Does vancomycin cause Red Man Syndrome?

From the Guidelines

Yes, vancomycin can cause Red Man Syndrome.

Vancomycin Administration and Red Man Syndrome

• The likelihood of Red Man Syndrome is reduced with an infusion of vancomycin over ≥1 hour 1.
• To minimize the risk of Red Man Syndrome, it is recommended to prolong the infusion time to 2 hours and consider the use of an antihistamine prior to administration of a loading dose of vancomycin, especially in seriously ill patients 1.
• Desired trough vancomycin levels should range between 10 and 15 μg/mL, and the infusion rate should be adjusted accordingly to minimize the risk of adverse reactions 1.
• It is essential to monitor patients closely for signs of Red Man Syndrome, such as rash, fever, and neutropenia, during vancomycin therapy 1.

From the FDA Drug Label

Infusion-related events may be minimized by the administration of vancomycin as a 60-minute infusion prior to anesthetic induction Concomitant administration of vancomycin and anesthetic agents has been associated with erythema and histamine-like flushing (see Pediatric Use, PRECAUTIONS) and anaphylactoid reactions (see ADVERSE REACTIONS)

• Red Man Syndrome is characterized by infusion-related events such as flushing and erythema.
• Vancomycin can cause infusion-related events, including erythema and histamine-like flushing, especially when administered with anesthetic agents.
• These events are similar to the symptoms of Red Man Syndrome. Vancomycin can cause Red Man Syndrome, as evidenced by the reports of infusion-related events, including erythema and histamine-like flushing 2.

From the Research

Vancomycin and Red Man Syndrome

• Vancomycin is known to cause Red Man Syndrome, a type of allergic reaction characterized by a rash on the face, neck, and upper torso 3, 4, 5, 6, 7.
• The syndrome is often associated with rapid infusion of vancomycin, but can also occur with slow local absorption, as seen in a case where vancomycin cement beads were used 3.
• Studies have shown that the risk of Red Man Syndrome is higher with higher doses of vancomycin and faster infusion rates 4, 6, 7.
• Symptoms of Red Man Syndrome include a pruritic, erythematous, macular rash, and can be treated with antihistamines and corticosteroids 3, 5, 7.

Risk Factors for Red Man Syndrome

• Age greater than 2 years is a risk factor for Red Man Syndrome in children receiving vancomycin 6.
• Previous history of Red Man Syndrome is also a risk factor, as well as vancomycin dose and concentration 6.
• Antecedent antihistamine use has been identified as a risk factor for Red Man Syndrome 6.
• Caucasian ethnicity is a risk factor, while African American race is protective 6.

Prevention and Treatment

• Slow intravenous administration of vancomycin can minimize the risk of infusion-related adverse effects, including Red Man Syndrome 5, 7.
• Discontinuation of the vancomycin infusion and administration of diphenhydramine can abort most reactions 5.
• Treatment with cetirizine and methylprednisolone sodium succinate has been successful in managing Red Man Syndrome 3.