Redefining Diagnostic and Management Approaches to Vancomycin Adverse Drug Reactions

Area of Science:

• Pharmacology
• Immunology
• Infectious Diseases

Background:

• Vancomycin is vital for treating resistant gram-positive infections.
• Adverse drug reactions (ADRs) to vancomycin are frequent and often misattributed.
• Mislabeled ADRs lead to unnecessary drug avoidance and negative patient outcomes.

Purpose of the Study:

• To review the epidemiology, mechanisms, diagnostics, and management of vancomycin-induced hypersensitivity.
• To support mechanism-based care for vancomycin hypersensitivity.
• To highlight limitations in current diagnostic tools and suggest emerging approaches.

Main Methods:

• Literature review summarizing existing data on vancomycin ADRs.
• Analysis of immunologic mechanisms underlying different hypersensitivity phenotypes.
• Evaluation of current and emerging diagnostic strategies, including intradermal testing.

Main Results:

• Vancomycin infusion reactions, potentially Mas-related G-protein coupled receptor X2-mediated, are the most common phenotype.
• IgE-mediated reactions are rare and mechanistically unproven.
• Diagnostic tools are limited, with emerging dose-response intradermal testing for infusion reactions.

Conclusions:

• Accurate diagnosis of vancomycin hypersensitivity is challenged by clinical similarity and diagnostic limitations.
• Management strategies vary based on reaction type, focusing on supportive care for infusion reactions and allergy evaluation for severe or recurrent cases.
• Advances in understanding immunologic mechanisms and standardized terminology are essential for improved diagnostic accuracy and antimicrobial stewardship.