Vancomycin and the 'Red-Neck Syndrome'

To the Editor.—Staphylococcal infection frequently complicates long-term central venous catheterization, especially in the presence of preexisting sepsis and hemodynamic instability. A cephalosporin or other penicillinderived antibiotic is generally chosen for the prevention or treatment of staphylococcal infection. When a patient is allergic to penicillin, vancomycin hydrochloride is often chosen to avoid allergic cross-reactions. Vancomycin, a very effective antistaphylococcal drug, can cause histamine-induced facial and neck flushing. This "red-neck syndrome" can be associated with profound hypotension and even cardiac arrest.¹

Hypotension has been reported during intravenous vancomycin hydrochloride administration, but it can usually be avoided by infusing the drug in a dilute (0.25% to 0.5%) solution over one hour.² Despite prolonged infusion, the red-neck syndrome has been reported, although without hypotension.¹ The syndrome usually subsides when administration of the drug is stopped. An antihistamine and/or fluid resuscitation can be added in severe cases.

Report of a Case