Vancomycin administration advice

Infuse vancomycin at a rate not exceeding 10 mg/minute to reduce the risk an infusion-related reaction.

If a 10 mg/minute infusion rate is tolerated, shorter infusion times may be possible, but should not be less than 60 minutes for a 1 g dose, 90 minutes for a 1.5 g dose, or 120 minutes for a 2 g doseErmer 2020.

Rapid vancomycin administration can cause vancomycin infusion reaction (previously termed ‘Red man syndrome’), a histamine-mediated nonallergic reaction characterised by flushing, pruritus, rash, muscle spasms of the chest and back, and sometimes hypotensionKorman 2021. Infusion-related reactions are more common in children aged 2 years or older than adults, but are rare in young infantsGwee 2019Myers 2012. To manage vancomycin infusion reactions:

• for mild reactions (eg flushing that is not bothersome to the patient), extend the infusion time
• for moderate reactions (eg flushing that is bothersome, pruritus) or severe reactions (eg muscle spasm, chest pain, hypotension), pause the infusion, treat symptoms (eg administer an antihistamine to patients who experience pruritus) and seek expert advice. Once symptoms have resolved, an expert may recommend restarting the infusion at a slower rate.

If anaphylaxis or severe cutaneous adverse drug reaction (eg drug rash with eosinophilia and systemic systems [DRESS]) is suspected, vancomycin should be stopped and not readministered.