A nurse administers a first dose of IV vancomycin over 20 minutes. The patient develops flushing of the face, neck, and upper torso with pruritus but no hypotension or bronchospasm. The most appropriate corrective action is:

• A Stop vancomycin permanently and switch to daptomycin
• B Administer adrenaline immediately and continue the same infusion rate
• C Give oral antihistamines daily as prophylaxis and keep the rapid infusion rate
• D Continue vancomycin with the infusion diluted and given over at least 60 minutes ✓

Explanation

Red man (red neck) syndrome is a nonimmunologic, infusion-rate dependent histamine release caused by vancomycin itself. Slowing and diluting the infusion prevents mast cell degranulation, and the drug need not be stopped. Adrenaline is reserved for true anaphylaxis, which this reaction is not, and routine antihistamine prophylaxis is unnecessary once the rate is corrected since the reaction is rate related rather than dose related.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.