What is the primary cause of red man syndrome?

Red man syndrome, an anaphylactoid reaction, is caused by the degranulation of mast cells and basophils, resulting in the release of histamine independent of preformed IgE or complement. The extent of histamine release is related partly to the amount and rate of the vancomycin infusion.

What causes vancomycin flushing syndrome?

Excerpt. Vancomycin flushing syndrome (VFS) is an anaphylactoid reaction caused by the rapid infusion of the glycopeptide antibiotic vancomycin. VFS consists of a pruritic, erythematous rash to the face, neck, and upper torso, which may also involve the extremities to a lesser degree.

What is the maximum rate of vancomycin to avoid red man syndrome?

The rapid infusion of vancomycin should be avoided as this most often is a rate-related adverse drug reaction. Facilities should establish infusion protocols to limit infusion rates of vancomycin to 1 gram/hour or slower at 10 mg/min.

What are the symptoms of vancomycin toxicity?


  • Black, tarry stools.
  • blood in the urine or stools.
  • continuing ringing or buzzing or other unexplained noise in the ears.
  • cough or hoarseness.
  • dizziness or lightheadedness.
  • feeling of fullness in the ears.
  • fever with or without chills.
  • general feeling of tiredness or weakness.

What happens during red man syndrome?

Red man syndrome (RMS) is a common allergic reaction to vancomycin that typically presents with a rash on the face, neck, and upper torso after intravenous administration of vancomycin. Less frequently, RMS may be accompanied by hypotension and angioedema.

Does red man syndrome go away?

Symptoms generally last a short time and can be managed with antihistamines. If you have developed red man syndrome before, you’re more likely to develop it again. Inform your doctor before receiving a vancomycin infusion if you’ve had this reaction in the past.

What is a toxic level of vancomycin?

It has been described that vancomycin trough plasma levels >20 μg/mL or AUC0–24 h >700 μg/mL*h are related to nephrotoxicity.

Is vancomycin induced nephrotoxicity reversible?

Vancomycin-induced nephrotoxicity was reversible in the majority of cases, with short-term dialysis required only in 3% of nephrotoxic episodes. The collective literature indicates that an exposure-nephrotoxicity relationship for vancomycin exists.