Incidence of vancomycin-induced red man syndrome in a women's and children's hospital

Background

Red man syndrome (RMS) is an adverse reaction to vancomycin. Symptoms include rash, itch, hypotension, hypothermia, angioedema and respiratory distress. The incidence of RMS in the paediatric population is unclear.

Aim

To estimate the incidence of RMS in a women's and children's hospital, focusing on the paediatric population, and to identify risk factors.

Method

Patients at a women's and children's hospital receiving IV vancomycin were identified during a 2‐month period and their case notes were reviewed for documented RMS symptoms.

Results

21 patients (5 days to 24 years of age) were identified, and 37 vancomycin courses were investigated. RMS symptoms occurred in 8/21 (38%) patients and in 8/37 (22%) vancomycin courses. 4 patients experienced a rash only, mostly an itchy, urticarial rash on the face and/or limbs. 4 patients experienced RMS without a rash: 2 had hypotension; 1 had bradycardia; and 1 had hypothermia, hypotension and bradycardia. None of the reactions were life‐threatening, and none resulted in cessation of vancomycin. 3/4 patients who experienced a rash received antihistamines, whereas none of the 4 patients who experienced RMS without a rash received antihistamines.

Conclusion

RMS is common and unpredictable. Cardiovascular symptoms can occur without accompanying dermatological symptoms. There may be potential for greater use of antihistamine prophylaxis and treatment for RMS.