What is red man syndrome?

Red man syndrome is a response or hypersensitive reaction to the antibiotic vancomycin. Vancomycin is prescribed to treat serious bacterial infections, including those of the bone, blood, and skin.

Vancomycin is an antibiotic that is commonly used in intensive care units to treat infections that are sensitive to it and for patients who are allergic to penicillin or cephalosporins. Red man syndrome occurs in around 5 to 13 percent of patients who are given vancomycin.

Along with red man syndrome, the other hypersensitive reaction that people may have to vancomycin is anaphylaxis, which is potentially life-threatening.

Fast facts on red man syndrome:

  • The syndrome is not an allergy but has similar symptoms to an allergic reaction.
  • There are several options for treating and preventing red man syndrome.
  • Drugs that release histamine in the body can also result in red man syndrome.

Causes and risk factors

antibiotic in liquid form

The infusion of vancomycin or similar antibiotics can cause red man syndrome.

It was previously thought that red man syndrome was caused because of vancomycin being prepared in an impure environment. However, cases of the syndrome persisted even after purification of the antibiotic.

Now, it is believed that vancomycin may change the way that blood cells are produced.

This can result in a lower level of platelets in the blood, or a change in the white blood cell count.

Red man syndrome is related to the infusion of vancomycin, or other similar antibiotics or drugs.

Infusion is when drugs are administered by a needle or catheter rather than orally. Often this is intravenous, meaning into a vein, but it can also be via intramuscular or epidural routes, for example, into the membranes around the spinal cord.

Red man syndrome is associated with rapid infusion of less than 1 hour of the first dose of vancomycin. Signs of the syndrome will usually appear shortly after the infusion, often within around 4 to 10 minutes.

There have been cases of delayed reactions after longer infusions, however.

In general, cases of red man syndrome occur in people who already have another medical condition, with common ones including:

  • Cancer: Commonly of the lung.
  • HIV: Infection may have an impact on antibiotic treatment.
  • Graft-versus-host disease: A reaction after a bone marrow transplant.

In around 30 percent of cases, there is no known cause of red man syndrome.

More severe cases of red man syndrome are more common in people under the age of 40 and particularly children.

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