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[Vancomycin and cardiac arrest in the infant]
A S Trentesaux1, N Bednarek, P Morville
1Unité de réanimation infantile polyvalente, American Memorial Hospital, CHU, Reims, France.
Insights
Vancomycin bolus infusion can rarely cause cardiac arrest in infants due to excessive dosage. Prompt resuscitation is effective, highlighting the need for proper drug dilution and slow infusion rates to prevent adverse events.
Area of Science:
- Pediatric Pharmacology
- Critical Care Medicine
- Adverse Drug Reactions
Background:
- Vancomycin is a critical antibiotic for treating serious Gram-positive bacterial infections.
- Adverse effects of vancomycin infusion are known, but cardiac arrest is considered a rare complication in all age groups.
Observation:
- Two infants experienced cardiac arrest following excessive dose vancomycin bolus infusions.
- Both infants recovered after immediate resuscitation, with normal short-term follow-up.
- The cardiac arrests were linked to potential anaphylactic shock and direct cardiovascular toxicity.
Findings:
- Cardiac arrest associated with vancomycin is dose- and infusion rate-dependent.
- Intersubject variability likely plays a role in susceptibility to these adverse events.
- Adequate resuscitation can effectively reverse vancomycin-induced cardiac arrest.
Implications:
- Prescribing vancomycin requires strict adherence to adequate dilution and slow infusion rates.
- Consideration of preventive antihistaminic therapy may be beneficial if adverse effects are suspected.
- This case series emphasizes the importance of cautious vancomycin administration in pediatric patients.
Background:
Different adverse effects induced by vancomycin bolus infusion are described, but cardiac arrest seems rare, in children as in adults.
Case Report:
Two infants, 5 and 12 months old, were admitted after cardiac arrest, following vancomycin bolus infusion in excessive dose. They recovered after prompt resuscitation and their short term follow-up was normal.
Conclusion:
Two mechanisms are invoked: anaphylactic shock and direct cardiovascular toxicity. Both are dose- and infusion rate-dependent, and probably intersubject dependent. Usually, cardiac arrest is promptly reversed by adequate resuscitation. The rules of prescription are: adequate dilution and slow rate of infusion. If any adverse effect occurred, preventive antihistaminic drug therapy should be advised.