What Is the Connection between Vancomycin and Redman Syndrome?

Vancomycin is an antibiotic that kills a variety of bacterial pathogens. A possible side effect of the drug is a collection of symptoms called Redman syndrome, due to the redness and rash that typically occurs. This problem is a hypersensitive allergic reaction that happens because the antibiotic interferes with immune system cells.

As many serious infections are not yet resistant to vancomycin, the drug is often useful for patients who have bacterial infections that are resistant to other drugs. Two major immune system side effects are possible with vancomycin, however. The more serious is anaphylaxis, which can cause breathing difficulties due to swollen facial and throat tissues. In the case of vancomycin and Redman syndrome, the symptoms can be mild and are not life-threatening.

Problems occur with vancomycin and Redman syndrome when a doctor infuses the antibiotic into a patient's vein. Symptoms of vancomycin and Redman syndrome are most obvious on the skin. A red and itchy rash develops, but this can be as insignificant as a slight reddening of the skin. Dizziness, and flu-like fevers and headaches can also occur. Some people suffering from issues caused by vancomycin and Redman syndrome also have a drop in blood pressure or pain in their chest.

Certain components of the immune system are responsible for causing these symptoms. Cells called mast cells and basophils contain storage granules of a substance named histamine. Histamine is one of the signal molecules of the immune system, and plays a role in the development of inflammation. Vancomycin works on these cells to release the histamine stored inside.

Abnormally high levels of histamine in the circulation then causes the symptoms associated with Redman syndrome. The rash and itchiness represent an unnecessary activation of the immune system. Doctors may actually give patients antihistamines before vancomycin treatment in anticipation of this immune system activation.

Only some people develop Redman syndrome, while others do not. Scientists think this is due to genetic differences between individual patients. For example, certain enzymes in the body naturally break down histamine. Two enzymes perform this role, which are histamine N-methyltranserase and diamine oxidase. Different people produce slightly different versions of these enzymes, that could have different efficiencies, and which may be one explanation for the absence of Redman syndrome in some people and the development of it in others.

As well as potential genetic causes, other antibiotics can work in conjunction with vancomycin and increase the risk of Redman syndrome. Examples of these antibiotics, which a doctor may administer along with vancomycin, include ciprofloxacin and amphotericinB. Certain painkillers and muscle relaxing drugs can also make the syndrome more likely.