Vancomycin adverse reaction

The nurse should administer each IV dose of vancomycin over 60 minutes Too rapid an infusion may result in a sudden and profound fall in blood pressure and shock. When giving the drug IV, the nurse closely monitors the infusion rate and the patient s blood pressure. The nurse reports any decrease in blood pressure or reports of throbbing neck or back pain. These symptoms could indicate a severe adverse reaction referred to as "red neck or "red man syndrome. 9/mptoms of this syndrome include a sudden and profound fall in blood pressure, fever, chills paresthesias and erythema (redness) of the neck and badk. 

MANAGING DIARRHEA. Diarrhea may be a sign of a superinfection or pseudomembranous colitis, both of which are adverse reactions tiiat may be seen with the administration of any anti-infective. The nurse checks each stool and reports any changes in color or consistency. When vancomycin is given as part of the treatment for pseudomembranous colitis, it is important to record the color and consistency of each stool to determine the effectiveness of therapy. 

Vancomycin can cause red-man syndrome consisting of diffuse flushing, presumably mediated by histamine-release. This problem can be prevented by limiting the infusion rate. The most serious adverse reactions are ototoxicity and nephrotoxicity. The toxicity for both organ systems is potentiated by aminoglycosides. Vancomycin will cross the placenta barrier and has the potential to cause fetal ototoxicity. 

The overall rate of adverse reactions in comparative trials was 19%, which is comparable with the rate observed with beta-lactams, but lower than the corresponding rate (39%) associated with vancomycin (6). 

Vancomycin is a narrow-spectrum glycopeptide antibiotic with potent antistaphylococcal activity. It was developed in the early 1950s. Early formulations contained substantial impurities, which were presumably responsible for some adverse reactions (1). When rapid infusion rates are avoided, vancomycin is rarely associated with serious toxicity. Reviews have suggested that the potential for vancomycin to cause significant ototoxicity or nephrotoxicity has been exaggerated (2,3). Improved manufacturing has resulted in a purer product and fewer toxic effects, but vancomycin is still associated with potentially serious adverse reactions (4). 

A unique and peculiar adverse reaction related to the rapid infusion of large doses is the so-caUed red neck or red man sjmdrome. It is the most common adverse reaction to vancomycin, characterized by fever, chills, paresthesia, and eiythema at the base of the neck and the upper back, and can be followed by a hypotensive episode (12). It is not a true allergic reaction. It seems to be due to vancomycin-induced release of histamine and possibly other vasoactive substances without the involvement of preformed antibodies (13,14). In rat peritoneal mast cells vancomycin provoked histamine release dose-dependently fosfomycin inhibited this effect (15). 

Adverse effects might be produced when vancomycin is administered with other medications. Here are potential adverse reactions ... 

Adverse reactions to vancomycin are fever, rashes and rarely ear and kidney toxicity. 

THERAPEUTIC USES Vancomycin (vancocin, others) is marketed for intravenous use as a sterile powder. It should be diluted and infused over at least 60 minutes to avoid infusion-related adverse reactions. The usual dose of vancomycin for adults is 30 mg/kg/day in 2-3 divided doses. A trough serum concentration of 5-15 (Xg/mL (10-20 (Xg/mL for serious infections such as endocarditis or meningitis) is recommended. Doses above 30 mg/kg/day may be required to achieve these trough concentrations, and up to 60 mg/kg/day has been suggested for meningitis. The peak concentration is not monitored routinely but should generally remain below 60 (Xg/mL to avoid ototoxicity. 

Vancomycin has adverse reactions when used with some medications. You must wait several hours before giving vancomycin to a patient who has received oral cholestyramine (Questran) or colestipol (Colestid) because these medications lower the therapeutic effect of vancomycin. 

The chemically similar teicoplanin, not approved in the USA, is not inferior to vancomycin with regard to efficiency of treating grampositive infections. It shows a lower rate of adverse reactions, particularly nephrotoxicity and, as already discussed, is used as a substitute for vancomycin in red man syndrome. When hypersensitivity reactions do occur with teicoplanin they are generally of the delayed type, but there are a few documented cases of apparent IgE antibody-mediated reactions implicated, for example, by an immediate wheal and flare skin reaction to the drug or by teicoplanin-induced histamine release from a patient s basophils. Despite the chemical and pharmacological... 

Skin testing with vancomycin and teicoplanin has not been well studied and the procedure remains to be validated with both positive and negative predictive values unknown. Skin test results, and particularly details of drug concentrations used and methodologies employed, are hard to find in the vancomycin-teicoplanin literature on adverse reactions. In a case study of vancomycin anaphylaxis followed by successful desensitization, intradermal skin tests with the drug were positive at a concentration of 0.1 pg/ml. Control subjects showed positive responses at concentrations of 10 pg/ml or greater. A loss of skin test reactivity to vancomycin has been demonstrated in one case study after successful desensitization to the drug. 

Verify the patient s allergy history and the type of reaction experienced. Attempt to discern between true allergy and adverse event. (3-Lactam-allergic patients may receive clindamycin, vancomycin, or other antimicrobials. Crossreactivity between penicillin allergy and cephalosporins is low but cephalosporins should be avoided in patients with a history of anaphylaxis to penicillins. 

Adverse effects. The main disadvantage to vancomycin is auditory damage. Tinnitus and deafness may improve if the drug is stopped. Nephrotoxicity and allergic reactions also occur. Rapid i.v. infusion may cause a maculopapular rash possibly due to histamine release (the red person syndrome). 

The most common adverse events associated with teicoplanin are hypersensitivity, fever, rash, diarrhea, nephrotoxicity, and thrombocytopenia (12,13). Local reactions at the injection site include pain, redness, or discomfort after intramuscular injection, or phlebitis after intravenous injection. Erythroderma has occurred during infusion of teicoplanin with fever and hypotension. Allergic reactions have been reported with teicoplanin, with cross-reactivity between teicoplanin and vancomycin documented by in vitro studies showing IgE release by basophils in response to stimulation by both vancomycin and teicoplanin. However, known hypersensitivity to vancomycin is not a contraindication to teicoplanin. Tumor-inducing effects have not been reported. 

Vancomycin is highly associated with adverse infusion-related events. These are especially prevalent with higher doses and a rapid infusion rate. A rapid infusion rate has been shown to cause anaphylactoid reactions, including hypotension, wheezing, dyspnea, urticaria, and pruritus. A significant drug rash (the so-called red man syndrome) also can occur. These events are much less frequent with a slower infusion rate. 

The most commonly occurring adverse effects caused by vancomycin are referred to collectively as red man syndrome. Reactions may range from mild pruritus, erythema, and flushing of the upper body to angioedema and rarely hypotension and cardiovascular collapse. Reactions may be prevented or their severity decreased by extending the infusion time and/or premedication with histamine H, and H2 receptor antagonists. 

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