From the Guidelines
Red Man Syndrome associated with Vancomycin infusion is best treated by infusing Vancomycin over a period of at least 1 hour.
Treatment Options
- Infusing Vancomycin over a period of at least 1 hour to reduce the risk of histamine-release “red man” syndrome 1
- Consideration of prolonging the infusion time to 2 hours and use of an antihistamine prior to administration of the loading dose in seriously ill patients 1
Important Considerations
- Vancomycin dose should be adjusted to achieve a trough concentration range of 10–15 μg/mL 1
- Monitoring for potential adverse effects such as thrombophlebitis, rash, fever, neutropenia, and ototoxic reactions is necessary 1
- Alternative treatments such as penicillin or ceftriaxone should be considered in patients who can tolerate them, as vancomycin is generally recommended for patients who are unable to tolerate these alternative treatments 1
From the FDA Drug Label
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
The 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. No specific treatment is recommended, suggesting that the condition is typically self-limiting. 2
From the Research
Treatment for Red Man Syndrome
The treatment for Red Man Syndrome associated with Vancomycin infusion involves:
- 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
- Slower infusion rates can prevent or reduce the syndrome in susceptible cases 4
Prevention
To prevent Red Man Syndrome, the following can be done:
- Administer Vancomycin over a longer period, such as 2 hours, instead of 1 hour 5
- Monitor patients for signs and symptoms of Red Man Syndrome during Vancomycin infusion
- Use a lower dose of Vancomycin, as higher doses have been associated with a higher incidence of Red Man Syndrome 6
Symptoms and Diagnosis
Red Man Syndrome is characterized by:
- Pruritus (itching)
- Erythema (redness of the skin)
- Angioedema (swelling of the skin and mucous membranes)
- Cardiovascular depression
- A flushed, erythematous rash on the face, neck, and around the ears 4 Diagnosis is based on clinical presentation and observation of these symptoms during Vancomycin infusion.
Histamine Release
While histamine release has been implicated in the pathogenesis of Red Man Syndrome, studies have shown that the relationship between histamine release and Red Man Syndrome is not always clear-cut 6, 5, 7. However, slowing down the infusion rate of Vancomycin can reduce the amount of histamine released and minimize the risk of Red Man Syndrome 5.