Immune-mediated reactions to vancomycin: A systematic case review and analysis

Area of Science:

• Pharmacology
• Immunology
• Dermatology

Background:

• Vancomycin is a critical broad-spectrum antibiotic.
• Adverse drug reactions (ADRs) can limit vancomycin use.
• Limited data exists on vancomycin-specific hypersensitivity reactions (HSRs).

Purpose of the Study:

• To systematically review and identify common vancomycin-induced HSRs.
• To analyze the clinical characteristics of reported vancomycin HSR cases.
• To assess the mortality associated with vancomycin HSRs.

Main Methods:

• Systematic literature search of case reports and series (1982-2015).
• Searches conducted on Ovid MEDLINE and PubMed using vancomycin and HSR-related terms.
• Clinical data extraction and summarization from 71 identified HSR cases.

Main Results:

• Nonimmediate HSRs were more common (64 cases) than immediate reactions (7 cases).
• Linear IgA bullous dermatosis (LABD) was the most frequent nonimmediate HSR (34 cases).
• Other significant nonimmediate HSRs included DRESS syndrome, acute interstitial nephritis (AIN), and Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN).
• A high mortality rate of 16% was observed, with 6% of deaths attributed to HSRs.

Conclusions:

• Vancomycin triggers diverse HSRs, predominantly nonimmediate types.
• Linear IgA bullous dermatosis is a frequently identified vancomycin-associated HSR.
• The observed mortality rate underscores the severity of vancomycin HSRs.
• Further investigation is required to fully understand vancomycin HSR frequency and severity.