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Related Experiment Videos

Antihistamine prophylaxis permits rapid vancomycin infusion.

C L Renz1, J D Thurn, H A Finn

  • 1Department of Anesthesia and Critical Care, The University of Chicago, IL, USA.

Critical Care Medicine
|October 3, 1999
PubMed
Summary

Pretreating patients with intravenous antihistamines significantly reduced hypotension and rash during rapid vancomycin infusions. This approach allowed for safe, rapid vancomycin administration in most patients, mitigating red-man syndrome symptoms.

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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.

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  • 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.