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
- Considering antihistamine use prior to administration of Vancomycin, especially in cases where a loading dose is required 1
- Prolonging the infusion time to 2 hours may also be considered, especially in seriously ill patients 1
Key Considerations
- Vancomycin dose should be adjusted to achieve a trough concentration range of 10–15 μg/mL 1
- Monitoring for potential complications such as thrombophlebitis, rash, fever, neutropenia, and ototoxic reactions is essential 1
- Alternative treatments such as penicillin or ceftriaxone may be considered for patients who are unable to tolerate Vancomycin 1
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 and prevent future occurrences.
- Discontinuation of the vancomycin infusion is often the first step in managing the reaction 2.
- Administration of diphenhydramine can help abort most of the reactions 2.
- Slowing down the infusion rate of vancomycin can minimize the risk of infusion-related adverse effects 2, 3, 4.
- Pretreatment with oral antihistamines, such as diphenhydramine and cimetidine, can reduce the incidence and severity of Red Man Syndrome 5.
Prevention of Red Man Syndrome
To prevent Red Man Syndrome, it is recommended to:
- Administer vancomycin over a longer period, such as 1-2 hours, to reduce the risk of histamine release and subsequent reaction 6, 3.
- Use a slower infusion rate, as faster infusion rates are more likely to cause the reaction 4.
- Consider pretreating patients with oral antihistamines before vancomycin infusion, especially if they have a history of Red Man Syndrome or are at high risk of developing the reaction 5.