The nurse is assigned to a 45-year-old HIV-positive male patient who is admitted with a MRSA skin infection on his right arm secondary to intravenous drug use. The patient is prescribed intravenous vancomycin. Twenty minutes after starting the vancomycin infusion, the patient develops a mild erythematous macular rash on the face, trunk and extremities. Which action is performed first?

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Accepted Answer

Stop the infusion. This patient presents with signs and symptoms of red man syndrome, a drug reaction associated with vancomycin. In patients who acutely develop red man syndrome during the infusion of the medication, stopping the infusion is the first recommended treatment step. Slowing the infusion rate would be appropriate if there was no concern for anaphylaxis, but it can sometimes be difficult to distinguish between red man syndrome and anaphylaxis. Red man syndrome is related to rate of infusion, however, so if anaphylaxis is ruled out, the drug can be restarted at a slower infusion rate (e.g. 50% initial). Topical hydrocortisone cream and prednisone can be used for symptomatic treatment, but they are not alternatives to temporary or permanently stopping the medication.

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