Red-Neck Syndrome with Slow Infusion of Vancomycin

Abstract

To the Editor: Rapid intravenous infusion of vancomycin can cause a histamine-induced reaction characterized by flushing and maculopapular rash of the neck, face, trunk, and extremities, prolonged hypotension, and in rare cases cardiac arrest.^{1 2 3 4} This reaction, often referred to as the "red-neck syndrome," is usually self-limiting, disappearing upon the discontinuation of therapy. In severe cases, however, the use of antihistamine or fluid resuscitation may be necessary. Patients who have experienced this reaction usually tolerate subsequent doses infused over a longer period. The manufacturer has recently recommended that a 500-mg or 1-g dose of vancomycin be infused over a period of . . .