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 is supported by multiple studies, including those published in prestigious journals such as Circulation 1.
• The infusion time can be extended to 2 hours in seriously ill patients, and an antihistamine can be administered prior to Vancomycin infusion to 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 recommended only for patients unable to tolerate penicillin or ceftriaxone 1.

Key Considerations

• Red Man Syndrome is a histamine-release associated reaction that can occur with Vancomycin infusion.
• Prolonged intravenous use of Vancomycin may be complicated by thrombophlebitis, rash, fever, anemia, thrombocytopenia, and, rarely, ototoxic reactions 1.
• The treatment guidelines for Red Man Syndrome are based on evidence from studies published in reputable medical journals, ensuring a well-established rationale for clinical practice.

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