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Related Experiment Video

Updated: Jul 15, 2025

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Vancomycin flushing reaction after intraperitoneal vancomycin: A case report.

Julia E Möhlmann1, Amely Mk Daza Zabaleta2, Matthijs van Luin1

  • 1Department of Clinical Pharmacy, University Medical Centre Utrecht, University Utrecht, The Netherlands.

Peritoneal Dialysis International : Journal of the International Society for Peritoneal Dialysis
|September 25, 2023
PubMed
Summary

Vancomycin flushing reaction (VFR) is rare with intraperitoneal vancomycin. A reduced dose safely reintroduced vancomycin after VFR occurred in a peritoneal dialysis patient.

Keywords:
Intraperitoneal vancomycinPD-related peritonitisVFRVFSperitonitisred man syndromevancomycin flushing reactionvancomycin flushing syndrome

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Area of Science:

  • Nephrology
  • Pharmacology
  • Infectious Diseases

Background:

  • Vancomycin is crucial for treating peritonitis in peritoneal dialysis (PD) patients.
  • Vancomycin flushing reaction (VFR), a hypersensitivity, is typically seen with IV administration.
  • VFR is uncommon with intraperitoneal (IP) vancomycin, especially in PD patients.

Observation:

  • A female PD patient with peritonitis developed VFR after a 2000 mg IP vancomycin loading dose.
  • Symptoms included flushing, erythema, and lip swelling 75 minutes post-instillation.
  • High vancomycin plasma concentration (54.8 mg/L) and peritonitis were noted.

Findings:

  • Risk factors for IP vancomycin-induced VFR include high/concentrated loading dose, low body weight, fast transport, and peritonitis.
  • Successful reintroduction of vancomycin at a 50% reduced dose (33.6 mg/L plasma concentration) was achieved.
  • Subsequent IP vancomycin treatment with 500 mg every 2-3 days maintained adequate trough levels (15-22 mg/L).

Implications:

  • This case highlights potential risk factors for VFR in PD patients receiving IP vancomycin.
  • Reintroducing vancomycin after VFR is feasible with dose adjustments.
  • Lowering the loading dose or slowing instillation may prevent VFR during IP vancomycin therapy.