These reactions usually resolve within 20 minutes but may persist for several hours

• Treatment for Red Man Syndrome associated with Vancomycin infusion is not explicitly stated in the label, but it is mentioned that these reactions usually resolve within 20 minutes but may persist for several hours 2

From the Research

Treatment for Red Man Syndrome

The treatment for Red Man Syndrome associated with Vancomycin infusion includes:

• Discontinuation of the vancomycin infusion 3
• Administration of diphenhydramine to abort most of the reactions 3
• Slow intravenous administration of vancomycin to minimize the risk of infusion-related adverse effects 3
• Oral antihistamines, such as diphenhydramine and cimetidine, can reduce the side effects from rapid vancomycin infusion 4
• Extending the infusion time of vancomycin from 1 hour to 2 hours can reduce the frequency and severity of Red Man Syndrome 5

Prevention

Preventive measures for Red Man Syndrome include:

• Administering vancomycin over a longer period, such as 2 hours, instead of 1 hour 5
• Using oral antihistamines before vancomycin infusion 4
• Avoiding rapid infusion of vancomycin 4, 5, 3

Management

Management of Red Man Syndrome involves:

• Monitoring patients for signs and symptoms of the syndrome, such as pruritus, erythema, and angioedema 6
• Measuring histamine concentrations to determine the severity of the reaction 7, 5, 6
• Adjusting the vancomycin infusion rate or discontinuing the infusion if necessary 7, 5, 3