Antihistamine prophylaxis permits rapid vancomycin infusion.

Area of Science:

• Pharmacology
• Clinical Medicine
• Anesthesiology

Background:

• Vancomycin is crucial for treating infections, but rapid infusion can cause red-man syndrome.
• Red-man syndrome involves histamine release, leading to adverse effects like hypotension and rash.
• Preventive strategies are needed to allow for efficient vancomycin administration.

Purpose of the Study:

• To evaluate the efficacy of pretreatment with intravenous antihistamines in preventing red-man syndrome symptoms.
• To determine if antihistamine pretreatment allows for rapid vancomycin infusion without significant adverse events.

Main Methods:

• A prospective, randomized, double-blind, placebo-controlled study was conducted.
• Patients received either intravenous antihistamines (diphenhydramine and cimetidine) or placebo before rapid vancomycin infusion.
• Hemodynamic parameters, symptoms, and plasma histamine levels were monitored.

Main Results:

• Antihistamine pretreatment significantly reduced the incidence of hypotension (11% vs. 63%) and rash (63% vs. 100%) compared to placebo.
• Plasma histamine levels increased significantly in both groups but did not differ between them.
• Rapid vancomycin infusion was successfully completed in 89% of the antihistamine-treated group versus 42% in the placebo group.

Conclusions:

• Intravenous antihistamine pretreatment is effective in attenuating red-man syndrome symptoms associated with rapid vancomycin infusion.
• This pretreatment strategy facilitates safe and efficient vancomycin administration in most patients.
• Rash occurrence did not necessitate discontinuation of rapid vancomycin infusion in the treated group.