During rapid IV infusion of vancomycin for MRSA sepsis, a 40-year-old patient develops flushing of the face, neck, and upper chest without wheeze or hypotension. Which measure would have prevented this reaction?

• A Premedication with hydrocortisone before each dose
• B Switching to teicoplanin given as an intramuscular injection
• C Administering the drug as a bolus through a central line
• D Infusing the dose slowly over at least 60 minutes ✓

Explanation

Vancomycin infusion flushing, historically called red man syndrome, is caused by direct, non-immunologic degranulation of mast cells releasing histamine. Its incidence depends directly on the rate of infusion, so slowing administration over 60 minutes or longer prevents it. It is not IgE mediated, hence antihistamine premedication rather than steroid premedication is used when rapid infusion is unavoidable. True IgE anaphylaxis to vancomycin is rare. Teicoplanin causes far less flushing but switching is not the first preventive step.

Reference: Katzung Basic and Clinical Pharmacology, 15th ed.

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Written and medically reviewed by the StethoPrep medical team.