Commentary

Red man syndrome

Soupramanien Sivagnanam¹ and Dirk Deleu²

¹Senior Registrar, Department of Anaesthesia & Intensive Care, Sultan Qaboos University Hospital, Al Khod, Muscat, Oman

²Associate Professor, Department of Clinical Pharmacology, College of Medicine, Sultan Qaboos University, Al Khod, Muscat, Oman

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Critical Care 2003, 7:119-120doi:10.1186/cc1871

Published:	23 December 2002

Abstract

Vancomycin can cause two types of hypersensitivity reactions, the red man syndrome and anaphylaxis. Red man syndrome has often been associated with rapid infusion of the first dose of the drug and was initially attributed to impurities found in vancomycin preparations. Even after improvement in vancomycin's purity, however, reports of the syndrome persist. Other antibiotics (e.g. ciprofloxacin, amphotericinB, rifampicin and teicoplanin) or other drugs that stimulate histamine release can result in red man syndrome. Discontinuation of the vancomycin infusion and administration of diphenhydramine can abort most of the reactions. Slow intravenous administration of vancomycin should minimize the risk of infusion-related adverse effects.