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.

Treatment Details

• This approach reduces the risk of histamine-release associated "red man" syndrome 1.
• Some studies also suggest considering the use of an antihistamine prior to administration of the loading dose, especially in seriously ill patients 1.
• The recommended dosage of Vancomycin is 30 mg/kg per 24 hours IV in 2 equally divided doses, not to exceed 2 g per 24 hours unless serum concentrations are inappropriately low 1.
• It is essential to adjust the Vancomycin dose to obtain a peak serum concentration of 30-45 μg/mL and a trough concentration range of 10-15 μg/mL 1.
• Vancomycin therapy is recommended only for patients unable to tolerate penicillin or ceftriaxone 1.

Key Considerations

• The infusion time and dosage adjustments are crucial in preventing Red Man Syndrome.
• Monitoring of serum concentrations and adjustment of the dose as needed is vital to ensure effective treatment while minimizing the risk of adverse effects.
• The use of Vancomycin should be reserved for patients who cannot tolerate other antibiotics, due to its potential side effects and the risk of developing resistance.

The FDA Drug Labels for vancomycin (PO) do not address this question.

From the Research

Treatment for Red Man Syndrome

The treatment for Red Man Syndrome associated with Vancomycin infusion involves several strategies to mitigate the symptoms:

• Discontinuation of the Vancomycin infusion 2
• Administration of antihistamines, such as diphenhydramine 3, 4, 2
• Slow intravenous administration of Vancomycin to minimize the risk of infusion-related adverse effects 5, 2

Antihistamine Prophylaxis

Antihistamine prophylaxis has been shown to be effective in reducing the symptoms of Red Man Syndrome:

• Pretreatment with intravenous H1 and H2 antihistamines permitted rapid Vancomycin administration in 89% of treated patients 3
• Oral antihistamines were as effective as IV antihistamines in reducing the incidence and severity of rash, as well as the need to discontinue the Vancomycin infusion 4

Infusion Rate

The infusion rate of Vancomycin also plays a role in the development of Red Man Syndrome:

• Rapid infusion of Vancomycin (1 g over 10 min) was associated with a higher incidence of Red Man Syndrome compared to slower infusion rates 6, 5
• Administration of Vancomycin over 2 hours reduced the frequency and severity of Red Man Syndrome compared to a 1-hour infusion 5