Ver el código de «Vancomycin infusion reaction»

==Background==
*Also known as Vancomycin Flushing Syndrome or "Red Man Syndrome"<ref>Alvarez-Arango, S, Ogunwole, SM, Sequist, TD, Burk, CM, Blumenthal, KG. Vancomycin infusion reaction—moving beyond “red man syndrome.” N Engl J Med. 2021;384:1283-1286. doi:10.1056/NEJMp2031891</ref>
*Anaphylactoid reaction after the rapid infusion of [[Vancomycin]]
**Predominantly seen in intravenous infusions, may occur via oral administration in patients with impaired kidney function
**Vancomycin triggers the direct release of histamine from mast cells and basophils
**Different from anaphylaxis in that reaction is not IgE-Mediated, does not preclude future administration
*Related to the rate of infusion
**Should be administered at a rate no faster than 10mg/minute (minimum of 1g over 100 minutes)
**Increased incidence when co-administering with opioids, radiocontrast dye, and some muscle relaxers

==Clinical Features==
[[File:PMC4215627 fpubh-02-00217-g002.png|thumb|Rash found in Vancomycin Infusion Reaction.]]
*Intensely pruritic, [[erythematous rash]]
**Predominantly face/neck/upper torso
*Occasional [[chest pain]]/[[dyspnea]], back spasms
*Less common tachycardia, [[fever]], [[angioedema]], [[hypotension]]

==Differential Diagnosis==
{{Erythematous rash DDX}}

==Evaluation==
===Workup===
*Typically not needed

===Diagnosis===
*Clinical
**Rule out from [[Anaphylaxis]]
**Assess presence/degree of angioedema
*Mild cases include pruritis and erythema
*Moderate to severe cases include hypotension, angioedema, chest pain and dyspnea

==Management==
*Immediately stop transfusion
*Supportive care
**IV H1/H2 blockers
**IVF for transient hypotension, if hypotension prolonged consider anaphylaxis
*In mild cases, infusion may be restarted after symptom resolution (typically ~20 minutes)
*In moderate to severe cases, consider pre-medicating after an hour or switching to an alternative antibiotic
*If patients require rapid infusion of vancomycin, consider pre-medication with diphenhydramine and cimetidine.

==Disposition==
*No observation period needed after resolution of symptoms
*Important to education patient to ''avoid'' future diagnosis of vancomycin allergy

==See Also==
*[[Vancomycin]]

==External Links==

==References==
<references/>
*Martel TJ, Jamil RT, King KC. Vancomycin Flushing Syndrome. [Updated 2023 Jan 25]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK482506/
*Sivagnanam S, Deleu D. Red man syndrome. Crit Care. 2003 Apr;7(2):119-20. doi: 10.1186/cc1871. Epub 2002 Dec 23. PMID: 12720556; PMCID: PMC270616.

[[Category:Pharmacology]]
[[Category:ID]]